title: The effect of efavirenz versus nevirapine-containing regimens on immunologic, virologic and clinical outcomes in a prospective observational study.
abstract: OBJECTIVE
  To compare regimens consisting of either efavirenz or nevirapine and two or more nucleoside reverse transcriptase inhibitors (NRTIs) among HIV-infected, antiretroviral-naive, and AIDS-free individuals with respect to clinical, immunologic, and virologic outcomes.
  
  
  METHODS
  Prospective studies of HIV-infected individuals in Europe and the US included in the HIV-CAUSAL Collaboration.
  
  
  METHODS
  Antiretroviral therapy-naive and AIDS-free individuals were followed from the time they started an NRTI, efavirenz or nevirapine, classified as following one or both types of regimens at baseline, and censored when they started an ineligible drug or at 6 months if their regimen was not yet complete. We estimated the 'intention-to-treat' effect for nevirapine versus efavirenz regimens on clinical, immunologic, and virologic outcomes. Our models included baseline covariates and adjusted for potential bias introduced by censoring via inverse probability weighting.
  
  
  RESULTS
  A total of 15 336 individuals initiated an efavirenz regimen (274 deaths, 774 AIDS-defining illnesses) and 8129 individuals initiated a nevirapine regimen (203 deaths, 441 AIDS-defining illnesses). The intention-to-treat hazard ratios [95% confidence interval (CI)] for nevirapine versus efavirenz regimens were 1.59 (1.27, 1.98) for death and 1.28 (1.09, 1.50) for AIDS-defining illness. Individuals on nevirapine regimens experienced a smaller 12-month increase in CD4 cell count by 11.49 cells/μl and were 52% more likely to have virologic failure at 12 months as those on efavirenz regimens.
  
  
  CONCLUSIONS
  Our intention-to-treat estimates are consistent with a lower mortality, a lower incidence of AIDS-defining illness, a larger 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for efavirenz compared with nevirapine.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cain
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: Sara
authors.initials: S
authors.lastname: Lodi
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Loveleen
authors.initials: L
authors.lastname: Bansi
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
authors.forename: Janet
authors.initials: J
authors.lastname: Tate
authors.forename: Roger
authors.initials: R
authors.lastname: Logan
authors.forename: James M
authors.initials: JM
authors.lastname: Robins
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.forename: Ard
authors.initials: A
authors.lastname: van Sighem
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.forename: Luigia
authors.initials: L
authors.lastname: Elzi
authors.forename: Giota
authors.initials: G
authors.lastname: Touloumi
authors.forename: Georgia
authors.initials: G
authors.lastname: Vourli
authors.forename: Anna
authors.initials: A
authors.lastname: Esteve
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
authors.forename: Julia
authors.initials: J
authors.lastname: del Amo
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
authors.forename: Rémonie
authors.initials: R
authors.lastname: Seng
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Hoyos
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Sophie
authors.initials: S
authors.lastname: Abgrall
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Hernán
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000494:pharmacology*; D048588:Benzoxazines / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003521:Cyclopropanes; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D054303:HIV Reverse Transcriptase / Q000037:antagonists & inhibitors*; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use*; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine; D054303:HIV Reverse Transcriptase; C098320:efavirenz