title: Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: A prospective study of HIV-positive individuals.
abstract: OBJECTIVE
  To compare regimens consisting of either ritonavir-boosted atazanavir or efavirenz and a nucleoside reverse transcriptase inhibitor (NRTI) backbone with respect to clinical, immunologic, and virologic outcomes.
  
  
  METHODS
  Prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States included in the HIV-CAUSAL Collaboration.
  
  
  METHODS
  HIV-positive, antiretroviral therapy-naive, and acquired immune deficiency syndrome (AIDS)-free individuals were followed from the time they started an atazanavir or efavirenz regimen. We estimated an analog of the "intention-to-treat" effect for efavirenz versus atazanavir regimens on clinical, immunologic, and virologic outcomes with adjustment via inverse probability weighting for time-varying covariates.
  
  
  RESULTS
  A total of 4301 individuals started an atazanavir regimen (83 deaths, 157 AIDS-defining illnesses or deaths) and 18,786 individuals started an efavirenz regimen (389 deaths, 825 AIDS-defining illnesses or deaths). During a median follow-up of 31 months, the hazard ratios (95% confidence intervals) were 0.98 (0.77, 1.24) for death and 1.09 (0.91, 1.30) for AIDS-defining illness or death comparing efavirenz with atazanavir regimens. The 5-year survival difference was 0.1% (95% confidence interval: -0.7%, 0.8%) and the AIDS-free survival difference was -0.3% (-1.2%, 0.6%). After 12 months, the mean change in CD4 cell count was 20.8 (95% confidence interval: 13.9, 27.8) cells/mm lower and the risk of virologic failure was 20% (14%, 26%) lower in the efavirenz regimens.
  
  
  CONCLUSIONS
  Our estimates are consistent with a smaller 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for efavirenz compared with atazanavir regimens. No overall differences could be detected with respect to 5-year survival or AIDS-free survival.
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cain
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Caniglia
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: Ashley
authors.initials: A
authors.lastname: Olson
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Hoyos
authors.forename: Sophie
authors.initials: S
authors.lastname: Abgrall
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Rafael
authors.initials: R
authors.lastname: Rubio
authors.forename: Inma
authors.initials: I
authors.lastname: Jarrín
authors.forename: Heiner
authors.initials: H
authors.lastname: Bucher
authors.forename: Jan
authors.initials: J
authors.lastname: Fehr
authors.forename: Ard
authors.initials: A
authors.lastname: van Sighem
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Vandenhende
authors.forename: Roger
authors.initials: R
authors.lastname: Logan
authors.forename: James
authors.initials: J
authors.lastname: Robins
authors.forename: Jonathan A C
authors.initials: JAC
authors.lastname: Sterne
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
authors.forename: Janet
authors.initials: J
authors.lastname: Tate
authors.forename: Giota
authors.initials: G
authors.lastname: Touloumi
authors.forename: Vasilis
authors.initials: V
authors.lastname: Paparizos
authors.forename: Anna
authors.initials: A
authors.lastname: Esteve
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
authors.forename: Rémonie
authors.initials: R
authors.lastname: Seng
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.forename: Sophie
authors.initials: S
authors.lastname: Jose
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Hernán
mesh_terms: D000328:Adult; D000480:Alkynes; D000069446:Atazanavir Sulfate / Q000008:administration & dosage*; D048588:Benzoxazines / Q000008:administration & dosage*; D003521:Cyclopropanes; D004305:Dose-Response Relationship, Drug; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017320:HIV Protease Inhibitors / Q000008:administration & dosage; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D019562:Viral Load
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D000069446:Atazanavir Sulfate; C098320:efavirenz