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Multicenter Study
. 2007 Jul 31;21(12):1579-89.
doi: 10.1097/QAD.0b013e3281532b31.

Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies

R Scott Braithwaite  1 , Michael J Kozal, Chung Chou H Chang, Mark S Roberts, Shawn L Fultz, Matthew Bidwell Goetz, Cynthia Gibert, Maria Rodriguez-Barradas, Larry Mole, Amy C Justice
Affiliations
Multicenter Study

Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies

R Scott Braithwaite et al. AIDS. .

Abstract

Objectives: We aimed to determine adherence, virological, and immunological outcomes one year after starting a first combination antiretroviral therapy (ART) regimen.

Design: Observational; synthesis of administrative, laboratory, and pharmacy data. Antiretroviral regimens were divided into efavirenz, nevirapine, boosted protease inhibitor (PI), and single PI categories. Propensity scores were used to control for confounding by treatment assignment. Adherence was estimated from pharmacy refill records.

Setting: Veterans Affairs Healthcare System, all sites.

Participants: HIV-infected individuals starting combination ART with a low likelihood of previous antiretroviral exposure.

Interventions: None.

Outcomes: The proportion of antiretroviral prescriptions filled as prescribed, a change in log HIV-RNA, the proportion with log HIV-RNA viral suppression, a change in CD4 cell count.

Results: A total of 6394 individuals unlikely to have previous antiretroviral exposure started combination ART between 1996 and 2004, and were eligible for analysis. Adherence overall was low (63% of prescriptions filled as prescribed), and adherence with efavirenz (67%) and nevirapine (65%) regimens was significantly greater than adherence with boosted PI (59%) or single PI (61%) regimens (P < 0.001). Efavirenz regimens were more likely to suppress HIV-RNA at one year (74%) compared with nevirapine (62%), boosted PI (63%), or single PI (53%) regimens (all P < 0.001), and this superiority was maintained when analyses were adjusted for baseline clinical characteristics and propensity for treatment assignment. Efavirenz also yielded more favorable immunological outcomes.

Conclusion: HIV-infected individuals initiating their first combination ART using an efavirenz-based regimen had improved virological and immunological outcomes and greater adherence levels.

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Figures

Fig. 1
Fig. 1. Change in log HIV-RNA level at one year, by adherence stratum
Adherence was approximated by estimating the maximum proportion of antiretroviral doses that could have been taken as prescribed based on pharmacy refill records. Allthough the regimens differed greatly in their maximum effectiveness, a similar proportion of the maximum effect was observed within each adherence stratum. formula image Efavirenz; formula image nevirapine; formula image boosted protease inhibitor; formula image single protease inhibitor.
Fig. 2
Fig. 2. Proportion with HIV-RNA suppression at one year, by adherence stratum
Adherence was approximated by estimating the maximum proportion of antiretroviral doses that could have been taken as prescribed based on pharmacy refill records. Although the regimens differed greatly in their maximum effectiveness, a similar proportion of the maximum effect was observed within each adherence stratum. formula image Efavirenz; formula image nevirapine; formula image boosted protease inhibitor; formula image single protease inhibitor.
Fig. 3
Fig. 3. Change in CD4 cell count at one year, by adherence stratum
Adherence was approximated by estimating the maximum proportion of antiretroviral doses that could have been taken as prescribed based on pharmacy refill records. The improved effectiveness of efavirenz was most evident in the highest adherence stratum. formula image Efavirenz; formula image nevirapine; formula image boosted protease inhibitor; formula image single protease inhibitor.
See this image and copyright information in PMC

References

    1. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 10 October 2006. The Panel on Clinical Practices for the Treatment of HIV Infection convened by the Department of Health and Human Services. Available at: http://AIDSinfo.nih.gov. Accessed: March 2007.

    1. Robbins GK, De Gruttola V, Shafer RW, Smeaton LM, Snyder SW, Pettinelli C, et al. Comparison of sequential three-drug regimens as initial therapy for HIV-1 infection. N Engl J Med. 2003;349:>2293–2303. - PMC - PubMed
    1. Staszewski S, Morales-Ramirez J, Tashima KT, Rachlis A, Skiest D, Stanford J, et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. Study 006 Team. N Engl J Med. 1999;241:>1865–1873. - PubMed
    1. Walmsley S, Bernstein B, King M, Arribas J, Beall G, Ruane P, et al. Lopinavir–ritonavir versus nelfinavir for the initial treatment of HIV infection. N Engl J Med. 2002;346:>2039–2046. - PubMed
    1. Rodriguez-French A, Boghossian J, Gray GE, Nadler JP, Quinones AR, Sepulveda GE, et al. The NEAT Study: a 48-week open-label study to compare the antiviral efficacy of GW433908 versus nelfinavir in antiretroviral naive HIV-1 infected patients. J Acquir Immune Defic Syndr. 2004;35:22–32. - PubMed

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