Superior Effectiveness of Zidovudine Compared With Tenofovir When Combined With Nevirapine-based Antiretroviral Therapy in a Large Nigerian Cohort.

Autor:	Scarsi KK; Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha., Eisen G; Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Darin KM; Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Meloni ST; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health., Rawizza HE; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital., Tchetgen Tchetgen EJ; Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts., Agbaji OO; Department of Medicine, University of Jos and Jos University Teaching Hospital., Onwujekwe DI; Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba., Gashau W; Department of Medicine, University of Maiduguri Teaching Hospital., Nkado R; Department of Medicine, 68 Military Hospital, Yaba (formerly, at the time of this work)., Okonkwo P; AIDS Prevention Initiative Nigeria, Ltd./Gte., Abuja, Nigeria., Murphy RL; Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Kanki PJ; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2016 Feb 15; Vol. 62 (4), pp. 512-8. Date of Electronic Publication: 2015 Nov 10.
DOI:	10.1093/cid/civ928
Abstrakt:	Background: Despite sparse efficacy data, tenofovir-emtricitabine or tenofovir-lamivudine plus nevirapine is used in many resource-constrained settings. Methods: This retrospective cohort study included patients initiating nevirapine-based antiretroviral therapy (ART) with either tenofovir-emtricitabine or lamivudine (tenofovir group) or zidovudine-lamivudine (zidovudine group). Clinical, virologic, and immunologic evaluations were performed at baseline and every 6 months. Virologic failure was defined as 2 consecutive human immunodeficiency virus (HIV)-RNA values >1000 copies/mL. Patients were included from ART initiation until time of failure, regimen switch, discontinuation, or last HIV-RNA measurement. Cox proportional hazards regression was used to model factors influencing time to failure. Bias due to dependent censoring was investigated via inverse probability weighted pooled logistic regression. Results: A total of 5547 patients were evaluated; 1484 (26.8%) were in the tenofovir group and 4063 (73.2%) were in the zidovudine group. In the adjusted model, tenofovir regimen (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.21-1.79) and higher baseline log10 HIV-RNA (HR, 1.15; 95% CI, 1.03-1.28) were associated with virologic failure. Higher baseline log10 CD4+ cell count (HR, 0.50; 95% CI, .40-.63) and increasing age (HR, 0.98; 95% CI, .97-.99) decreased the risk of virologic failure. Inverse probability weighting results were consistent with the primary analysis. Conclusions: Compared with zidovudine-lamivudine, the use of tenofovir-lamivudine or emtricitabine in combination with nevirapine was a strong predictor of virologic failure in our cohort, which was not explained by other risk factors or criteria for regimen selection. (© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America.)
Databáze:	MEDLINE
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