Interpreting the reasons for the choice and changing of two drug regimens in an observational cohort: comparison of a ritonavir-boosted protease inhibitor-based versus a nonnucleoside reverse transcriptase inhibitor-based first-line regimen

Autor:	Sonia Moreno, Ignacio Santos, Beatriz Hernández-Novoa, R Rubio, Belén Alejos, José López-Aldeguer, Inma Jarrín, José Ramón Blanco, M Riera, Antonio Antela, Félix Gutiérrez
Rok vydání:	2014
Předmět:	Adult Cyclopropanes Male medicine.medical_specialty Efavirenz Anti-HIV Agents HIV Infections Drug Administration Schedule chemistry.chemical_compound Abacavir Internal medicine Humans Medicine Pharmacology (medical) Prospective Studies Ritonavir business.industry Proportional hazards model Health Policy Age Factors Lamivudine HIV Protease Inhibitors Viral Load Confidence interval Benzoxazines CD4 Lymphocyte Count Surgery Atazanavir Regimen Treatment Outcome Infectious Diseases chemistry Spain Alkynes RNA Viral Drug Therapy Combination Female business medicine.drug
Zdroj:	HIV Medicine. 15:547-556
ISSN:	1464-2662
DOI:	10.1111/hiv.12144
Popis:	Objectives We compared reasons for the choice of regimen, time to and reasons for third drug modification, virological response and change in CD4 T-cell counts in patients started on atazanavir/ritonavir (ATV/r)- vs. efavirenz (EFV)-based first-line regimens. Methods We included patients from the Cohort of the Spanish HIV Research Network (CoRIS), a multicentre cohort of HIV-positive treatment-naive subjects, in the study. We used logistic regression to assess factors associated with choosing ATV/r vs. EFV, proportional hazards models on the subdistribution hazard to estimate subdistribution hazard ratios (sHRs) for third drug modification, logistic regression to estimate odds ratios (ORs) for virological response and linear regression to assess mean differences in CD4 T-cell count increase from baseline. Results Of 2167 patients, 10.7% started on ATV/r. ATV/r was more likely than EFV to be prescribed in injecting drug users [adjusted OR 1.85; 95% confidence interval (CI) 1.03–3.33], in 2009–2010 (adjusted OR 1.63; 95% CI 1.08–2.47) and combined with abacavir plus lamivudine (adjusted OR 1.53; 95% CI 0.98–2.43). Multivariate analyses showed no differences, comparing ATV/r vs. EFV, in the risk of third drug modification (sHR 1.04; 95% CI 0.74–1.46) or in virological response (OR 0.81; 95% CI 0.46–1.41); differences in mean CD4 T-cell count increase from baseline were at the limit of statistical significance (mean difference 29.8 cells/μL; 95% CI −4.1 to 63.6 cells/μL). In patients changing from EFV, 48% of changes were attributable to toxicity/adverse events, 16% to treatment failure/resistance, 3% to simplification, and 8 and 12%, respectively, to patients' and physicians' decisions; these percentages were 24, 6, 12, 14 and 24%, respectively, in those changing from ATV/r. Conclusions ATV/r- and EFV-based regimens meet the requirements of both efficacy and safety for initial combination antiretroviral regimen, which relate to better durability.
Databáze:	OpenAIRE
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