Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: A prospective study of HIV-positive individuals.
Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: A prospective study of HIV-positive individuals.
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DOI：
10.1097/md.0000000000005133
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发表时间：
2016-10
期刊：
影响因子：
1.6
通讯作者：
HIV-CAUSAL Collaboration
中科院分区：
文献类型：
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作者：
Cain LE;Caniglia EC;Phillips A;Olson A;Muga R;Pérez-Hoyos S;Abgrall S;Costagliola D;Rubio R;Jarrín I;Bucher H;Fehr J;van Sighem A;Reiss P;Dabis F;Vandenhende MA;Logan R;Robins J;Sterne JAC;Justice A;Tate J;Touloumi G;Paparizos V;Esteve A;Casabona J;Seng R;Meyer L;Jose S;Sabin C;Hernán MA;HIV-CAUSAL Collaboration
比较利托那韦加强阿扎那韦或依法韦仑和核苷逆转录酶抑制剂（NRTI）骨架组成的方案在临床、免疫学和病毒学结局方面的差异。对欧洲和美国人类免疫缺陷病毒（HIV）感染者的前瞻性研究，包括在HIV-CAUSAL协作中。HIV阳性、未接受过抗逆转录病毒治疗和无获得性免疫缺陷综合征（AIDS）的患者从开始阿扎那韦或依法韦仑治疗时开始接受随访。我们通过对时变协变量的逆概率加权进行调整，估计了依非韦伦与阿扎那韦方案对临床、免疫学和病毒学结局的“意向治疗”效应的模拟。共有4301人开始阿扎那韦治疗（83例死亡，157例艾滋病定义疾病或死亡），18,786人开始依法韦仑治疗（389例死亡，825例艾滋病定义疾病或死亡）。在31个月的中位随访期间，依非韦伦与阿扎那韦方案相比，死亡的风险比（95%置信区间）为0.98（0.77，1.24），艾滋病定义疾病或死亡的风险比为1.09（0.91，1.30）。5年生存率差异为0.1%（95%置信区间：-0.7%，0.8%），无艾滋病生存率差异为-0.3%（-1.2%，0.6%）。12个月后，依非韦伦治疗方案中CD 4细胞计数的平均变化为20.8（95%置信区间：13.9，27.8）个细胞/mm 3，病毒学失败的风险降低20%（14%，26%）。与阿扎那韦方案相比，依非韦伦治疗12个月后CD 4细胞计数增加较小，病毒学失败风险较小，我们的估计结果与此一致。在5年生存率或无艾滋病生存率方面没有检测到总体差异。
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. Prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States included in the HIV-CAUSAL Collaboration. 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. 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/mm3 lower and the risk of virologic failure was 20% (14%, 26%) lower in the efavirenz regimens. 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.