Qing Wang1, Jim Young1, Enos Bernasconi2, Pietro Vernazza3, Alexandra Calmy4, Matthias Cavassini5, Hansjakob Furrer6, Jan Fehr7, Heiner C Bucher1, Manuel Battegay8. 1. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland. 2. Division of Infectious Diseases, Regional Hospital of Lugano, Lugano, Switzerland. 3. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 4. Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland. 5. Division of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland. 6. Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland. 7. Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zürich, Zürich, Switzerland. 8. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Abstract
BACKGROUND: Atazanavir boosted with ritonavir (ATV/r) and efavirenz (EFV) are both recommended as first-line therapies for HIV-infected patients. We compared the 2 therapies for virologic efficacy and immune recovery. METHODS: We included all treatment-naïve patients in the Swiss HIV Cohort Study starting therapy after May 2003 with either ATV/r or EFV and a backbone of tenofovir and either emtricitabine or lamivudine. We used Cox models to assess time to virologic failure and repeated measures models to assess the change in CD4 cell counts over time. All models were fit as marginal structural models using both point of treatment and censoring weights. Intent-to-treat and various as-treated analyses were carried out: In the latter, patients were censored at their last recorded measurement if they changed therapy or if they were no longer adherent to therapy. RESULTS: Patients starting EFV (n = 1,097) and ATV/r (n = 384) were followed for a median of 35 and 37 months, respectively. During follow-up, 51% patients on EFV and 33% patients on ATV/r remained adherent and made no change to their first-line therapy. Although intent-to-treat analyses suggest virologic failure was more likely with ATV/r, there was no evidence for this disadvantage in patients who adhered to first-line therapy. Patients starting ATV/r had a greater increase in CD4 cell count during the first year of therapy, but this advantage disappeared after one year. CONCLUSIONS: In this observational study, there was no good evidence of any intrinsic advantage for one therapy over the other, consistent with earlier clinical trials. Differences between therapies may arise in a clinical setting because of differences in adherence to therapy.
BACKGROUND:Atazanavir boosted with ritonavir (ATV/r) and efavirenz (EFV) are both recommended as first-line therapies for HIV-infectedpatients. We compared the 2 therapies for virologic efficacy and immune recovery. METHODS: We included all treatment-naïve patients in the Swiss HIV Cohort Study starting therapy after May 2003 with either ATV/r or EFV and a backbone of tenofovir and either emtricitabine or lamivudine. We used Cox models to assess time to virologic failure and repeated measures models to assess the change in CD4 cell counts over time. All models were fit as marginal structural models using both point of treatment and censoring weights. Intent-to-treat and various as-treated analyses were carried out: In the latter, patients were censored at their last recorded measurement if they changed therapy or if they were no longer adherent to therapy. RESULTS:Patients starting EFV (n = 1,097) and ATV/r (n = 384) were followed for a median of 35 and 37 months, respectively. During follow-up, 51% patients on EFV and 33% patients on ATV/r remained adherent and made no change to their first-line therapy. Although intent-to-treat analyses suggest virologic failure was more likely with ATV/r, there was no evidence for this disadvantage in patients who adhered to first-line therapy. Patients starting ATV/r had a greater increase in CD4 cell count during the first year of therapy, but this advantage disappeared after one year. CONCLUSIONS: In this observational study, there was no good evidence of any intrinsic advantage for one therapy over the other, consistent with earlier clinical trials. Differences between therapies may arise in a clinical setting because of differences in adherence to therapy.
Authors: Sara Lodi; Andrew Phillips; Jens Lundgren; Roger Logan; Shweta Sharma; Stephen R Cole; Abdel Babiker; Matthew Law; Haitao Chu; Dana Byrne; Andrzej Horban; Jonathan A C Sterne; Kholoud Porter; Caroline Sabin; Dominique Costagliola; Sophie Abgrall; John Gill; Giota Touloumi; Antonio G Pacheco; Ard van Sighem; Peter Reiss; Heiner C Bucher; Alexandra Montoliu Giménez; Inmaculada Jarrin; Linda Wittkop; Laurence Meyer; Santiago Perez-Hoyos; Amy Justice; James D Neaton; Miguel A Hernán Journal: Am J Epidemiol Date: 2019-08-01 Impact factor: 5.363
Authors: Lauren E Cain; Ellen C Caniglia; Andrew Phillips; Ashley Olson; Roberto Muga; Santiago Pérez-Hoyos; Sophie Abgrall; Dominique Costagliola; Rafael Rubio; Inma Jarrín; Heiner Bucher; Jan Fehr; Ard van Sighem; Peter Reiss; François Dabis; Marie-Anne Vandenhende; Roger Logan; James Robins; Jonathan A C Sterne; Amy Justice; Janet Tate; Giota Touloumi; Vasilis Paparizos; Anna Esteve; Jordi Casabona; Rémonie Seng; Laurence Meyer; Sophie Jose; Caroline Sabin; Miguel A Hernán Journal: Medicine (Baltimore) Date: 2016-10 Impact factor: 1.889