[O3] COMPARISON OF FIRST-LINE ANTIRETROVIRAL THERAPY SUCCESS IN A COHORT ANALYSIS OF OVER 1000 PATIENTS (PROTEASE INHIBITOR VS NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR)

7th Annual Conference Of The British HIV Association [BHIVA]

27 – 29 April 2001, The Hove Centre, Brighton

[TITLE:] COMPARISON OF FIRST-LINE ANTIRETROVIRAL THERAPY SUCCESS IN A COHORT ANALYSIS OF OVER 1000 PATIENTS (PROTEASE INHIBITOR VS NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR)

[AUTHOR(S):] GV Matthews¹, CA Sabin², S Mandalia¹, AN Phillips², MR Nelson¹, M Bower¹, F Lampe², MA Johnson², BG Gazzard¹
¹Chelsea and Westminster Hospital and ²Royal Free and University College Medical School, London, UK

BHIVA Conf 2001 Apr 27-29;7:O3

OBJECT: To determine whether the likelihood of achieving viral load (VL) suppression at 6 months is related to the choice of therapy.

METHODS: Databases were used to identify all treatment-naïve patients starting highly active antiretroviral therapy with a protease inhibitor (PI)-/two PIs- or a non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimen). Proportional hazards analysis and logistic regression were used to determine the likelihood of VL <500 HIV-1 RNA copies/ml by 6 months and to identify variables associated with virological success/failure. Patients excluded were on hard-gel saquinavir (SQV) or had no VL available after commencing therapy.

RESULTS: A total of 1109 patients were included (726 Chelsea and Westminster, 383 Royal Free Hospitals); 60% received a PI (40% indinavir, 41% nelfinavir); 40% received an NNRTI [40% efavirenz (EFV), 60% nevirapine (NVP)]. Adjusting for starting therapy year and centre gave no differences between PI regimens. A comparison of NVP vs EFV suggested a treatment benefit for EFV [relative hazard (RH) 0.81 for NVP]. The final analysis compared PI vs EFV vs NVP. 83% of all patients achieved VL<500 copies/ml by 6 months. In multivariate analysis EFV was associated with increased likelihood of success over both PIs and NVP (RH 0.71 for PI, P=0.007; RH 0.78 for NVP, P=0.04) after controlling for all variables including start year and centre. No effect was seen for baseline CD4, age, sex, ethnicity or prior ADI. Baseline VL was also significantly associated with VL<500 copies/ml.

CONCLUSIONS: This large treatment-naïve cohort analysis suggests that EFV may be associated with a better initial virological response at 6 months than either PIs or NVP, both of which had similar responses.

PRESENTING AUTHOR: GV Matthews

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