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9th Annual Conference Of The British HIV Association [BHIVA]24 – 26 April 2003, University of Manchester
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[AUTHOR(S):] G Matthews, Y Gilleece, C Orkin, S Mandalia, MR Nelson, B Fisher, M Bower and BG Gazzard
Chelsea and Westminster Hospital, London, UK
BHIVA Conf 2003 Apr 24-26;9:O7
BACKGROUND: Few long-term data directly compare outcomes for efavirenz (EFV) versus nevirapine (NVP) regimens in antiretroviral-naïve patients. We provide durability data on non-nucleoside reverse transcriptase inhibitors (NNRTIs) with up to 260 weeks' follow-up.
METHODS: Antiretroviral-naïve patients initiating EFV or NVP since 01/96 were identified from a prospective observational database. Virological failure [two viral load (VL) measurements >500 copies/ml] or switch failure (discontinuation/switch) was identified. Multivariate analysis determining significant factors associated with failure and time to failure (TTVF) Kaplan–Meier (KM) curves was performed.
RESULTS: 694 patients initiated NNRTI-based highly active antiretroviral therapy (HAART) (357 EFV, 337 NVP) since 01/96 with a total followup of 292 patient-years. No significant differences between EFV and NVP were found for sex, baseline VL or CD4, prior AIDS. EFV tended to be commenced in later years and with zidovudine/lamivudine (ZDV/3TC), NVP with stavudine/didanosine (d4T/ddI). In multivariate analysis, significant independent predictors of failure (virological and/or switch) were: prior AIDS illness [RH 1.48, 95% confidence interval (CI) 0.99- 2.22], backbone d4T/ddI (RH 1.96, 95% CI 1.21–3.17) and NVP HAART (RH 1.60, 95% CI 1.07-2.40). Stratifying by year of therapy had no effect on outcome. 73 (10.5%) patients failed to achieve HIV VL <500 copies/ ml within 6 months of therapy. Of 621 patients achieving <500, 31 (5.0%) later developed virological failure and 45 (7.2%) had failure as defined by switch of therapy. KM curves showed an EFV benefit both in TTVF (P=0.0476) and time to treatment failure (VF±switch) (P=0.0324).
CONCLUSIONS: This cohort provides the strongest evidence yet that durability of EFV over NVP continues with long-term follow-up.
PRESENTING AUTHOR: C Orkin
030424
O7
Copyright © 2003 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD