AEGiS-15IAC: Which antiretroviral regimens yield the best odds of survival in San Francisco?

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Which antiretroviral regimens yield the best odds of survival in San Francisco?

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrC1082)

Chen SY, Hsu L, Schwarcz SK, McFarland W
Johns Hopkins Bloomberg School of Public Health, Baltimore, United States

BACKGROUND: There is a myriad of antiretroviral drug combinations currently available to HIV-infected individuals. We used AIDS surveillance data in San Francisco to determine which combinations of initial regimens yield the best odds of survival.

METHODS: We performed a retrospective, matched, nested case-control study using citywide AIDS case and mortality surveillance data. Cases were AIDS patients who died prior to the end of 2002; controls were AIDS patients alive through 2002. We compared the odds of survival for regimens that were initiated by at least 10 persons (comprising 39 different combinations). Regimens considered included, at a minimum, one protease inhibitor or one non-nucleoside reverse transcriptase inhibitor. A forward and backward stepwise conditional logistic regression analysis identified regimens with the highest odds of survival. To adjust for stage of disease and temporal changes in treatment availability, we matched cases and controls to year of AIDS diagnosis, the level and year of their earliest known CD4 count (within 100/uL), and controlled for CD4 count nearest to treatment initiation, age, injection drug use, and homelessness.

RESULTS: Analysis included 310 AIDS deaths and 1,161 AIDS patients alive through 2002. The four most common initiating regimens were: D4T-3TC-Nelfinavir (n=151), AZT-3TC-Nelfinavir (n=148), AZT-3TC-Indinavir (n=142), AZT-3TC-Efavirenz (n=122). The best survival outcomes were among patients initiating treatment with D4T-3TC-Efavirenz (adjusted odds ratio [AOR] 0.40, p=0.045) or AZT-3TC-Efavirenz (AOR 0.45, p=0.033). Conclusion Patients in San Francisco initiating AIDS treatment with either D4T-3TC-Efavirenz or AZT-3TC-Efavirenz had significantly better odds of survival than patients initiating with other combinations. Of note, these two combinations are currently being recommended by WHO/UNAIDS as part of their "Three by Five" plan to treat three million HIV-infected individuals worldwide by 2005.

Keywords: AEGIS, Lamivudine, Zidovudine, Stavudine, CD4 Lymphocyte Count, Anti-HIV Agents, Indinavir, Acquired Immunodeficiency Syndrome, Oxazines, HIV Infections, HIV Protease Inhibitors, HIV, Nelfinavir, Survival, Case-Control Studies, San Francisco, efavirenz, Humans, mortality

040711
MoOrC1082