2026-04-13T06:44:37Zhttps://recercat.cat/oai/request

oai:recercat.cat:2072/4677822025-10-13T10:21:35Zcom_2072_98col_2072_378192

urn:hdl:2072/467782 Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes : A prospective study of HIV-positive individuals Cain, Lauren E. Caniglia, Ellen C. Phillips, Andrew Olson, Ashley Muga, Roberto Pérez Hoyos, Santiago Abgrall, Sophie Costagliola, Dominique Rubio, Rafael Jarrín, Inma Bucher, Heiner Fehr, Jan van Sighem, Ard Reiss, Peter Dabis, François Vandenhende, Marie-Anne Logan, Roger Robins, James Sterne, Jonathan A C Justice, Amy C Tate, Janet Touloumi, Giota Paparizos, Vasilis Esteve, Anna Casabona-Barbarà, Jordi Seng, Rémonie Meyer, Laurence Jose, Sophie Sabin, Caroline A Hernán, Miguel A HIV CAUSAL Collaboration Universitat Autònoma de Barcelona. Departament de Medicina Atazanavir Efavirenz HIV Mortality Observational studies SDG 3 - Good Health and Well-being Altres ajuts: NIH R01-AI073127, U10-AA013566; MRC G0700820 Objective: 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. Design: Prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States included in the HIV-CAUSAL Collaboration. Methods: 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. Results: 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. Conclusion: 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. 2016 Article Medicine ; Vol. 95 Núm. 41 (2016), art. e5133 open access Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades. https://creativecommons.org/licenses/by-nc-nd/4.0/