Skip to main content

Advertisement

SpringerLink
Log in

Treatment Outcomes of Nevirapine- Versus Efavirenz-Based Highly Active Antiretroviral Therapy Regimens Among Antiretroviral-Naive Adult Patients in Ethiopia: A Cohort Study

  • Global Perspectives: Original Research
  • Published:
Therapeutic Innovation & Regulatory Science Aims and scope Submit manuscript

Abstract

Background

Despite wide use of nevirapine- and efavirenz-based highly active antiretroviral therapy regimens in Ethiopia, their treatment outcome has not been well studied. The objective of this study was to compare treatment outcome of nevirapine- and efavirenz-based regimens.

Methods

This retrospective cohort study was conducted on antiretroviral-naive adult patients with human immunodeficiency virus (HIV) who had started antiretroviral therapy. Study participants were excluded after treatment failure, regimen change, loss to follow-up, or transfer to other health facility. The outcomes of interest included immunologic recovery, immunologic failure, clinical failure, and treatment failure.

Results

There were 1064 HIV patients in the study; an equal proportion (1:1) from both efavirenz- and nevirapine-based regimens was included. Patients in both regimens had similar baseline CD4 cells count (P =.876). In multivariate analysis, efavirenz-based regimens showed more likelihood of immunologic recovery, whether defined as a CD4 cell count of >200 cells/mm3 (hazard ratio [HR] = 1.31 [95% CI, 1.05-1.59]), >350 cells/mm3 (HR = 1.26 [95% CI, 1.08-1.47]), or >500 cells/mm3 (HR = 1.95 [95% CI, 1.57-2.41]). Moreover, efavirenz-based regimens showed a lower hazard of treatment failure (HR = 0.66 [95% CI, 0.49-0.88]).

Conclusion

Although the finding of retrospective study should be interpreted with caution, efavirenz-based regimens were associated with superior treatment outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization, UNICEF. Global HIV/AIDS Response: Epidemic Update and Health Sector Progress Towards Universal Access. Geneva, Swizerland: WHO; 2012.

    Google Scholar 

  2. World Health Organization and UNAIDS unveil plan to get 3 million AIDS patients on treatment by 2005. Ann Saudi Med. 2004;24(1):71–72.

    Google Scholar 

  3. HAPCO. Progress Report on HIV/AIDS Response. Addis Ababa, Ethiopia: HAPCO; 2012.

    Google Scholar 

  4. Zaragoza-Macias E, Cosco D, Nguyen ML, Del Rio C, Lennox J. Predictors of success with highly active antiretroviral therapy in an antiretroviral-naive urban population. AIDS Res Hum Retroviruses. 2010;26(2):133–138.

    Article  CAS  Google Scholar 

  5. Vo TT, Ledergerber B, Keiser O, et al. Durability and outcome of initial antiretroviral treatments received during 2000–2005 by patients in the Swiss HIV Cohort Study. J Infect Dis. 2008;197(12):1685–1694.

    Article  Google Scholar 

  6. Gilks CF, Crowley S, Ekpini R, et al. The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet. 2006;368(9534):505–510.

    Article  Google Scholar 

  7. World Health Organization. Rapid Advice: Antiretroviral Therapy for HIV Infection in Adult and Adolescent. Geneva, Switzerland: WHO; 2009.

    Google Scholar 

  8. World Health Organization. Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach: 2010 Revision. Geneva, Switzerland: WHO; 2010.

    Google Scholar 

  9. Thompson MA, Aberg JA, Cahn P, et al. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society–USA panel. JAMA. 2010;304(3):321–333.

    Article  CAS  Google Scholar 

  10. Thompson MA, Aberg JA, Hoy JF, et al. Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA. 2012;308(4):387–402.

    Article  CAS  Google Scholar 

  11. US Department of Health and Human Services. adult and adolescent ARV guidelines AIDSinfo. http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/11/what-to-start. Accessed February 12, 2013.

  12. Gazzard BG, on behalf of the BTGWG. British HIV Association guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008. HIV Med. 2008;9(8):563–608.

    Article  CAS  Google Scholar 

  13. Nunez M, Soriano V, Martin-Carbonero L, et al. SENC (Spanish efavirenz vs. nevirapine comparison) trial: a randomized, open-label study in HIV-infected naive individuals. HIV Clin Trials. 2002;3(3):186–194.

    Article  Google Scholar 

  14. van Leth F, Phanuphak P, Ruxrungtham K, et al. Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz, or both drugs, plus stavudine and lamivudine: a randomised open-label trial, the 2NN Study. Lancet. 2004;363(9417):1253–1263.

    Article  Google Scholar 

  15. Mbuagbaw LC, Irlam JH, Spaulding A, Rutherford GW, Siegfried N. Efavirenz or nevirapine in three-drug combination therapy with two nucleoside-reverse transcriptase inhibitors for initial treatment of HIV infection in antiretroviral-naive individuals. Cochrane Database Syst Rev. 2010;(12):CD004246.

  16. The effect of efavirenz versus nevirapine-containing regimens on immunologic, virologic and clinical outcomes in a prospective observational study. AIDS. 2012;26(13):1691–1705.

  17. Braithwaite RS, Kozal MJ, Chang CC, et al. Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies. AIDS. 2007;21(12):1579–1589.

    Article  CAS  Google Scholar 

  18. Cozzi-Lepri A, Phillips AN, d’Arminio Monforte A, et al. Virologic and immunologic response to regimens containing nevirapine or efavirenz in combination with 2 nucleoside analogues in the Italian Cohort Naive Antiretrovirals (I.Co.N.A.) study. J Infect Dis. 2002;185(8):1062–1069.

    Article  CAS  Google Scholar 

  19. Bannister WP, Ruiz L, Cozzi-Lepri A, et al. Comparison of genotypic resistance profiles and virological response between patients starting nevirapine and efavirenz in EuroSIDA. AIDS. 2008;22(3):367–376.

    Article  CAS  Google Scholar 

  20. Pillay P, Ford N, Shubber Z, Ferrand RA. Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis. PLoS ONE. 2013;8(7):e68995.

    Article  CAS  Google Scholar 

  21. Nachega JB, Hislop M, Dowdy DW, et al. Efavirenz versus nevirapine-based initial treatment of HIV infection: clinical and virological outcomes in Southern African adults. AIDS. 2008;22(16):2117–2125.

    Article  CAS  Google Scholar 

  22. Keiser P, Nassar N, White C, Koen G, Moreno S. Comparison of nevirapine- and efavirenz-containing antiretroviral regimens in antiretroviral-naive patients: a cohort study. HIV Clin Trials. 2002;3(4):296–303.

    Article  Google Scholar 

  23. de Beaudrap P, Etard JF, Gueye FN, et al. Long-term efficacy and tolerance of efavirenz- and nevirapine-containing regimens in adult HIV type 1 Senegalese patients. AIDS Res Hum Retroviruses. 2008;24(6):753–760.

    Article  Google Scholar 

  24. Wester CW, Thomas AM, Bussmann H, et al. Non-nucleoside reverse transcriptase inhibitor outcomes among combination antiretroviral therapy-treated adults in Botswana. AIDS. 2010;24 (suppl 1): S27–S36.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacy, College of Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia

    Muktar Sano Kedir MSc, BPharm

  2. Department of Epidemiology, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia

    Desta Hiko Gemeda MPHE

  3. Department of Pharmacy, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia

    Sultan Suleman MSc, BPharm, PhD

Authors
  1. Muktar Sano Kedir MSc, BPharm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Desta Hiko Gemeda MPHE
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sultan Suleman MSc, BPharm, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muktar Sano Kedir MSc, BPharm.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kedir, M.S., Gemeda, D.H. & Suleman, S. Treatment Outcomes of Nevirapine- Versus Efavirenz-Based Highly Active Antiretroviral Therapy Regimens Among Antiretroviral-Naive Adult Patients in Ethiopia: A Cohort Study. Ther Innov Regul Sci 49, 443–449 (2015). https://doi.org/10.1177/2168479014565472

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/2168479014565472

Keywords

Search

Navigation