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Durability of Efavirenz Compared With Boosted Protease Inhibitor-Based Regimens in Antiretroviral-Naïve Patients in the Caribbean and Central and South America

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dc.contributor.author Caro-Vega, Yanink
dc.contributor.author Belaunzarán-Zamudio, Pablo F.
dc.contributor.author Crabtree-Ramírez, Brenda E.
dc.contributor.author Shepherd, Bryan E.
dc.contributor.author Grinsztejn, Beatriz
dc.contributor.author Wolff, Marcelo
dc.contributor.author Pape, Jean W.
dc.contributor.author Padgett, Denis
dc.contributor.author Gotuzzo, Eduardo
dc.contributor.author McGowan, Catherine C.
dc.contributor.author Sierra-Madero, Juan G.
dc.date.accessioned 2018-06-18T15:26:48Z
dc.date.available 2018-06-18T15:26:48Z
dc.date.issued 2018
dc.identifier.uri https://doi.org/10.1093/ofid/ofy004
dc.identifier.uri http://repositorio.upch.edu.pe/handle/upch/3663
dc.description.abstract Background Efavirenz (EFV) and boosted protease inhibitors (bPIs) are still the preferred options for firstline antiretroviral regimens (firstline ART) in Latin America and have comparable short-term efficacy. We assessed the long-term durability and outcomes of patients receiving EFV or bPIs as firstline ART in the Caribbean, Central and South America network for HIV epidemiology (CCASAnet). Methods We included ART-naïve, HIV-positive adults on EFV or bPIs as firstline ART in CCASAnet between 2000 and 2016. We investigated the time from starting until ending firstline ART according to changes of third component for any reason, including toxicity and treatment failure, death, and/or loss to follow-up. Use of a third-line regimen was a secondary outcome. Kaplan-Meier estimators of composite end points were generated. Crude cumulative incidence of events and adjusted hazard ratios (aHRs) were estimated accounting for competing risk events. Results We included 14 519 patients: 12 898 (89%) started EFV and 1621 (11%) bPIs. The adjusted median years on firstline ART were 4.6 (95% confidence interval [CI], 4.4–4.7) on EFV and 3.8 (95% CI, 3.8–4.0) on bPI (P < .001). Cumulative incidence of firstline ART ending at 10 years of follow-up was 32% (95% CI, 31–33) on EFV and 44% (95% CI, 39–48) on bPI (aHR, 0.88; 95% CI, 0.78–0.97). The cumulative incidence rates of third-line initiation in the bPI-based group were 6% (95% CI, 2.4–9.6) and 2% (95% CI, 1.4–2.2) among the EFV-based group (P < .01). Conclusions Durability of firstline ART was longer with EFV than with bPIs. EFV-based regimens may continue to be the preferred firstline regimen for our region in the near future due to their high efficacy, relatively low toxicity (especially at lower doses), existence of generic formulations, and affordability for national programs.
dc.language.iso eng
dc.publisher Oxford University Press
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject antiretroviral therapy
dc.subject durability
dc.subject HIV
dc.subject Latin America
dc.subject nonnucleoside reverse transcriptase inhibitor
dc.subject protease inhibitor
dc.title Durability of Efavirenz Compared With Boosted Protease Inhibitor-Based Regimens in Antiretroviral-Naïve Patients in the Caribbean and Central and South America
dc.type info:eu-repo/semantics/article
dc.identifier.journal Open Forum Infectious Diseases


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