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Treatment Outcomes of Recommended First-Line Antiretroviral Regimens in Resource-Limited Clinics

Amoroso, Anthony MD; Etienne-Mesubi, Martine DrPH; Edozien, Anthony MD; Ojoo, Sylvia MBBS, MRCP, DTM&H; Sheneberger, Robert MD; Obiefune, Michael MBBS; Hossain, Mian Bazle PhD; Stafford, Kristen MPH; Redfield, Robert R. MD

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2012 - Volume 60 - Issue 3 - p 314–320
doi: 10.1097/QAI.0b013e31824e5256
Epidemiology and Prevention

Background: Although used globally, little data exist on the efficacy of nevirapine (NVP) used in combination with tenofovir (TDF)/emtricitabine or lamivudine (XTC), and no large randomized prospective control trials exists comparing this combination with efavirenz (EFV)/TDF/(XTC).

Methods: As part of the AIDSRelief program, a retrospective review of patient medical chart information along with a cross-sectional viral load, and adherence measurement was conducted between 2004 and 2009. An on-treatment analysis excluded patients who died, transferred out of care, or were lost to follow-up. A switch of antiretrovirals for any reason was considered a failure in the intent-to-treat analysis. Patients with only clinically relevant reasons for switching such as toxicity, adverse effects, viral failure or clinical/immunological failure, lost to follow-up, and death were considered failures as part of the modified-intent-to-treat analysis. Step-wise multiple regression analysis was used to identify variables that were associated with viral suppression.

Results: A random sample of 3862 patients met criteria and were included in this analysis. In the on-treatment analysis, older age (P < 0.004) and baseline CD4 <100 cells per cubic millimeter (P < 0.021) were the most significant variables impacting viral load. Patients on TDF/XTC/EFV achieved higher rates of viral suppression compared with patients on TDF/XTC/NVP or azidothymidine (AZT)/lamivudine (3TC)/NVP.

Conclusion: Our data show that patients on TDF/XTC/EFV had better outcomes than patients on TDF/XTC/NVP, AZT/3TC/EFV, or AZT/3TC/NVP. High rates of virologic suppression seen in patients on this regimen are consistent with previous studies and indicate the need to increase use of this regimen in HIV programs to promote sustainable viral suppression over time.

Institute of Human Virology, Clinical Division, Baltimore, MD.

Correspondence to: Martine Etienne-Mesubi, DrPH, Institute of Human Virology, Clinical Division, 725 W Lombard Street, Baltimore MD, 21201 (e-mail: metienne@ihv.umaryland.edu).

Supported by the President's Emergency Plan for AIDS Relief through a multicounty grant to the AIDSRelief Consortium from the US Department of Health and Human Services and Centers for Disease Control and Prevention. Supported by President's Emergency Plan for AIDS Relief, through the Office of the Global AIDS Coordinator and the Human Resources and Services Administration, Department of Health and Human Services. Cooperative Agreement #4U51HA02521-01-03.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received August 31, 2011

Accepted January 31, 2012

© 2012 Lippincott Williams & Wilkins, Inc.