Virologic and Immunologic Responses in Treatment-Naive Patients to Ritonavir-Boosted Atazanavir or Efavirenz With a Common Backbone

Qing Wang, Jim Young, Enos Bernasconi, Pietro Vernazza, Alexandra Calmy, Matthias Cavassini, Hansjakob Furrer, Jan Fehr, Heiner C. Bucher, Manuel Battegay
2014 HIV Clinical Trials  
Atazanavir boosted with ritonavir (ATV/r) and efavirenz (EFV) are both recommended as fi rst-line therapies for HIV-infected patients. We compared the 2 therapies for virologic effi cacy and immune recovery. Methods: We included all treatment-naïve patients in the Swiss HIV Cohort Study starting therapy after May 2003 with either ATV/r or EFV and a backbone of tenofovir and either emtricitabine or lamivudine. We used Cox models to assess time to virologic failure and repeated measures models to
more » ... assess the change in CD4 cell counts over time. All models were fi t as marginal structural models using both point of treatment and censoring weights. Intent-to-treat and various as-treated analyses were carried out: In the latter, patients were censored at their last recorded measurement if they changed therapy or if they were no longer adherent to therapy. Results: Patients starting EFV (n = 1,097) and ATV/r (n = 384) were followed for a median of 35 and 37 months, respectively. During follow-up, 51% patients on EFV and 33% patients on ATV/r remained adherent and made no change to their fi rst-line therapy. Although intentto-treat analyses suggest virologic failure was more likely with ATV/r, there was no evidence for this disadvantage in patients who adhered to fi rst-line therapy. Patients starting ATV/r had a greater increase in CD4 cell count during the fi rst year of therapy, but this advantage disappeared after one year. Conclusions: In this observational study, there was no good evidence of any intrinsic advantage for one therapy over the other, consistent with earlier clinical trials. Differences between therapies may arise in a clinical setting because of differences in adherence to therapy.
doi:10.1310/hct1503-92 pmid:24947533 fatcat:xqxvuc7bwreefpzbja5i2wwwka