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HIV drugs raltegravir, efavirenz similar in AIDS, mortality outcomes
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A regimen containing the integrase inhibitor raltegravir yielded AIDS and overall mortality outcomes similar to one containing efavirenz in patients with HIV, according to researchers.
“Given favorable short-term virologic control, integrase inhibitor-containing regimens have become the preferred initial treatment options in many resource-rich countries, such as the United States,” Stephen R. Cole, PhD, a professor of epidemiology at the University of North Carolina, Chapel Hill, and colleagues wrote in Clinical Infectious Diseases. “However, there has not yet been extensive investigation of longer term comparative effectiveness, especially in terms of clinical endpoints such as HIV disease progression or mortality.”
The researchers gathered data from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS), which includes more than 32,000 adult patients with HIV who received care at any of eight Centers for AIDS Research facilities. They sought to measure the longer term efficacy of integrase inhibitors, of which raltegravir is one.
In their study, they included more than 3,000 patients who received a regimen containing a backbone of emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) with either raltegravir (n = 415) or efavirenz (n = 2,646), a non-nucleoside reverse transcriptase inhibitor. They followed the patients 4 years after the start of treatment.
The raltegravir cohort had a median CD4 count of 347 cells/µL and median viral load of 4.4 copies/mL, compared with 319 cells/µL and 4.5 copies/mL in the efavirenz cohort.
Ninety-four patients receiving raltegravier (23%) and 647 (24%) patients receiving efavirenz left follow-up before the 4-year mark.
Among intent-to-treat patients, the researchers found an 8.4% risk of incident AIDS or death from any cause at 4 years in patients receiving raltegravir and a 9.3% risk in patients receiving efavirenz (HR = 0.96; 95% CI, 0.63-1.45).
Among the per-protocol patients, the risk was 7.2% in the raltegravir cohort and 7.7% in the efavirenz cohort (HR = 0.95; 95% CI, 0.59-1.54).
The researchers concluded that measuring the time span of integrase inhibitors’ effectiveness will take more work.
“Although there is some experimental evidence for a short- and moderate-term advantage of integrase inhibitor regimens on viremia, our analysis indicates a similar clinical effect to 4 years,” they wrote. “Continuing assessment of the longer term comparative effectiveness of these regimens using observational data is needed.” – by Joe Green
Disclosure: Cole reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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