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Clin Infect Dis. 2017 Jun 1;64(11):1591-1596. doi: 10.1093/cid/cix199.

Incident AIDS or Death After Initiation of Human Immunodeficiency Virus Treatment Regimens Including Raltegravir or Efavirenz Among Adults in the United States.

Author information

1
Department of Epidemiology, University of North Carolina, Chapel Hill.
2
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
3
Department of Medicine, University of California, San Diego.
4
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
5
Department of Medicine, University of Washington, Seattle.
6
Department of Medicine, University of Alabama at Birmingham; and.
7
Department of Medicine, University of North Carolina, Chapel Hill.

Abstract

Background.:

The long-term effectiveness of human immunodeficiency virus (HIV) treatments containing integrase inhibitors is unknown.

Methods.:

We use observational data from the Centers for AIDS Research Network of Integrated Clinical Systems and the Centers for Disease Control and Prevention to estimate 4-year risk of AIDS and all-cause mortality among 415 patients starting a raltegravir regimen compared to 2646 starting an efavirenz regimen (both regimens include emtricitabine and tenofovir disoproxil fumarate). We account for confounding and selection bias as well as generalizability by standardization for measured variables, and present both observational intent-to-treat and per-protocol estimates.

Results.:

At treatment initiation, 12% of patients were female, 36% black, 13% Hispanic; median age was 37 years, CD4 count 321 cells/µL, and viral load 4.5 log10 copies/mL. Two hundred thirty-five patients incurred an AIDS-defining illness or died, and 741 patients left follow-up. After accounting for measured differences, the 4-year risk was similar among those starting both regimens (ie, intent-to treat hazard ratio [HR], 0.96 [95% confidence interval {CI}, .63-1.45]; risk difference, -0.9 [95% CI, -4.5 to 2.7]), as well as among those remaining on regimens (ie, per-protocol HR, 0.95 [95% CI, .59-1.54]; risk difference, -0.5 [95% CI, -3.8 to 2.9]).

Conclusions.:

Raltegravir and efavirenz-based initial antiretroviral therapy have similar 4-year clinical effects. Vigilance regarding longer-term comparative effectiveness of HIV regimens using observational data is needed because large-scale experimental data are not forthcoming.

KEYWORDS:

HIV; cohort study; comparative effectiveness; mortality.; raltegravir

PMID:
28498892
PMCID:
PMC6059161
DOI:
10.1093/cid/cix199
[Indexed for MEDLINE]
Free PMC Article

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