Efavirenz-based initial therapies associated with better outcomes in HIV-infec...( A study led by researchers at the Jo...)

A study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that HIV-infected patients taking the antiretroviral drug efavirenz were more likely to adhere to treatment and less likely to experience virologic failure and death compared to patients taking nevirapine. Nevirapine is the most frequently prescribed drug for patients undergoing highly active antiretroviral therapy (HAART) for the treatment of HIV/AIDS in sub-Saharan Africa, where the study was conducted. The study is published in the October 18, 2008 issue of the journal AIDS.

"Our findings add to existing limited evidence that efavirenz-based therapies produce a more favorable virological and clinical outcome than nevirapine," says Jean Nachega, MD, PhD, MPH, lead author of the study and associate scientist with the Bloomberg School's Department of International Health. "Patients started on nevirapine had an increased risk of virologic failure and death, were significantly less likely than those started on efavirenz to achieve high treatment adherence."

Nachega, in collaboration with Gary Maartens, MD, FCP, professor of Medicine at University of Cape Town, and several other colleagues from the University of Cape Town in South Africa, examined the records of 2,817 HIV- infected adults currently enrolled in Aid for AIDS, a private-sector employer-subsidized disease management program in Africa. Participants were HAART nave adults who began nevirapine-based or efvirenz-based therapies between January 1998 and September 2004. Researchers determined how often patients requested reimbursement for their purchases of nevirapine- or efavirenz-based HAART to estimate adherence to their treatment regimens. They also evaluated patients CD4 counts, viral load changes and mortality, which are measurements that indicate how well a treatment is working. Program participants were in nine countries in Africa with the majority in South Africa.

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