Factors associated with remaining on initial randomized efavirenz-containing regimens.

Area of Science:

• Infectious Diseases
• HIV/AIDS Research
• Pharmacological Outcomes

Background:

• Efavirenz (EFV) combined with nucleoside reverse transcriptase inhibitors (NRTIs) is a standard initial HIV treatment.
• Understanding factors influencing EFV treatment success is crucial for optimizing patient outcomes.

Purpose of the Study:

• To identify pretreatment characteristics and year 1 behaviors associated with short-term (1 year) and long-term (2-5 years) EFV treatment success.
• To analyze data from a large cohort of antiretroviral-naive participants initiating EFV-based regimens.

Main Methods:

• Analysis of data from 2220 antiretroviral-naive participants in four ACTG trials and a long-term cohort.
• Logistic regression with inverse probability of censoring weighting was used to identify factors associated with EFV success (defined as no treatment interruptions >30 days and HIV RNA <200 copies/ml).

Main Results:

• Short-term success was associated with white or Hispanic race, absence of severe pretreatment symptoms, and no history of injection drug use (HxIDU).
• Long-term success predictors included no HxIDU, complete adherence in year 1, fewer missed visits in year 1, viral load <50 copies/ml at year 1, and older age (>50 years).

Conclusions:

• Pretreatment characteristics predicting EFV success differed between short-term and long-term outcomes, with HxIDU being a consistent negative predictor.
• Patient behaviors during the first year of treatment, such as adherence and visit attendance, significantly influenced long-term EFV success over 5 years.