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Please use this identifier to cite or link to this item: http://hdl.handle.net/123456789/11888

Title: Long-term effectiveness of first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy in Ghana
Authors: Sarfo, Fred S.
Sarfo, Maame Anima
Kasim, Adetayo
Phillips, Richard
Booth, Mark
et. al
Keywords: HIV
Africa
ART
Issue Date: 26-Jul-2013
Publisher: Oxford University Press
Citation: Oxford University Press doi:10.1093/jac/dkt336 Advance Access publication
Abstract: Objectives: Information on the long-term effectiveness and tolerability of efavirenz- or nevirapine-based antiretroviral therapy (ART) in Africa is lacking. The primary objective of this retrospective observational study was to compare the long-term clinical and immunological outcomes of efavirenz- versus nevirapine-based first-line ART in a large government clinic in Ghana. Patients and methods: The main outcomes were AIDS, death, ART-related toxicity, discontinuation of ARTand a composite endpoint of death, AIDS or ARTdiscontinuation. These time-to-event outcomeswere compared using a Cox proportional hazards regression model. CD4 counts on ART were compared using a mixed-effects model. Results: A total of 3990 patients started non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART between 2004 and 2010, of which 2369 (59%) were on efavirenz. No significant differences were apparent between each NNRTI for subsequent risk of AIDS, death or the composite of treatment failure; however, stavudine usewas independently associated with an increased risk of death [adjusted hazard ratio (HR) 1.60 (95% CI: 1.21– 2.11)]. There was an increased risk of early toxicity with nevirapine leading to discontinuation [adjusted HR 1.53 (95% CI: 1.23–1.97)], mostly due to excess skin rashes in the first 2 months of treatment; however, overall discontinuation rates were low. Conclusions: Therewas no difference in the long-term effectiveness of efavirenz- and nevirapine-based ART in this population; however, patients initiating nevirapine were more likely to develop early toxicity and discontinue this drug. The excess mortality observed in patients taking stavudine is of concern and should prompt increased efforts to replace it with alternative antiretroviral drugs in developing countries.
Description: An article published by Oxford University Press and available at doi:10.1093/jac/dkt336
URI: http://hdl.handle.net/123456789/11888
Appears in Collections:College of Health Sciences

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