Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis

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dc.contributor.authorPillay, Prinithaen_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorShubber, Zaraen_ZA
dc.contributor.authorFerrand, Rashida Aen_ZA
dc.date.accessioned2015-11-16T04:09:34Z
dc.date.available2015-11-16T04:09:34Z
dc.date.issued2013en_ZA
dc.description.abstractIntroduction There is conflicting evidence and practice regarding the use of the non-nucleoside reverse transcriptase inhibitors (NNRTI) efavirenz (EFV) and nevirapine (NVP) in first-line antiretroviral therapy (ART). METHODS: We systematically reviewed virological outcomes in HIV-1 infected, treatment-naive patients on regimens containing EFV versus NVP from randomised trials and observational cohort studies. Data sources include PubMed, Embase, the Cochrane Central Register of Controlled Trials and conference proceedings of the International AIDS Society, Conference on Retroviruses and Opportunistic Infections, between 1996 to May 2013. Relative risks (RR) and 95% confidence intervals were synthesized using random-effects meta-analysis. Heterogeneity was assessed using the I 2 statistic, and subgroup analyses performed to assess the potential influence of study design, duration of follow up, location, and tuberculosis treatment. Sensitivity analyses explored the potential influence of different dosages of NVP and different viral load thresholds. RESULTS: Of 5011 citations retrieved, 38 reports of studies comprising 114 391 patients were included for review. EFV was significantly less likely than NVP to lead to virologic failure in both trials (RR 0.85 [0.73-0.99] I 2  = 0%) and observational studies (RR 0.65 [0.59-0.71] I 2  = 54%). EFV was more likely to achieve virologic success than NVP, though marginally significant, in both randomised controlled trials (RR 1.04 [1.00-1.08] I 2  = 0%) and observational studies (RR 1.06 [1.00-1.12] I 2  = 68%). CONCLUSION: EFV-based first line ART is significantly less likely to lead to virologic failure compared to NVP-based ART. This finding supports the use of EFV as the preferred NNRTI in first-line treatment regimen for HIV treatment, particularly in resource limited settings.en_ZA
dc.identifier.apacitationPillay, P., Ford, N., Shubber, Z., & Ferrand, R. A. (2013). Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis. <i>PLoS One</i>, http://hdl.handle.net/11427/14994en_ZA
dc.identifier.chicagocitationPillay, Prinitha, Nathan Ford, Zara Shubber, and Rashida A Ferrand "Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/14994en_ZA
dc.identifier.citationPillay, P., Ford, N., Shubber, Z., & Ferrand, R. A. (2012). Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis. PloS one, 8(7), e68995. doi:10.1371/journal.pone.0068995en_ZA
dc.identifier.ris TY - Journal Article AU - Pillay, Prinitha AU - Ford, Nathan AU - Shubber, Zara AU - Ferrand, Rashida A AB - Introduction There is conflicting evidence and practice regarding the use of the non-nucleoside reverse transcriptase inhibitors (NNRTI) efavirenz (EFV) and nevirapine (NVP) in first-line antiretroviral therapy (ART). METHODS: We systematically reviewed virological outcomes in HIV-1 infected, treatment-naive patients on regimens containing EFV versus NVP from randomised trials and observational cohort studies. Data sources include PubMed, Embase, the Cochrane Central Register of Controlled Trials and conference proceedings of the International AIDS Society, Conference on Retroviruses and Opportunistic Infections, between 1996 to May 2013. Relative risks (RR) and 95% confidence intervals were synthesized using random-effects meta-analysis. Heterogeneity was assessed using the I 2 statistic, and subgroup analyses performed to assess the potential influence of study design, duration of follow up, location, and tuberculosis treatment. Sensitivity analyses explored the potential influence of different dosages of NVP and different viral load thresholds. RESULTS: Of 5011 citations retrieved, 38 reports of studies comprising 114 391 patients were included for review. EFV was significantly less likely than NVP to lead to virologic failure in both trials (RR 0.85 [0.73-0.99] I 2  = 0%) and observational studies (RR 0.65 [0.59-0.71] I 2  = 54%). EFV was more likely to achieve virologic success than NVP, though marginally significant, in both randomised controlled trials (RR 1.04 [1.00-1.08] I 2  = 0%) and observational studies (RR 1.06 [1.00-1.12] I 2  = 68%). CONCLUSION: EFV-based first line ART is significantly less likely to lead to virologic failure compared to NVP-based ART. This finding supports the use of EFV as the preferred NNRTI in first-line treatment regimen for HIV treatment, particularly in resource limited settings. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0068995 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis TI - Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis UR - http://hdl.handle.net/11427/14994 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14994
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0068995
dc.identifier.vancouvercitationPillay P, Ford N, Shubber Z, Ferrand RA. Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis. PLoS One. 2013; http://hdl.handle.net/11427/14994.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Pillay et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherObservational studiesen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHIV-1en_ZA
dc.subject.otherViral loaden_ZA
dc.subject.otherMeta-analysisen_ZA
dc.subject.otherCohort studiesen_ZA
dc.subject.otherDatabase searchingen_ZA
dc.titleOutcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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