Efavirenz-Based Initial Therapies Associated with Better Outcomes in HIV-Infected Adults

October 15, 2008

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," said 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 na�-ve adults who began nevirapine-based or efavirenz-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.

Current World Health Organization guidelines recommend the use of a non-nucleoside reverse transcriptase inhibitor such as nevirapine or efavirenz in resource limited settings. Nearly 67 percent of countries in sub-Saharan Africa recommend nevirapine-based regimens for first line therapy because it is available at a lower cost and in a variety of generic fixed-dose combination regimens. In contrast, the U.S. Department of Health and Human Services and the International AIDS Society-USA both recommend the use of efavirenz because it has a more favorable toxicity profile and greater efficacy.

"Given the rapid roll-out of antiretroviral programs in Africa and the frequent use of first-line nevirapine-based HAART in such programs the assumption that efavirenz and nevirapine are equally effective needs to be reassessed," said Nachega, who is also professor and director of the Centre for Infectious Diseases at Stellenbosch University in South Africa. "Based on our results, there is a critical need for a large randomized clinical trial to definitively compare the outcomes of efavirenz and nevirapine and for acceleration of efforts to develop lower cost formulations of efavirenz, including generic, fixed-dose combinations in Africa."

"Efavirenz versus nevirapine-based initial treatment of HIV infection: clinical and virological outcomes in Southern African adults" was written by Jean B. Nachega, Michael Hislop, David W. Dowdy, Joel E. Gallant, Richard E. Chaisson, Leon Regensberg and Gary Maartens.

The researchers were funded by grants from the National Institute of Allergy and Infectious Diseases of the U.S. National Institutes of Health (NIH) and the NIH Medical Scientist Training Program.

Johns Hopkins University

Efavirenz: Webster's Timeline History, 1997 - 2007
by Icon Group International (Author)

Webster's bibliographic and event-based timelines are comprehensive in scope, covering virtually all topics, geographic locations and people. They do so from a linguistic point of view, and in the case of this book, the focus is on "Efavirenz," including when used in literature (e.g. all authors that might have Efavirenz in their name). As such, this book represents the largest compilation of timeline events associated with Efavirenz when it is used in proper noun form. Webster's timelines cover bibliographic citations, patented inventions, as well as non-conventional and alternative meanings which capture ambiguities in usage. These furthermore cover all parts of speech (possessive, institutional usage, geographic usage) and contexts, including pop culture, the arts, social sciences...

Trial of efavirenz vs. nevirapine for HIV ends in a draw. (Multicenter, International Study).: An article from: Family Practice News
by Diana Mahoney (Author)

This digital document is an article from Family Practice News, published by International Medical News Group on May 1, 2003. The length of the article is 736 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

Citation Details
Title: Trial of efavirenz vs. nevirapine for HIV ends in a draw. (Multicenter, International Study).
Author: Diana Mahoney
Publication: Family Practice News (Magazine/Journal)
Date: May 1, 2003
Publisher: International Medical News Group
Volume: 33 Issue: 9 Page: 22(1)

Distributed by Thomson...

Efavirenz and nevirapine: which baffles HIV best? (Head-to-Head Trial).: An article from: Internal Medicine News
by Diana Mahoney (Author)

This digital document is an article from Internal Medicine News, published by International Medical News Group on May 1, 2003. The length of the article is 727 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

Citation Details
Title: Efavirenz and nevirapine: which baffles HIV best? (Head-to-Head Trial).
Author: Diana Mahoney
Publication: Internal Medicine News (Magazine/Journal)
Date: May 1, 2003
Publisher: International Medical News Group
Volume: 36 Issue: 9 Page: 45(1)

Distributed by Thomson...

Efavirenz vs. nevirapine for HIV trial inconclusive: head-to-head trial a draw.(Dermatoligic Theraphy): An article from: Skin & Allergy News
by Diana Mahoney (Author)

This digital document is an article from Skin & Allergy News, published by International Medical News Group on August 1, 2003. The length of the article is 726 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

Citation Details
Title: Efavirenz vs. nevirapine for HIV trial inconclusive: head-to-head trial a draw.(Dermatoligic Theraphy)
Author: Diana Mahoney
Publication: Skin & Allergy News (Magazine/Journal)
Date: August 1, 2003
Publisher: International Medical News Group
Volume: 34 Issue: 8 Page: 35(1)

Article Type: Product/Service Evaluation

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Efavirenz the backbone for initial treatment of HIV: ZDV, 3TC, efavirenz a good place to start. (Combination Regimen).: An article from: Internal Medicine News
by Mitchel L. Zoler (Author)

This digital document is an article from Internal Medicine News, published by International Medical News Group on August 15, 2002. The length of the article is 612 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

Citation Details
Title: Efavirenz the backbone for initial treatment of HIV: ZDV, 3TC, efavirenz a good place to start. (Combination Regimen).
Author: Mitchel L. Zoler
Publication: Internal Medicine News (Magazine/Journal)
Date: August 15, 2002
Publisher: International Medical News Group
Volume: 35 Issue: 16 Page: 1(2)

Distributed by Thomson...

Efavirenz: backbone of starting HIV regimen. (Combine with ZDV, 3TC).: An article from: Family Practice News
by Mitchel L. Zoler (Author)

This digital document is an article from Family Practice News, published by International Medical News Group on September 1, 2002. The length of the article is 593 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

Citation Details
Title: Efavirenz: backbone of starting HIV regimen. (Combine with ZDV, 3TC).
Author: Mitchel L. Zoler
Publication: Family Practice News (Magazine/Journal)
Date: September 1, 2002
Publisher: International Medical News Group
Volume: 32 Issue: 17 Page: 24(1)

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Potentes armas para el VIH-sida.(medicamentos en terapia contra el SIDA; Efavirenz, medicamento): An article from: Siempre!
by G. Rodríguez (Author)

This digital document is an article from Siempre!, published by Thomson Gale on August 8, 2004. The length of the article is 538 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

Citation Details
Title: Potentes armas para el VIH-sida.(medicamentos en terapia contra el SIDA; Efavirenz, medicamento)
Author: G. Rodríguez
Publication: Siempre! (Magazine/Journal)
Date: August 8, 2004
Publisher: Thomson Gale
Volume: 51 Issue: 2669 Page: 85(1)

Distributed by Thomson...

FDA warns against efavirenz during pregnancy.(Infectious Diseases): An article from: Family Practice News
by Jane Salodof MacNeil (Author)

This digital document is an article from Family Practice News, published by International Medical News Group on July 15, 2005. The length of the article is 602 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

Citation Details
Title: FDA warns against efavirenz during pregnancy.(Infectious Diseases)
Author: Jane Salodof MacNeil
Publication: Family Practice News (Magazine/Journal)
Date: July 15, 2005
Publisher: International Medical News Group
Volume: 35 Issue: 14 Page: 32(1)

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Efavirenz-based Tx better at reducing viral load: the best regimen was efavirenz plus two nucleosides for initial treatment, even in advanced HIV ... An article from: Family Practice News
by Fran Lowry (Author)

This digital document is an article from Family Practice News, published by International Medical News Group on September 15, 2006. The length of the article is 523 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

Citation Details
Title: Efavirenz-based Tx better at reducing viral load: the best regimen was efavirenz plus two nucleosides for initial treatment, even in advanced HIV disease.(Infectious Diseases)
Author: Fran Lowry
Publication: Family Practice News (Magazine/Journal)
Date: September 15, 2006
Publisher: International Medical News Group
Volume: 36 Issue: 18 Page:...

Development of a competitive immunoassay for efavirenz: Hapten design and validation studies [An article from: Analytica Chimica Acta]
by C. Roucairol (Author), S. Azoulay (Author), M.C. Nevers (Author), C Creminon (Author)

This digital document is a journal article from Analytica Chimica Acta, published by Elsevier in 2007. The article is delivered in HTML format and is available in your Amazon.com Media Library immediately after purchase. You can view it with any web browser.

Description:
The reverse transcriptase inhibitor efavirenz (EFV) is widely used in human immunodefiency virus (HIV) therapy. Knowledge of the plasma and intracellular concentrations of the drug is of prime importance to get further insight into EFV action in vivo and would be useful for therapeutic drug monitoring (TDM). The aim of this study was to develop a sensitive and specific competitive enzyme immunoassay (EIA) for EFV in biological fluids. Two haptens that differed by the position of the linker were synthesized...