Objective: The prevalence of overweight and obesity is increasing among HIV-infected patients. Whether standard antiretroviral drug dosage is adequate in heavy individuals remains unresolved. We assessed the virological and immunological responses to initial efavirenz (EFV)-containing regimens in heavy compared to normal-weight HIV-infected patients. Design: Observational European cohort collaboration study. Methods: Eligible patients were antiretroviral-naive with documented weight prior to EFV start and follow-up viral loads after treatment initiation. Cox regression analyses evaluated the association between weight and time to first undetectable viral load (<50 copies/ml) after treatment initiation, and time to viral load rebound ( two consecutive viral load >50 copies/ml) after initial suppression over 5 years of follow-up. Recovery of CD4(+) cell count was evaluated 6 and 12 months after EFV initiation. Analyses were stratified by weight (kg) group (I - <55; II - > 55, < 80 (reference); III > 80, < 85; IV - > 85, < 90; V - > 90, < 95; VI - > 95). Results: The study included 19 968 patients, of whom 9.1, 68.3, 9.1, 5.8, 3.5, and 4.3% were in weight groups I-VI, respectively. Overall, 81.1% patients attained virological suppression, of whom 34.1% subsequently experienced viral load rebound. After multiple adjustments, no statistical difference was observed in time to undetectable viral load and virological rebound for heavier individuals compared to their normal weight counterparts. Although heaviest individuals had significantly higher CD4(+) cell count at baseline, CD4(+) cell recovery at 6 and 12 months after EFV initiation was comparable to normal-weight individuals. Conclusion: Virological and immunological responses to initial EFV-containing regimens were not impaired in heavy individuals, suggesting that the standard 600 mg EFV dosage is appropriate across a wide weight range. (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
Impact of body weight on virological and immunological responses to efavirenz-containing regimens in HIV-infected, treatment-naive adults
Torti C;
2015-01-01
Abstract
Objective: The prevalence of overweight and obesity is increasing among HIV-infected patients. Whether standard antiretroviral drug dosage is adequate in heavy individuals remains unresolved. We assessed the virological and immunological responses to initial efavirenz (EFV)-containing regimens in heavy compared to normal-weight HIV-infected patients. Design: Observational European cohort collaboration study. Methods: Eligible patients were antiretroviral-naive with documented weight prior to EFV start and follow-up viral loads after treatment initiation. Cox regression analyses evaluated the association between weight and time to first undetectable viral load (<50 copies/ml) after treatment initiation, and time to viral load rebound ( two consecutive viral load >50 copies/ml) after initial suppression over 5 years of follow-up. Recovery of CD4(+) cell count was evaluated 6 and 12 months after EFV initiation. Analyses were stratified by weight (kg) group (I - <55; II - > 55, < 80 (reference); III > 80, < 85; IV - > 85, < 90; V - > 90, < 95; VI - > 95). Results: The study included 19 968 patients, of whom 9.1, 68.3, 9.1, 5.8, 3.5, and 4.3% were in weight groups I-VI, respectively. Overall, 81.1% patients attained virological suppression, of whom 34.1% subsequently experienced viral load rebound. After multiple adjustments, no statistical difference was observed in time to undetectable viral load and virological rebound for heavier individuals compared to their normal weight counterparts. Although heaviest individuals had significantly higher CD4(+) cell count at baseline, CD4(+) cell recovery at 6 and 12 months after EFV initiation was comparable to normal-weight individuals. Conclusion: Virological and immunological responses to initial EFV-containing regimens were not impaired in heavy individuals, suggesting that the standard 600 mg EFV dosage is appropriate across a wide weight range. (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
