Impact of body weight on virological and immunological responses to efavirenz-containing regimens in HIV-infected, treatment-naive adults. (14th January 2015)

• Record Type: Journal Article
• Authors: Marzolini, Catia; Sabin, Caroline; Raffi, François; Siccardi, Marco; Mussini, Cristina; Launay, Odile; Burger, David; Roca, Bernardino; Fehr, Jan; Bonora, Stefano; Mocroft, Amanda; Obel, Niels; Dauchy, Frederic-Antoine; Zangerle, Robert; Gogos, Charalambos; Gianotti, Nicola; Ammassari, Adriana; Torti, Carlo; Ghosn, Jade; Chêne, Genevieve; Grarup, Jesper; Battegay, Manuel
• Is Part Of: AIDS. Volume 29:Number 2(2015)
• Publication Date: 2015-01-14
• Subjects: AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000000530
• Languages: English
• ISSNs: 0269-9370

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>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.</p> </sec> <sec> <title>Design:</title> <p>Observational European cohort collaboration study.</p> </sec> <sec> <title>Methods:</title> <p>Eligible patients were antiretroviral-naïve 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 (<underline><</underline>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<sup>+</sup> cell count was evaluated 6 and 12 months after EFV initiation. Analyses were stratified by weight (kg) group (I – <55; II – <underline>></underline>55, <80 (reference); III – <underline>></underline>80, <85; IV – <underline>></underline>85, <90; V – <underline>></underline>90, <95; VI – <underline>></underline>95).</p> </sec> <sec> <title>Results:</title> <p>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<sup>+</sup> cell count at baseline, CD4<sup>+</sup> cell recovery at 6 and 12 months after EFV initiation was comparable to normal-weight individuals.</p> </sec> <sec> <title>Conclusion:</title> <p>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.</p> </sec> <sec> <title>Video Abstract:</title> <p> <ext-link ext-link-type="uri" xlink:href="http://links.lww.com/QAD/A635" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://links.lww.com/QAD/A635</ext-link> </p> </sec> </abstract>