TY - JOUR

T1 - Impact of body weight on virological and immunological responses to efavirenz-containing regimens in HIV-infected, treatment-naive adults

AU - Marzolini, Catia

AU - Sabin, Caroline

AU - Raffi, François

AU - Siccardi, Marco

AU - Mussini, Cristina

AU - Launay, Odile

AU - Burger, David

AU - Roca, Bernardino

AU - Fehr, Jan

AU - Bonora, Stefano

AU - Mocroft, Amanda

AU - Obel, Niels

AU - Dauchy, Frederic-Antoine

AU - Zangerle, Robert

AU - Gogos, Charalambos

AU - Gianotti, Nicola

AU - Ammassari, Adriana

AU - Torti, Carlo

AU - Ghosn, Jade

AU - Chêne, Genevieve

AU - Grarup, Jesper

AU - Battegay, Manuel

AU - Efavirenz, Obesity Project Team on behalf of Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

PY - 2015/1

Y1 - 2015/1

N2 - 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-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 (<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.

AB - 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-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 (<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.

KW - Adult

KW - Antiretroviral Therapy, Highly Active

KW - Benzoxazines

KW - Body Weight

KW - CD4 Lymphocyte Count

KW - Cohort Studies

KW - Female

KW - HIV Infections

KW - Humans

KW - Male

KW - Middle Aged

KW - Obesity

KW - Regression Analysis

KW - Reverse Transcriptase Inhibitors

KW - Treatment Outcome

KW - Viral Load

U2 - 10.1097/QAD.0000000000000530

DO - 10.1097/QAD.0000000000000530

M3 - Journal article

C2 - 25426810

VL - 29

SP - 193

EP - 200

JO - AIDS

JF - AIDS

SN - 1350-2840

IS - 2

ER -