@article{3226576,
  abstract     = {{Objectives : The durability of combination antiretroviral therapy (cART) regimens can be measured as time to discontinuation because of toxicity or treatment failure, development of clinical disease or serious long-term adverse events. The aim of this analysis was to compare the durability of nevirapine, efavirenz and lopinavir regimens based on these measures.
Methods : Patients starting a nevirapine, efavirenz or lopinavir-based cART regimen for the first time after 1 January 2000 were included in the analysis. Follow-up started >= 3 months after initiation of treatment if viral load was < 500 HIV-1 RNA copies/mL. Durability was measured as discontinuation rate or development/worsening of clinical markers.
Results : A total of 603 patients (21%) started nevirapine-based cART, 1465 (51%) efavirenz, and 818 (28%) lopinavir. After adjustment there was no significant difference in the risk of discontinuation for any reason between the groups on nevirapine and efavirenz (P=0.43) or lopinavir (P=0.13). Compared with the nevirapine group, those on efavirenz had a 48% (P=0.0002) and those on lopinavir a 63% (P < 0.0001) lower risk of discontinuation because of treatment failure and a 31% (P=0.01) and 66% (P <.0001) higher risk, respectively, of discontinuation because of toxicities or patient/physician choice. There were no significant differences in the incidence of non-AIDS-related events, worsening anaemia, severe weight loss, increased aspartate aminotransferase (AST)/alanine aminotransferase (ALT) levels or increased total cholesterol. Compared with patients on nevirapine, those on lopinavir had an 80% higher incidence of high-density lipoprotein (HDL) cholesterol decreasing below 0.9 mmol/L (P=0.003), but there was no significant difference in this variable between those on nevirapine and those on efavirenz (P=0.39).
Conclusions : The long-term durability of nevirapine-based cART, based on risk of all-cause discontinuation and development of long-term adverse events, was comparable to that of efavirenz or lopinavir, in patients in routine clinical practice across Europe who initially tolerated and virologically responded to their regimen.}},
  author       = {{Reekie, J and Reiss, P and Ledergerber, B and Sedlacek, D and Parczewski, M and Gatell, J and Katlama, C and Fätkenheuer, G and Lundgren, JD and Mocroft, A and EuroSIDA study group, the and Vandekerckhove, Linos}},
  issn         = {{1464-2662}},
  journal      = {{HIV MEDICINE}},
  keywords     = {{antiviral therapy,long-term adverse events,durability,HIV-INFECTED PATIENTS,RETROVIRAL-NAIVE PATIENTS,ANTIRETROVIRAL THERAPY,INITIAL TREATMENT,REGIMENS,COHORT,LAMIVUDINE,ADULTS,ASSOCIATION,COMBINATION}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{259--268}},
  title        = {{A comparison of the long-term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study}},
  url          = {{http://doi.org/10.1111/j.1468-1293.2010.00877.x}},
  volume       = {{12}},
  year         = {{2011}},
}

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