Tdf+3tc+nvp vs tdf+3tc+efv

A Global Clinical Comparison of TDF+3TC+NVP vs. TDF+3TC+EFV in Resource Constrained Populations
Etienne-Mesubi M., Amoroso A., Edozien A., Obiefune M.,Sheneberger R., Bositis C., Stafford K., MianBH, Redfield R. Institute of Human Virology, University of Maryland School of Medicine Baltimore, United States
ABSTRACT
Background: Although widely used globally, little data exists on the efficacyof the combination of TDF-3TC with Nevirapine, and no large randomized prospective control trials exist. The efficacy of this combination has important implications for the management of HIV infectedpatients, particularly women, in resource constrained settings. Methods: A cross-sectional retrospective review of patient health information documented in patient medical charts is conducted annuallyin AIDSRelief supported sites as part of the quality improvement program. A global random sample of 8367 patients across 90 sites in rural and urban settings from Zambia, Tanzania, Uganda, Kenya andNigeria, was conducted between 2006-2008. An on-treatment analysis excluding patients who died, transferred out of care, or loss to follow up (defined as no contact with the clinic for 3 consecutivemonths). Previous exposure to antiretroviral therapy is defined as any previous history of ART including SDNVP. Adherence was measured by assessing missed doses in the last week, missed doses in thelast month and missed clinic appointment in the last three months. Univariate analyses were conducted to describe demographics of the TDF+3TC+NVP and TDF+3TC+EFV patient groups. Logistic regressions andmultivariate analyses were conducted. Results: Patients were on treatment for an average of 19 months. 1,011 patients started on TDF+3TC+EFV and 740 patients started on TDF+3TC+NVP. Median baselineCD4 for patients on TDF+3TC+NVP and TDF+3TC+EFV was 188 and 163 cells/mm3 respectively. Of the patients on TDF+3TC+NVP 11.1% were previously exposed to antiretroviral therapy compared to 9.3% of...