Journal article
Risk factors for treatment-limiting toxicities in patients starting nevirapine-containing antiretroviral therapy
AIDS, Vol.23(13), pp.1689-1699
2009
Abstract
BACKGROUND:
This collaboration of seven observational clinical cohorts investigated risk factors for treatment-limiting toxicities in both antiretroviral-naive and experienced patients starting nevirapine-based combination antiretroviral therapy (NVPc).
METHODS:
Patients starting NVPc after 1 January 1998 were included. CD4 cell count at starting NVPc was classified as high (>400/microl/>250/microl for men/women, respectively) or low. Cox models were used to investigate risk factors for discontinuations due to hypersensitivity reactions (HSR, n = 6547) and discontinuation of NVPc due to treatment-limiting toxicities and/or patient/physician choice (TOXPC, n = 10,186). Patients were classified according to prior antiretroviral treatment experience and CD4 cell count/viral load at start NVPc. Models were stratified by cohort and adjusted for age, sex, nadir CD4 cell count, calendar year of starting NVPc and mode of transmission.
RESULTS:
Median time from starting NVPc to TOXPC and HSR were 162 days [interquartile range (IQR) 31-737] and 30 days (IQR 17-60), respectively. In adjusted Cox analyses, compared to naive patients with a low CD4 cell count, treatment-experienced patients with high CD4 cell count and viral load more than 400 had a significantly increased risk for HSR [hazard ratio 1.45, confidence interval (CI) 1.03-2.03] and TOXPC within 18 weeks (hazard ratio 1.34, CI 1.08-1.67). In contrast, treatment-experienced patients with high CD4 cell count and viral load less than 400 had no increased risk for HSR 1.10 (0.82-1.46) or TOXPC within 18 weeks (hazard ratio 0.94, CI 0.78-1.13).
CONCLUSION:
Our results suggest it may be relatively well tolerated to initiate NVPc in antiretroviral-experienced patients with high CD4 cell counts provided there is no detectable viremia.
Details
- Title
- Risk factors for treatment-limiting toxicities in patients starting nevirapine-containing antiretroviral therapy
- Authors/Creators
- A.M. Kesselring (Author/Creator)F.W. Wit (Author/Creator)C.A. Sabin (Author/Creator)J.D. Lundgren (Author/Creator)M.J. Gill (Author/Creator)J.M. Gatell (Author/Creator)A. Rauch (Author/Creator)J.S. Montaner (Author/Creator)F. de Wolf (Author/Creator)P. Reiss (Author/Creator)A. Mocroft (Author/Creator)E. Phillips (Author/Creator)
- Publication Details
- AIDS, Vol.23(13), pp.1689-1699
- Publisher
- Lippincott Williams & Wilkins Ltd.
- Identifiers
- 991005544914607891
- Copyright
- © 2017 Wolters Kluwer Health, Inc.
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
- Additional Information
- Murdoch University authors made contribution to this work as part of the Nevirapine Toxicity Multicohort Collaboration
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.66 HIV
- 1.66.1372 HIV Comorbidities
- Web Of Science research areas
- Immunology
- Infectious Diseases
- Virology
- ESI research areas
- Immunology