Naiel Nassar

Comparison of Nevirapine- and Efavirenz-Containing Antiretroviral Regimens in Antiretroviral-Naïve Patients: A Cohort Study

OBJECTIVE Efavirenz (EFV) was superior to nevirapine (NVP) in two recent cohort studies; but data from clinical trials suggest that three studies are needed to validate cohort results. We performed a cohort analysis comparing time to treatment failure and change in plasma HIV-1 RNA from baseline in antiretroviral therapy (ART)-naïve individuals treated with NVP- or EFV-containing regimens. METHOD A cohort analysis of three observational databases (N = >10,000 patients) found 1,078 ART-naïve individuals treated with NVP-containing (n = 523) or EFV-containing (n = 555) regimens. Patients were evenly matched and received at least three antiretroviral agents. The primary endpoint was time to treatment failure defined as a rebound in plasma HIV-1 RNA > 400 copies/mL. Other endpoints were change in plasma HIV-1 RNA from baseline and percent with plasma HIV-1 RNA <400 copies/mL over time. Potential confounding variables were analyzed using the Cox proportional hazards model. RESULTS Compared to EFV, NVP patients had a shorter time to treatment failure (307 days vs. 589 days; p <.001), less decrease in plasma HIV-1 RNA (-0.51 log vs. -1.32 log; p <.001), and fewer patients with plasma HIV-1 RNA < 400 copies/ mL (45% vs. 51%; p <.001). Significant factors for failure were baseline CD4 count (per 100 cell increase) or viral load (per log increase), treatment center, and year of entry (p <.05 for all comparisons). Race, gender, and background nucleoside use were insignificant factors. Multivariate analysis that included significant factors for failure demonstrated improved relative hazard with EFV compared to NVP (odds ratio = 0.50, p <.001). CONCLUSION EFV-containing antiretroviral regimens were associated with superior clinical outcome, as measured by time to treatment failure. Results are commensurate with other large cohort studies comparing EFV and NVP.Abstract Objective: Efavirenz (EFV) was superior to nevirapine (NVP) in two recent cohort studies; but data from clinical trials suggest that three studies are needed to validate cohort results. We performed a cohort analysis comparing time to treatment failure and change in plasma HIV-1 RNA from baseline in antiretroviral therapy (ART)-naÏve individuals treated with NVP- or EFV-containing regimens. Method: A cohort analysis of three observational databases (N = >10,000 patients) found 1,078 ART-naÏve individuals treated with NVP-containing (n = 523) or EFV-containing (n = 555) regimens. Patients were evenly matched and received at least three antiretroviral agents. The primary endpoint was time to treatment failure defined as a rebound in plasma HIV-1 RNA > 400 copies/mL. Other endpoints were change in plasma HIV-1 RNA from baseline and percent with plasma HIV-1 RNA <400 copies/mL over time. Potential confounding variables were analyzed using the Cox proportional hazards model. Results: Compared to EFV, NVP patients had a shorter time to treatment failure (307 days vs. 589 days; p < .001), less decrease in plasma HIV-1 RNA (-0.51 log vs. -1.32 log; p < .001), and fewer patients with plasma HIV-1 RNA < 400 copies/mL (45% vs. 51%; p < .001). Significant factors for failure were baseline CD4 count (per 100 cell increase) or viral load (per log increase), treatment center, and year of entry (p < .05 for all comparisons). Race, gender, and background nucleoside use were insignificant factors. Multivariate analysis that included significant factors for failure demonstrated improved relative hazard with EFV compared to NVP (odds ratio = 0.50, p < .001). Conclusion: EFV-containing antiretroviral regimens were associated with superior clinical outcome, as measured by time to treatment failure. Results are commensurate with other large cohort studies comparing EFV and NVP.

Protease inhibitor-based therapy is associated with decreased HIV- related health care costs in men treated at a veterans administration hospital

BACKGROUND Protease inhibitor (PI) therapy for HIV infection is associated with decreased rates of opportunistic infections and death. Statistical models predict that decreased complications will be associated with decreased hospitalization costs. A recent report suggested that the decrease in the HIV hospitalization costs were offset by increases in demand for outpatient services. We performed a study of hospital use and HIV-associated health care costs in our center to determine the following: whether PI therapy is associated with decreased inpatient use; whether PI therapy is associated with decreased outpatient use and costs; whether decreased HIV health care costs are associated with increased use of nucleoside analogues. METHODS The Dallas Veteran Affairs Medical Center provides comprehensive inpatient and outpatient HIV care and thus can evaluate the relation between inpatient and outpatient costs. The mean monthly number of hospital days, Infectious Diseases clinic visits, emergency department visits, other outpatient clinic visits, inpatient costs, outpatient costs, and PI costs were determined from January 1, 1995 through July 31, 1997. This time period was then divided into three intervals. Comparisons of PI use and HIV-related health care costs were during the three intervals was performed using analysis of variance (ANOVA). Significant differences between the baseline characteristics were further analyzed through multiple linear regression. RESULTS A decrease in hospital days, and all outpatient visits including emergency visits, and HIV clinic visits was determined. No difference was found in the rate of use of other outpatient services. The per patient costs of HIV care decreased from a monthly average of

Long-term impact of Highly active antiretroviral therapy on HIV-related health care costs

1905 U.S. in the first interval to

Comparison of symptoms of influenza A with abacavir-associated hypersensitivity reaction

1122 U.S. in the last interval (p < .01). Linear regression demonstrated an inverse relation between PI use and total HIV costs (B=-0.67, p=.00, adjusted R2=0.52) but no relation between nucleoside use, stage of disease or financial class. CONCLUSIONS PI therapy is associated with decreased hospital days and use of outpatient services. Total patient costs decreased, but a concomitant rise in outpatient costs took place. This increase was primarily a result of increased costs of acquiring PI. Increases in the number of nucleoside agents prescribed were not associated with decreased costs.

A retrospective study of the addition of ciprofloxacin to clarithromycin and ethambutol in the treatment of disseminated Mycobacterium avium complex infection

Context: Highly active antiretroviral therapy (HAART) is associated with decreased opportunistic infections, hospitalization, and HIV‐related health care costs over relatively short periods of time. We have previously demonstrated that decreases in total HIV cost are proportional to penetration of protease inhibitor therapy in our clinic. Objective: To determine the effects of HAART on HIV health care use and costs over 44 months. Setting: A comprehensive HIV service within a Veterans Affairs Medical Center. Design: A cost‐effectiveness analysis of HAART. Main Outcome Measurements: The mean monthly number of hospital days, infectious diseases clinic visits, emergency room visits, non‐HIV‐related outpatient visits, inpatient costs, and antiretroviral treatment costs per patient were determined by dividing these during the period from January 1995 through June 1998 into four intervals. Viral load tests were available from October 1996. Cost‐effectiveness of HAART was evaluated by determining the costs of achieving an undetectable viral load over time. Results: Mean monthly hospitalization and associated inpatient costs decreased and remained low 2 years after the introduction of protease inhibitors (37 hospital days per 100 patients). Total cost decreased from

Time to virological failure with atazanavir/ritonavir and lopinavir/ritonavir, with or without an H2-receptor blocker, not significantly different in HIV observational database study

1905 per patient per month during the first quarter to

Traumatic joint infection due to Geotrichum candidum.

1090 per patient per month in the third quarter but increased to

An open-label pilot study of the efficacy and tolerability of once-daily didanosine versus twice-daily didanosine.

1391 perpatient per month in the fourth quarter. Antiretroviral treatment costs increased throughout the entire observation period from

Keeping travelers healthy

79 per patient per month to

Southwestern Internal Medicine ConferenceKeeping Travelers Healthy

518 perpatient per month. Hospitalization costs decreased from