TY - JOUR
T1 - Patterns of efavirenz use as first-line antiretroviral therapy in the United States
T2 - 1999-2015
AU - Bengtson, Angela M.
AU - Pence, Brian W.
AU - Eaton, Ellen F.
AU - Edwards, Jessie K.
AU - Eron, Joseph J.
AU - Mathews, William C.
AU - Mollan, Katie
AU - Moore, Richard D.
AU - O'Cleirigh, Connall
AU - Geng, Elvin
AU - Mugavero, Michael J.
N1 - Funding Information:
KM has received research support from grants awarded to UNC from Merck, AbbVie and Gilead. All other authors declare no competing interests.
Funding Information:
This work was supported by the National Institutes of Health (grant numbers K99MH112413, R01MH100970, R24AI067039, U01 AI069918). The Center for AIDS Research sites involved in CNICS include: University of Alabama at Birmingham (P30 AI027767), University of Washington (P30 AI027757), University of California San Diego (P30 AI036214), University of California San Francisco (P30 AI027763), Case Western Reserve University (P30 AI036219), Johns Hopkins University (P30 AI094189, U01 DA036935), Fenway Health/Harvard (P30 AI060354) and University of North Carolina Chapel Hill (P30 AI50410). A version of this work was presented at the Conference on Retroviruses and Opportunistic Infections in Seattle, Washington, 13-16 February 2017.
Publisher Copyright:
©2018 International Medical Press
PY - 2018
Y1 - 2018
N2 - Background: Efavirenz has been a mainstay of antiretroviral therapy (ART) for over 15 years in the US. Its association with neuropsychiatric side effects may influence clinical prescribing and management. Methods: We included HIV-infected adults enrolled in care at seven sites across the US, who initiated combination ART between 1999 and 2015. We examined the proportion initiating and continuing on efavirenz, overall and by mental health status. Log binomial and Cox models were used to estimate associations between mental health, clinical and sociodemographic characteristics and initiating or switching from efavirenz as first-line ART. Results: Of the 8,230 participants included, 3,710 (45%) initiated efavirenz. In multivariable analyses, prior mono- or dual-ART, ART initiation after 2006, being female, intravenous drug use, antidepressant prescription, previous mental health diagnosis and baseline CD4+ T-cell count >350 cells/mm3 were inversely associated with initiating efavirenz. Participants initiating efavirenz had a faster time to a regimen switch, compared with those initiating an efavirenz-free regimen (P-value <0.01). Among efavirenz initiators, starting efavirenz in more recent time periods and a previous mental health diagnosis were associated with faster time to switching from efavirenz. Despite this, 40-50% of participants with a previous mental health diagnosis initiated and continued on efavirenz for much of the follow-up period. Conclusions: Multiple clinical factors, including mental health diagnoses, appeared to influence efavirenz use. While mental health diagnosis status and more recent treatment starts were associated with shorter duration of efavirenz therapy, a previous mental health diagnosis did not preclude efavirenz initiation or continuation in many participants.
AB - Background: Efavirenz has been a mainstay of antiretroviral therapy (ART) for over 15 years in the US. Its association with neuropsychiatric side effects may influence clinical prescribing and management. Methods: We included HIV-infected adults enrolled in care at seven sites across the US, who initiated combination ART between 1999 and 2015. We examined the proportion initiating and continuing on efavirenz, overall and by mental health status. Log binomial and Cox models were used to estimate associations between mental health, clinical and sociodemographic characteristics and initiating or switching from efavirenz as first-line ART. Results: Of the 8,230 participants included, 3,710 (45%) initiated efavirenz. In multivariable analyses, prior mono- or dual-ART, ART initiation after 2006, being female, intravenous drug use, antidepressant prescription, previous mental health diagnosis and baseline CD4+ T-cell count >350 cells/mm3 were inversely associated with initiating efavirenz. Participants initiating efavirenz had a faster time to a regimen switch, compared with those initiating an efavirenz-free regimen (P-value <0.01). Among efavirenz initiators, starting efavirenz in more recent time periods and a previous mental health diagnosis were associated with faster time to switching from efavirenz. Despite this, 40-50% of participants with a previous mental health diagnosis initiated and continued on efavirenz for much of the follow-up period. Conclusions: Multiple clinical factors, including mental health diagnoses, appeared to influence efavirenz use. While mental health diagnosis status and more recent treatment starts were associated with shorter duration of efavirenz therapy, a previous mental health diagnosis did not preclude efavirenz initiation or continuation in many participants.
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U2 - 10.3851/IMP3223
DO - 10.3851/IMP3223
M3 - Article
C2 - 29424697
AN - SCOPUS:85054084775
SN - 1359-6535
VL - 23
SP - 363
EP - 372
JO - Antiviral therapy
JF - Antiviral therapy
IS - 4
ER -