TITLE:
Immunological responses of HIV/AIDS patients treated with Nevirapine versus Efavirenz based highly active anti-retroviral therapy in Addis Ababa, Ethiopia: A retrospective cohort study
AUTHORS:
Zemedu Mehamed Tirfe, Tekabe Abdosh Ahmed, Negga Baraki Tedla, Mesfin Kote Debere, Andamlak Gizaw Alamdo
KEYWORDS:
Efavirenz; Nevirapine; Immunological Response Rate; Mean CD4 Count
JOURNAL NAME:
Health,
Vol.5 No.9,
September
23,
2013
ABSTRACT: Background: There are two approved non-nucleoside reverse transcriptase inhibitor antiretroviral drugs; namely Nevirapine
(NVP) and Efavirenz (EFV). Nevirapine and EFV have comparable clinical
efficacy when administered in combination
regimens. But there is a lack of recent evidence showing the effect of
NVP and EFV-based ARTs on immunological responses in HIV infected individuals
in Ethiopia in general and Addis Ababa in particular. Methods: Retrospective cohort study design was used to compare immunological response rate of NVP and
EFV based HAART regimen in Addis Ababa. Four hundred ninety two HIV infected
patients who started HAART in ten selected health facilities were included in
the study. Rate of immunologic response
was examined at the 6th, 12th, 18th, and 24th months of follow-up period.
The time required to get immunological response was analyzed by Kaplan-Meier
survival curve. Adjusted hazard ratio was calculated with a 95% confidence
interval by Cox proportional hazards model to determine the rate of
immunological response. To ascertain the association, bivariate and multi
variable Cox proportional hazard model was used. Statistical significance was
considered with two sides P-value of 0.05. Results: The mean CD4 count ranged between 132.2 cell/μl at baseline and 302.3
cell/μl at the end of the follow-up period. This change was significant
at 95% of CI but did not show significant differences among the comparison
group. The median time to get immunological
response was 18 (75% percental 12) months. At the end of the follow-up period,
73.2% (76.6% for NVP and 69.8% for EVF P-value 0.13) of the study population
had immunological response. Conclusion: As a conclusion, there was a robust and
sustained CD4 response and the effect of NVP
and EFV based ART on change of mean CD4 count and immunological response
was comparable and effective. Initiation
of ART with high baseline CD4 count, in combination of IPT and with
either NVP or EFV based NNTI was recommended.