Risk factors for treatment-limiting toxicities in patients starting nevirapine-containing antiretroviral therapy

• Published in: AIDS (London) Vol. 23; no. 13; pp. 1689 - 1699
• Main Authors: KESSELRING, Anouk M, WIT, Ferdinand W, MOCROFT, Amanda, SABIN, Caroline A, LUNDGREN, Jens D, GILL, M. John, GATELL, Jose M, RAUCH, Andri, MONTANER, Julio S, DE WOLF, Frank, REISS, Peter
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 24.08.2009
• Subjects: Adult; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active - adverse effects; Antiretroviral Therapy, Highly Active - methods; Antiviral agents; Biological and medical sciences; CD4 Lymphocyte Count; Drug Hypersensitivity - etiology; Female; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - mortality; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Nevirapine - adverse effects; Nevirapine - therapeutic use; Pharmacology. Drug treatments; Retrospective Studies; Risk Factors; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Antiretroviral agent; RNA-directed DNA polymerase; Nevirapine; Toxicity; Non nucleoside compound; CD4 cell count; Microbiological investigation; Immunological investigation; Reverse transcriptase inhibitor; T-Lymphocyte; Antiviral; Viral load; Human; Immunopathology; Enzyme; Transferases; Enzyme inhibitor; Retroviridae; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Numeration; Nucleotidyltransferases; Chemotherapy; Treatment; HIV; Viral disease; Risk factor; Human immunodeficiency virus
• ISSN: 0269-9370; 1473-5571; 1473-5571
• DOI: 10.1097/QAD.0b013e32832d3b54

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). 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. 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). 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.