Objective: The prevalence of overweight and obesity is increasing among HIV-infected patients. Whether standard antiretroviral drug dosage is adequate in heavy individuals remains unresolved.We assessed the virological and immunological responses to initial efavirenz (EFV)-containing regimens in heavy compared to normal-weight HIV-infected patients. Design: Observational European cohort collaboration study. Methods: Eligible patients were antiretroviral-naïve with documented weight prior to EFV start and follow-up viral loads after treatment initiation. Cox regression analyses evaluated the association between weight and time to first undetectable viral load (<50 copies/ml) after treatment initiation, and time to viral load rebound (two consecutive viral load >50 copies/ml) after initial suppression over 5 years of follow-up. Recovery of CD4+ cell count was evaluated 6 and 12 months after EFV initiation. Analyses were stratified by weight (kg) group (I - <55; II - >55, <80 (reference); III - >80, <85; IV - >85, <90; V - >90, <95; VI - >95). Results: The study included 19 968 patients, of whom 9.1, 68.3, 9.1, 5.8, 3.5, and 4.3% were in weight groups I-VI, respectively. Overall, 81.1% patients attained virological suppression, of whom 34.1% subsequently experienced viral load rebound. After multiple adjustments, no statistical difference was observed in time to undetectable viral load and virological rebound for heavier individuals compared to their normal-weight counterparts. Although heaviest individuals had significantly higher CD4+ cell count at baseline, CD4+ cell recovery at 6 and 12 months after EFV initiation was comparable to normal-weight individuals. Conclusion: Virological and immunological responses to initial EFV-containing regimens were not impaired in heavy individuals, suggesting that the standard 600mg EFV dosage is appropriate across a wide weight range.

Impact of body weight on virological and immunological responses to efavirenz-containing regimens in HIV-infected, treatment-naive adults / Marzolini, C.; Sabin, C.; Raffi, F.; Siccardi, M.; Mussini, C.; Launay, O.; Burger, D.; Roca, B.; Fehr, J.; Bonora, S.; Mocroft, A.; Obel, N.; Dauchy, F. -A.; Zangerle, R.; Gogos, C.; Gianotti, N.; Ammassari, A.; Torti, C.; Ghosn, J.; Chene, G.; Grarup, J.; Battegay, M.. - In: AIDS. - ISSN 0269-9370. - 29:2(2015), pp. 193-200. [10.1097/QAD.0000000000000530]

Impact of body weight on virological and immunological responses to efavirenz-containing regimens in HIV-infected, treatment-naive adults

Mussini C.;Bonora S.;
2015

Abstract

Objective: The prevalence of overweight and obesity is increasing among HIV-infected patients. Whether standard antiretroviral drug dosage is adequate in heavy individuals remains unresolved.We assessed the virological and immunological responses to initial efavirenz (EFV)-containing regimens in heavy compared to normal-weight HIV-infected patients. Design: Observational European cohort collaboration study. Methods: Eligible patients were antiretroviral-naïve with documented weight prior to EFV start and follow-up viral loads after treatment initiation. Cox regression analyses evaluated the association between weight and time to first undetectable viral load (<50 copies/ml) after treatment initiation, and time to viral load rebound (two consecutive viral load >50 copies/ml) after initial suppression over 5 years of follow-up. Recovery of CD4+ cell count was evaluated 6 and 12 months after EFV initiation. Analyses were stratified by weight (kg) group (I - <55; II - >55, <80 (reference); III - >80, <85; IV - >85, <90; V - >90, <95; VI - >95). Results: The study included 19 968 patients, of whom 9.1, 68.3, 9.1, 5.8, 3.5, and 4.3% were in weight groups I-VI, respectively. Overall, 81.1% patients attained virological suppression, of whom 34.1% subsequently experienced viral load rebound. After multiple adjustments, no statistical difference was observed in time to undetectable viral load and virological rebound for heavier individuals compared to their normal-weight counterparts. Although heaviest individuals had significantly higher CD4+ cell count at baseline, CD4+ cell recovery at 6 and 12 months after EFV initiation was comparable to normal-weight individuals. Conclusion: Virological and immunological responses to initial EFV-containing regimens were not impaired in heavy individuals, suggesting that the standard 600mg EFV dosage is appropriate across a wide weight range.
29
2
193
200
Impact of body weight on virological and immunological responses to efavirenz-containing regimens in HIV-infected, treatment-naive adults / Marzolini, C.; Sabin, C.; Raffi, F.; Siccardi, M.; Mussini, C.; Launay, O.; Burger, D.; Roca, B.; Fehr, J.; Bonora, S.; Mocroft, A.; Obel, N.; Dauchy, F. -A.; Zangerle, R.; Gogos, C.; Gianotti, N.; Ammassari, A.; Torti, C.; Ghosn, J.; Chene, G.; Grarup, J.; Battegay, M.. - In: AIDS. - ISSN 0269-9370. - 29:2(2015), pp. 193-200. [10.1097/QAD.0000000000000530]
Marzolini, C.; Sabin, C.; Raffi, F.; Siccardi, M.; Mussini, C.; Launay, O.; Burger, D.; Roca, B.; Fehr, J.; Bonora, S.; Mocroft, A.; Obel, N.; Dauchy, F. -A.; Zangerle, R.; Gogos, C.; Gianotti, N.; Ammassari, A.; Torti, C.; Ghosn, J.; Chene, G.; Grarup, J.; Battegay, M.
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