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

This collaboration of seven observational clinical cohorts investigated risk factors for treatment-limiting toxicities in both anti retroviral-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/mu l/>250/mu l 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, Cl 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, Cl 0.78-1.13). Our results suggest it may be relatively well tolerated to initiate NVPc in anti retroviral-experienced patients with high CD4 cell counts provided there is no detectable viremia. (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Adult; Anti-HIV Agents/ adverse effects/therapeutic use; Antiretroviral Therapy; Highly Active/adverse effects/methods; CD4 Lymphocyte Count; Drug Hypersensitivity/etiology; Female; HIV Infections/ drug therapy/immunology/mortality; Humans; Male; Middle Aged; Nevirapine/ adverse effects/therapeutic use; Retrospective Studies; Risk Factors; Treatment Outcome; Viral Load

Group Authors: Nevirapine Toxicity, Multicohort.