Quantifying the risks and benefits of efavirenz use in HIV-infected women of childbearing age in the USA.
HIV Med
; 12(2): 97-108, 2011 Feb.
Article
de En
| MEDLINE
| ID: mdl-20561082
ABSTRACT
OBJECTIVES:
The aim of the study was to quantify the benefits (life expectancy gains) and risks (efavirenz-related teratogenicity) associated with using efavirenz in HIV-infected women of childbearing age in the USA.METHODS:
We used data from the Women's Interagency HIV Study in an HIV disease simulation model to estimate life expectancy in women who receive an efavirenz-based initial antiretroviral regimen compared with those who delay efavirenz use and receive a boosted protease inhibitor-based initial regimen. To estimate excess risk of teratogenic events with and without efavirenz exposure per 100,000 women, we incorporated literature-based rates of pregnancy, live births, and teratogenic events into a decision analytic model. We assumed a teratogenicity risk of 2.90 events/100 live births in women exposed to efavirenz during pregnancy and 2.68/100 live births in unexposed women.RESULTS:
Survival for HIV-infected women who received an efavirenz-based initial antiretroviral therapy (ART) regimen was 0.89 years greater than for women receiving non-efavirenz-based initial therapy (28.91 vs. 28.02 years). The rate of teratogenic events was 77.26/100,000 exposed women, compared with 72.46/100,000 unexposed women. Survival estimates were sensitive to variations in treatment efficacy and AIDS-related mortality. Estimates of excess teratogenic events were most sensitive to pregnancy rates and number of teratogenic events/100 live births in efavirenz-exposed women.CONCLUSIONS:
Use of non-efavirenz-based initial ART in HIV-infected women of childbearing age may reduce life expectancy gains from antiretroviral treatment, but may also prevent teratogenic events. Decision-making regarding efavirenz use presents a trade-off between these two risks; this study can inform discussions between patients and health care providers.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Tératogènes
/
Malformations dues aux médicaments et aux drogues
/
Infections à VIH
/
Agents antiVIH
/
Benzoxazines
Type d'étude:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Patient_preference
Limites:
Adult
/
Female
/
Humans
/
Pregnancy
Pays/Région comme sujet:
America do norte
Langue:
En
Journal:
HIV Med
Sujet du journal:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Année:
2011
Type de document:
Article
Pays d'affiliation:
États-Unis d'Amérique