Impact of body weight on virological and immunological responses to efavirenz-containing regimens in HIV-infected, treatment-naive adults
Catia Marzolini, Caroline Sabin, François Raffi, Marco Siccardi, Cristina Mussini, Odile Launay, David Burger, Bernardino Roca, Jan Fehr, Stefano Bonora, Amanda Mocroft, Niels Obel, Frederic-Antoine Dauchy, Robert Zangerle, Charalambos Gogos, Nicola Gianotti, Adriana Ammassari, Carlo Torti, Jade Ghosn, Genevieve Chêne, Jesper Grarup, Manuel Battegay, Efavirenz, Obesity Project Team on behalf of Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, Catia Marzolini, Caroline Sabin, François Raffi, Marco Siccardi, Cristina Mussini, Odile Launay, David Burger, Bernardino Roca, Jan Fehr, Stefano Bonora, Amanda Mocroft, Niels Obel, Frederic-Antoine Dauchy, Robert Zangerle, Charalambos Gogos, Nicola Gianotti, Adriana Ammassari, Carlo Torti, Jade Ghosn, Genevieve Chêne, Jesper Grarup, Manuel Battegay, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Peter Reiss, Ferdinand Wit, Maria Prins, Heiner Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Perez-Hoyos, Osamah Hamouda, Barbara Bartmeyer, Nikoloz Chkhartishvili, Antoni Noguera-Julian, Andrea Antinori, Antonella d'Arminio Monforte, Norbert Brockmeyer, Luis Prieto, Pablo Rojo Conejo, Antoni Soriano-Arandes, Manuel Battegay, Andri Rauch, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M Miro, Antonella Castagna, Deborah Konopnick, Tessa Goetghebuer, Carlo Torti, Ramon Teira, Myriam Garrido, David Haerry, Stéphane de Wit, Jordi Casabona, Dominique Costagliola, Antonella d'Arminio-Monforte, Manuel Battegay, Julia del Amo, Amanda Mocroft, Dorthe Raben, Genevieve Chêne, Ali Judd, Pablo Rojo Conejo, Diana Barger, Céline Colin, Christine Schwimmer, Monique Termote, Linda Wittkop, Maria Campbell, Nina Friis-Moller, Jesper Kjaer, Dorthe Raben, Rikke Salbol Brandt, Manuel Battegay, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, François Dabis, Antonella d'Arminio Monforte, Julia del Amo, Maria Dorrucci, Matthias Egger, Hansjakob Furrer, Ali Judd, Ole Kirk, Olivier Lambotte, Sara Lodi, Sophie Matheron, Laurence Meyer, Jose Miro, Amanda Mocroft, Susana Monge, Fumiyo Nakagawa, Roger Paredes, Andrew Phillips, Massimo Puoti, Caroline Sabin, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Giota Touloumi, Marc van der Valk, Linda Wittkop, Natasha Wyss, Catia Marzolini, Caroline Sabin, François Raffi, Marco Siccardi, Cristina Mussini, Odile Launay, David Burger, Bernardino Roca, Jan Fehr, Stefano Bonora, Amanda Mocroft, Niels Obel, Frederic-Antoine Dauchy, Robert Zangerle, Charalambos Gogos, Nicola Gianotti, Adriana Ammassari, Carlo Torti, Jade Ghosn, Genevieve Chêne, Jesper Grarup, Manuel Battegay, Efavirenz, Obesity Project Team on behalf of Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, Catia Marzolini, Caroline Sabin, François Raffi, Marco Siccardi, Cristina Mussini, Odile Launay, David Burger, Bernardino Roca, Jan Fehr, Stefano Bonora, Amanda Mocroft, Niels Obel, Frederic-Antoine Dauchy, Robert Zangerle, Charalambos Gogos, Nicola Gianotti, Adriana Ammassari, Carlo Torti, Jade Ghosn, Genevieve Chêne, Jesper Grarup, Manuel Battegay, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Peter Reiss, Ferdinand Wit, Maria Prins, Heiner Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Perez-Hoyos, Osamah Hamouda, Barbara Bartmeyer, Nikoloz Chkhartishvili, Antoni Noguera-Julian, Andrea Antinori, Antonella d'Arminio Monforte, Norbert Brockmeyer, Luis Prieto, Pablo Rojo Conejo, Antoni Soriano-Arandes, Manuel Battegay, Andri Rauch, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M Miro, Antonella Castagna, Deborah Konopnick, Tessa Goetghebuer, Carlo Torti, Ramon Teira, Myriam Garrido, David Haerry, Stéphane de Wit, Jordi Casabona, Dominique Costagliola, Antonella d'Arminio-Monforte, Manuel Battegay, Julia del Amo, Amanda Mocroft, Dorthe Raben, Genevieve Chêne, Ali Judd, Pablo Rojo Conejo, Diana Barger, Céline Colin, Christine Schwimmer, Monique Termote, Linda Wittkop, Maria Campbell, Nina Friis-Moller, Jesper Kjaer, Dorthe Raben, Rikke Salbol Brandt, Manuel Battegay, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, François Dabis, Antonella d'Arminio Monforte, Julia del Amo, Maria Dorrucci, Matthias Egger, Hansjakob Furrer, Ali Judd, Ole Kirk, Olivier Lambotte, Sara Lodi, Sophie Matheron, Laurence Meyer, Jose Miro, Amanda Mocroft, Susana Monge, Fumiyo Nakagawa, Roger Paredes, Andrew Phillips, Massimo Puoti, Caroline Sabin, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Giota Touloumi, Marc van der Valk, Linda Wittkop, Natasha Wyss
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 600 mg EFV dosage is appropriate across a wide weight range.
Source: PubMed