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- Title
Quantifying the risks and benefits of efavirenz use in HIV-infected women of childbearing age in the USA.
- Authors
Hsu, H. E.; Rydzak, C. E.; Cotich, K. L.; Wang, B.; Sax, P. E.; Losina, E.; Freedberg, K. A.; Goldie, S. J.; Lu, Z.; Walensky, R. P.
- 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. Decisionmaking regarding efavirenz use presents a trade-off between these two risks; this study can inform discussions between patients and health care providers.
- Subjects
UNITED States; ENZYME inhibitors; PHARMACOEPIDEMIOLOGY; ANTIVIRAL agents; CONFIDENCE intervals; DRUG side effects; HIV infections; LIFE expectancy; RESEARCH funding; SURVIVAL analysis (Biometry); TERATOGENIC agents; WOMEN; EARLY medical intervention
- Publication
HIV Medicine, 2011, Vol 12, Issue 2, p97
- ISSN
1464-2662
- Publication type
Article
- DOI
10.1111/j.1468-1293.2010.00856.x