Quality of life in patients treated with first-line antiretroviral therapy containing nevirapine or efavirenz in Uganda: a prospective non-randomized study

Abstract

BackgroundThe goal of antiretroviral therapy (ART) is to suppress viral replication, reduce morbidity and mortality, and improve quality of life (QoL). For resource-limited settings, the World Health Organization recommends a first-line regimen of two-nucleoside reverse-transcriptase inhibitors and one non-nucleoside transcriptase inhibitor (nevirapine (NVP) or efavirenz (EFV)). There are few data comparing the QoL impact of NVP versus EFV. This study assessed the change in QoL and factors associated with QoL among HIV patients receiving ART regimens based on EFV or NVP.MethodsWe enrolled 640 people with HIV eligible for ART who received regimens including either NVP or EFV. QoL was assessed at baseline, three months and six months using Physical Health Summary (PHS) and Mental Health Summary (MHS) scores and the Global Person Generated Index (GPGI). Data were analyzed using generalized estimating equations, with ART regimen as the primary exposure, to identify associations between patient and disease factors and QoL.ResultsQoL increased on ART. The mean QoL scores did not differ significantly for regimens based on NVP versus EFV during follow-up for MHS and GPGI regardless of CD4 stratum and for PHS among patients with a CD4 count >250 cells/μL. The PHS-adjusted β coefficients for ART regimens based on EFV versus NVP by CD4 count strata were as follows: −1.61 (95 % CI −2.74, −0.49) for CD4 count <100 cells/μL; 0.82 (0.22, 1.43) for CD4 count 101–250 cells/μL; and −1.33 (−5.66, 3.00) for CD4 count >250 cells/μL. The corresponding MHS-adjusted β coefficients were as follows: −0.39 (−1.40, 0.62) for CD4 < 100 cells/μL; 0.16 (−0.66, 0.98) for CD4 count 101–250 cells/μL; and −0.75 (−2.01, 0.51) for CD4 count >250 cells/μL. The GPGI-adjusted odds ratios for EFV versus NVP were 0.51 (0.25, 1.04) for CD4 count <100 cells/μL, 0.98 (0.60, 1.58) for CD4 count 101–250 cells/μL, 1.39 (0.66, 2.90) for CD4 > 250 cells/μL. QoL improved among patients on EFV over the 6-month follow-up period (MHS p < 0.001; PHS p = 0.04, p = 0.028). Overall, patients with depression (PHS p < 0.001; GPGI p < 0.001) had lower scores and women had lower MHS (on NVP, p = 0.001). Other factors associated with lower QoL included alcohol use, low education level and advanced HIV disease.ConclusionsART improves QoL. The results support use of either NVP or EFV. Patients initiating ART should be assessed for depression and managed appropriately. Women may require extra support to improve their QoL.

Long-Term Immunological and Virological Outcomes in Children Receiving Highly Active Antiretroviral Therapy at Hawassa University College of Medicine and Health Sciences, Southern Ethiopia

“…Nevirapine-based regimen was significantly associated with virological and immunological failure compared to those children who were on EFV-based treatment (AOR = 1:90, (1.41-2.56), P = 0:001) or which is 2 times higher in virological and immunological failure than EFVbased treatment. Consistent findings were reported from Tanzania (AOR = 4:1, (1.6-10.4), P = 0:003) [39], Uganda [41], and Bahir Dar, Ethiopia (AOR = 1:90, 95% CI: 1.41-2.56, P = 0:001) [24]. Contrasting finding from our study was reported from Asella, Ethiopia [42] that indicated HAART regimen variability was not significantly associated Journal of Immunology Research with recovery of CD4 counts and viral load failure, Addis Ababa, Ethiopia [43] and in Uganda study [44].…”

Incidence and predictors of Adverse Drug Reaction (ADR) among adult HIV positive patients on anti-retroviral treatment in Arba Minch town public health facilities, southern Ethiopia: A retrospective cohort study, 2020

“…This study found that Zidovudine and Nevirapin based regimen was significantly more toxic than Tenofovir and Efaverinz based regimens. This finding was supported by a study done in Uganda in 2013 in which ART related ADRs was higher in Nevirapin containing regimen compared to Efaverinz and also study in Ethiopia at Hiwot Fana hospital, in which TDF based regimens was less toxic compared to AZT containing regimens [ 29 , 45 ].…”

HIV status and treatment influence on fertility desires among women newly becoming eligible for antiretroviral therapy in western Kenya: insights from a qualitative study

“…This recommendation is informed by a growing body of evidence that highlights the benefits of early ART initiation [ 2 – 4 ], including reduced mortality [ 5 ] and morbidity among HIV-infected individuals [ 1 , 6 ]. Expanding access to ART in resource-limited settings over the last two decades has transformed the disease to a manageable chronic illness [ 7 , 8 ] and allows HIV-infected individuals an improved overall quality of life [ 9 ] in these settings. Additionally, a study conducted in Uganda demonstrates that HIV-infected individuals now have similar life expectancy to the general population [ 10 ].…”