Efavirenz versus Protease Inhibitors in Patients with HIV: A Systematic Review and Meta-Analysis
Sabina O. Nduaguba 1, Chinyere Okoh 2, Jamie C. Barner 2, Kentya H. Ford 3, James N. Barnes 4, Kenneth A. Lawson 2, James P. Wilson 2, Tasha Beretvas 5
1 Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA; 2 Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA; 3 Department of Health and Kinesiology, Prairie View A&M University, College Station, TX, USA; 4 Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX, USA; 5 Department of Educational Psychology, The University of Texas at Austin, TX., USA
*Correspondence: Chinyere Okoh, Email not available
Abstract
Efavirenz- and protease inhibitor (PI)-based regimens remain viable options across the globe. We conducted a meta-analysis to compare the effectiveness of efavirenz-based regimens relative to PI-based regimens. EMBASE, PubMed, Cochrane, and clinicaltrials.gov were searched for randomized controlled trials conducted between 1987 and 2018 comparing efavirenz- with PI-based regimens. This was followed by title, abstract, and full-text screens. The quality of selected studies was assessed using the Cochrane risk of bias tool. Meta-analysis of the odds of virological suppression was conducted using the robust variance estimation approach. Fifteen studies met the inclusion criteria and totaled 6712 patients (efavirenz arm = 3339; PI arm = 3373), of which 1610 (24.0%) were females. Follow-up ranged from 24 to 144 weeks. Mean/median age ranged from 33 to 44 years. Mean/median baseline CD4 count ranged from 32 to 557 cells/mL while mean/median baseline viral load ranged from log10 4.5 to log10 5.5 copies/mL. Meta-analysis showed that patients receiving efavirenz-based regimens had 37% higher odds of virological suppression compared to PI-based regimens (odds ratio = 1.37, 95% confidence interval = 1.06-1.77, p = 0.02). The Egger test suggested the presence of publication bias (B = 0.927, t = 2.214, p = 0.033). The main threat to the quality of evidence was attrition bias. Regarding virological suppression, efavirenzbased regimens were more effective than PI-based regimens and, therefore, might be ideal for the management of treatment na�ve patients with HIV in settings where NNRTIs and PIs are used.
