Author | Outcomes | Intervention | Confounder adjusted | Main findings | Newcastle-Ottawa scale |
---|---|---|---|---|---|
Stringer et al. [50] | Treatment failure | n NVPÂ =Â 355 n EFVÂ =Â 523 | Month on ART, CD4 cell count, viral load, WHO stage, age, Hgb, BMI, Weight, NNRTI, TB at baseline | -Month on ART, CD4 cell count, viral load, WHO stage, age, Hgb, and BMI were significantly associated factors. -In total, 724 women (82%) completed 48Â weeks of follow-up on an NNRTI-containing regimen | Selection 2 stars Comparability 1 star Outcome 2 stars |
Kwobah et al. [51] | Treatment failure | n EFVÂ =Â 427 n NVPÂ =Â 2633 | Education level, CD4 category, WHO stage, BMI, Hemoglobin, Adherence, disclosure, travel time, NNRTI, and NRTI | -No association between the choice of NNRTI used (Nevirapine or Efavirenz) and treatment failure -Low baseline CD4, AZT based NRTI, imperfect adherence are associated with first line ART failure | Selection 3 stars Comparability 2 stars Outcome 1 star |
Nachega et al. [45] | Virologic failure | n EFVÂ =Â 212 n NVPÂ =Â 103 | Age, sex, race, baseline CD4, baseline VL, NRTI, year of ART, adherence | -Nevirapine was associated with greater risk of virologic failure compared to efavirenz -NNRTI, age, sex, baseline viral load, year on ART, and adherence were significantly associated with failure | Selection 2 stars Comparability 2 stars Outcome 2 stars |
NNRTI substitution | n EFVÂ =Â 1612 n NVPÂ =Â 1067 | Weight, age, WHO stage per increment, CD4 Count, district | -Substantial difference in the tolerability of commonly used first line ART drugs. -Baseline weight, and Age, for NVP and Weigh and WHO stage for EFV | Selection 2 stars Comparability 2 stars Outcome 2 stars | |
Shearer et al. [47] | Treatment failure | n EFVÂ =Â 11,962 n NVPÂ =Â 878 | NNRTI, ART year, sex, age, baseline CD4, WHO stage, BMI, NRTI, baseline anemia | -Patients with NVP-are more likely to experience virologic failure -NNRTI, years of ART initiation, age, and baseline CD4 cell counts | Selection 3 stars Comparability 2 stars Outcome 1 star |
Sarfo et al. [10] | Composite endpoint | n EFVÂ =Â 2369 n NVPÂ =Â 1621 | Sex, age, NNRTI, NRTI, Baseline CD4, baseline BMI, WHO stage, adherence | -Treatment outcomes were comparable whether EFV or NVP is used -There was a 36% lower risk of all-cause discontinuation of EFV compared with NVP -NRTI, age, baseline CD4 counts, BMI, WHO stage, and adherence were associated factors of treatment failure | Selection 3 stars Comparability 2 stars Outcome 2 stars |
Shearer et al. [46] | Treatment failure | n EFVÂ =Â 2254 n NVPÂ =Â 131 | NNRTI, sex, age, baseline CD4, WHO stage, Anemia, BMI | -Given TDF as NRTI, Nevirapine has higher risk of treatment failure as compared to EFV. -Regimen, and Baseline CD4 cell counts were significantly associated with failure | Selection 3 star Comparability 1 star Outcome 1 star |
Barth et al. [49] | Treatment failure | n EFV = 426 n NVP = 309 | Gender, age, BMI, Karnofsky score, CD4 counts, time since start ART, NNRTI, Occupation | -No difference between EFV and NVP in treatment failure −60% of patients showed virological failure; only few of them were switched to second-line treatment -Gender, mean BMI, and baseline CD4 counts were associated in the univariate | Selection 2 star Comparability 1 star Outcome 2 star |
Gsponer et al. 2012 [54] | Treatment failure | n EFVÂ =Â 186 n NVPÂ =Â 2218 | Age, Sex, baseline CD4, WHO stage | -Mortality was lower among patients who switched compared to patients remaining on failing first-line ART -Current CD4 count was associated | Selection 2 star Comparability 1 star Outcome 1 star |
Sarfo et al. [10] | NNRTI Substitution | n EFVÂ =Â 2378 n NVPÂ =Â 1621 | NNRTI, gender, age, BMI, WHO stage, CD4 counts, hepatitis B surface antigen status, ALT | -Patients starting nevirapine are more likely to develop rashes and then more likely to discontinue therapy than those starting efavirenz. -NNRTI, gender, and low baseline CD4 counts were associated factors | Selection 3 star Comparability 2 star Outcome 1 star |
Keiser et al. [55] | Treatment failure | n EFVÂ =Â 1951 n NVPÂ =Â 2325 | Not controlled | -Compared to patients who remained on non-failing first-line therapy, mortality and loss from follow-up was higher in patients who switched, and substantially higher in patients who remained on failing first-line therapy | Selection 2 star Comparability 1 star Outcome 1 star |
Anlay et al. [53] | NNRTI Substitution | n EFVÂ =Â 289 n NVPÂ =Â 121 | Weight, WHO stage, TB on initial regimen, NRTI, NNRTI, Co-medication, and side effect | -There is no difference in regimen change between NVP and EFV -WHO stage, TB status, co-medication, and side effect were associated factors | Selection 3 star Comparability 2 star Outcome 2 star |
van Zyl et al. [43] | NNRTI resistance | n EFVÂ =Â 82 n NVPÂ =Â 85 | Age, gender, ART regimen, most recent CD4 count, concurrent viral load, and genotypic resistance information | -Failure on NVP therapy may result in cross-resistance to ETV. NNRTI and estimated period of failure were associated | Selection 2star Comparability 2 star Outcome 1 star |
Abah et al. [42] | NNRT substitution | n EFVÂ =Â 558 n NVPÂ =Â 5751 | Sex, age, HBV, CD4 count, WHO stage, NNRTI, NRTI | -Drug substitutions of efavirenz (EFV) were more likely than of nevirapine (NVP) -Age, greater immunosuppression, EFV compared to NVP, and drug toxicity were significant predictors | Selection 2 star Comparability 1 star Outcome 2 star |
Bock et al. [44] | NNRT substitution | n EFVÂ =Â 19,441 n NVPÂ =Â 7909 | NNRTI, NRTI (AZT & D4T), gender, age, baseline CD4, WHO stage, TB treatment at baseline, year of ART initiation, level of care | -Superior efficacy of EFV compared with NVP for first-line ART -NNRTI, gender, year of initiation, and province were associated factors | Selection 3 stars Comparability 2 stars Outcome 2 stars |
Tirfe et al. [25] | Treatment failure | n EFVÂ =Â 246 n NVPÂ =Â 246 | NNRTI, facility type, age, sex, marital status, education status, religion, NRTI, presence of OIs, eligibility criteria, WHO stage, functional status, BMI, provision of IPT, and baseline CD4 counts | -NVP and EFV based HAART regimens were effective and comparable, in term of immunological responses. -Gender, eligibility criteria, WHO stage, provision of IPT, and baseline CD4 counts were associated factors | Selection 3 stars Comparability 2 stars Outcome 2 stars |