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Table 2 Selected results of the included studies

From: Choice of initial antiretroviral drugs and treatment outcomes among HIV-infected patients in sub-Saharan Africa: systematic review and meta-analysis of observational studies

Author

Outcomes

Intervention

Confounder adjusted

Main findings

Newcastle-Ottawa

scale

Stringer et al. [50]

Treatment failure

n NVP = 355

n EFV = 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 48 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 EFV = 427

n NVP = 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 EFV = 212

n NVP = 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

Boulle et al. [18, 48]

NNRTI substitution

n EFV = 1612

n NVP = 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 EFV = 11,962

n NVP = 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 EFV = 2369

n NVP = 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 EFV = 2254

n NVP = 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 EFV = 186

n NVP = 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 EFV = 2378

n NVP = 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 EFV = 1951

n NVP = 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 EFV = 289

n NVP = 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 EFV = 82

n NVP = 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 EFV = 558

n NVP = 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 EFV = 19,441

n NVP = 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 EFV = 246

n NVP = 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