Nevirapine‐ versus efavirenz‐based highly active antiretroviral therapy regimens in antiretroviral‐naïve patients with advanced HIV infection

Abstract

ObjectiveTo compare virological and immunological responses to nevirapine (NVP)-based and efavirenz (EFV)-based highly active antiretroviral therapy (HAART) regimens in antiretroviral-naïve patients with advanced HIV infection. MethodsA retrospective observational cohort study was conducted on antiretroviral-naïve HIV-infected patients whose pretreatment CD4 cell counts were less than 100 cells/mL or whose viral loads were greater than 100 000 HIV-1 RNA copies/mL. ResultsBaseline characteristics of patients in the NVP (n 5 24) and EFV (n 5 29) groups were not different. The proportion of patients with viral loads 4100 000 copies/mL was higher in the EFV group. The probability of virological success estimated by the Kaplan-Meier method showed that 3-and 6-month success rates were 30.8% [95% confidence interval (CI): 16.7-52.2%] and 63.1% (95% CI: 44.7-81.3%) for the NVP group. The corresponding values were 41.2% (95% CI: 25.8-61.0%) and 62.9% (95% CI: 45.7-80.1%) for the EFV-based group. The median success times of the two groups were about 4 and 3 months (P 5 0.678), respectively, for NVP and EFV. Cox's proportional hazard was used after adjusting for age, previous opportunistic infections (OIs), and viral load at baseline, and showed that patients who received the NVP-based regimen had about 25% [hazard ratio (HR) 5 0.75, 95% CI: 0.37-1.51] less chance of virological success than patients who received the EFV-based regimen (P 5 0.415). The median times to CD4 ! 100 cells/mL were 5.6 and 4.4 months for the NVP-and EFV-based regimens, respectively (log-rank test, P 5 0.144). ConclusionsNVP-and EFV-based HAART regimens as initial regimens in patients with advanced HIV infection are effective and comparable, in term of virological and immunological responses. However, further large-scale randomized controlled clinical trials in this group of patients with advanced HIV infection are needed. IntroductionHighly active antiretroviral therapy (HAART) is effective in reducing the plasma viral load and in prolonging AIDS-free survival, as shown in various studies [1][2][3]. Nevirapine (NVP) and efavirenz (EFV) are nonnucleoside reverse transcriptase inhibitors (NNRTI) which were approved by the Food and Drug Administration of the United States in the late 1990s to treat HIV infection [4][5][6]. In developing countries, the majority of HIV-infected patients who present to clinics are in an advanced stage of the disease [7,8]. Although the EFV-based regimen has been shown to be effective in patients with advanced infection [9][10][11] (2) were naïve to antiretroviral therapy, and (3) had a CD4 cell count o100 cells/ mL or a viral load (determined by PCR; Amplicor; Roche Diagnostics, Indianapolis, IN) ! 100 000 HIV-1 RNA copies/mL. Each eligible patient was followed up since receiving HAART until the end of the study, in August 2002, and (4) received a NVP-based or EFV-based HAART regimen. After receiving treatment, patients were followed up to assess their CD4 cell counts and viral loads every 3-4 months. Medical records w...

Immunological responses of HIV/AIDS patients treated with Nevirapine versus Efavirenz based highly active anti-retroviral therapy in Addis Ababa, Ethiopia: A retrospective cohort study

“…Like the above study, findings from retrospective cohort conducted among patients whose pre-treatment CD4 cell count was less than 100 cells/μl; NVP and EFV based HAART regimens were effective and comparable, in term of immunological responses. Those, received NVPbased regimen had about 40% (HR = 0.49, 95% CI 0.22 -1.09, P ≥ 0.144) lower chance of achieving immunological response than patients who received the EFV-based regimen [9]. A similar finding was observed in Meta-analysis conducted among seven clinical trials.…”

Intracellular Concentrations of Non-Nucleoside Reverse Transcriptase Inhibitors and its Potential Role on Apoptosis in Peripheral Blood Mononuclear Cells

“…Although our data demonstrate that ICs of NVP are lower than that of EFV and induce less apoptotic cells compared to EFV in PBMC when the cells are treated with close to the mean-peak steady state concentrations, no clinical data, to our knowledge, have identified differences in immunologic recovery between NVP and EFV regimens [30,31]; therefore, the clinical relevance of our findings remains uncertain. Other factors that may alter the ICs of NVP and EFV will need to be considered including hepatic CYP2B6 genotypes [32] and metabolization of each drug by CYP2B6 and CYP3A4 in PBMC [33].…”

Initiation of antiretroviral therapy in advanced AIDS with active tuberculosis: clinical experiences from Thailand

“…21 The rate of patients who achieved undetectable HIV RNA in the present study is similar to that from the other studies of antiretroviral therapy in advanced HIV-infected patients without active TB. 22,23 This high virological success rate is partly explained by good tolerability of HAART and TB treatment. The immunological response in both EFV and NVP group is favorable.…”