First-line nevirapine in combination with nucleoside analogues compared with nevirapine added to a salvage HAART

Although non-nucleoside reverse transcriptase inhibitors are presently recommended as a part of an initial triple antiretroviral regimen, or as an adjunct to a rescue therapy in patients with poor response to highly active antiretroviral therapy (HAART), no controlled data are available comparing these two different strategies of administration of nevirapine.

Laboratorys data of 59 consecutive patients were prospectively followed up to compare the virologic and immunologic response to nevirapine in those starting a triple therapy combination (group A), versus subjects with prior HAART failure (group B). Laboratory data of 59 consecutive were prospectively followed up.

In group A (33 cases), nevirapine was started with two nucleoside analogues in six subjects naïve to antiretrovirals, while in 27 cases it was added to a novel combination of nucleoside analogues. In group B (26 cases), highly experienced patients failing a protease inhibitor-containing HAART, were given nevirapine concurrently with nelfinavir in 19 cases, and with two protease inhibitors in seven patients. Compared with group B patients, subjects belonging to group A showed a more favorable 9-month virologic response (-2.2 Log10 after 9 months with two thirds of patients attaining viral suppression, versus -0.8 Log10 in group A, with only 34.6% of patients with undetectable viremia) (p < 0.001). A greater rise of mean absolute CD4+ lymphocyte count was also observed in group A as opposed to group B (p < 0.001). No significant difference was found comparing the laboratory response of antiretroviral-naïve versus -experienced patients, as well as of participants who changed one versus both nucleoside analogues at the time of nevirapine adjunct in group A, and between patients who switched to nelfinavir versus those treated with two protease inhibitors in group B.

Nevirapine used as a component of an initial triple anti-HIV regimen seems to ensure a significantly more favorable virologic and immunologic outcome, compared with nevirapine adjunct to a salvage regimen carried out after HAART failure. Controlled data are needed, to better define the role of nevirapine in different therapeutic situations.