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Colegio de Medicina Interna de México.

2007, Number 6

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Med Int Mex 2007; 23 (6)

Substitution with non-nucleoside reverse transcriptase inhibitors (neviraptine o efavirenz) in a protease inhibitors regimen in patients with HIV infection

Chávez GJM, Zapata GER, Sánchez LLA, Valdovinos CSB, González MPM, Albarrán RC, Ayala GJJ

Language: Spanish
References: 17
Page: 503-507
PDF size: 137.82 Kb.


ABSTRACT

Background: Antiretroviral therapy was designed on the basis of protease inhibitors, these drugs need an important number of pills, have higher drug interaction, dietetic restrictions, and metabolic side effects. Recently there were demonstrated excellent results with this kind of therapy based on non-nucleoside reverse transcriptase inhibitors: nevirapine and efavirenz.
Objective: To assess the response in a group of patients with antiretroviral therapy switched with non-nucleosides (nevirapine or efavirenz) for a protease inhibitor (PI) based regime in comparison to a group of patients that remained on PI-based therapy.
Patients and method: A cohort of 83 adult patients, with PI-based antiretroviral treatment, who maintained undetectable viral load for one year or more. Sixty-three of these patients were switched; whereas to efavirenz (33) or nevirapine (30), while 20 remained unswitched as control group.
Results: Mean baseline levels of viral load and CD4+ counts were similar for the three groups, but baseline length of time in months with the PI regime, was different for each group as follows: nevirapine 38.4, efavirenz 30.4, and controls (PI-based) 28.75 months, (p = 0.024). From the PI group, two patients dropped (ITT = 90%), two from the nevirapine group (ITT = 93.3%), and no patient with efavirenz (ITT = 100%). CD4+ counts showed an increase of 152 cells in the nevirapine group (p = 0.018), such counts decreased respectively to -17 in the efavirenz group, and -11 in the PI group. One patient in the nevirapine group was discontinued because of severe skin rash. No patients in this study experienced progression of disease, AIDS defining events, or death.
Conclusions: The substitution of nevirapine or efavirenz for protease inhibitors in patients with undetectable viral load for more than one year, demonstrated efficacy on virologic and immunologic grounds, did not represent an increment in toxicity, and favors better adherence to therapy.


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