Virological, immunological, and clinical impact of switching from protease inhibitors to nevirapine or to efavirenz in patients with human immunodeficiency virus infection and long-lasting viral suppression.
Seventy-seven subjects infected with human immunodeficiency virus were randomized to switch from protease inhibitor (PI) therapy to nevirapine therapy (group A; n=26) or to efavirenz therapy (group B; n=25) or to continue PI therapy (group C; n=26). At month 12, viral suppression had been maintained in 96% of patients in group A, 92% of patients in group B, and 92% of patients in group C. A significant increase in the CD4(+) level was observed in all 3 groups. In group A, lipid profiles improved, whereas levels of gamma-glutamiltransferase and alanine aminotransferase significantly increased; 1 subject interrupted treatment because of hepatotoxicity. In group B, an increase in gamma-glutamiltransferase levels was also observed, and 3 patients interrupted treatment because of central nervous system symptoms. Two patients in group C withdrew therapy. Quality of life significantly improved for groups A and B. In patients receiving effective PI-based therapy, the replacement of the PI with either nevirapine or efavirenz is safe and virologically effective.
Negredo
Eugenia
E
Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain. enegredo@ns.hugtip.scs.es
Cruz
Luís
L
Paredes
Roger
R
Ruiz
Lidia
L
Fumaz
Carmina R
CR
Bonjoch
Anna
A
Gel
Silvia
S
Tuldrà
Albert
A
Balagué
Montserrat
M
Johnston
Susan
S
Arnó
Albert
A
Jou
Antoni
A
Tural
Cristina
C
Sirera
Guillem
G
Romeu
Joan
J
Clotet
Bonaventura
B
D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology; D006801:Humans; D019829:Nevirapine / Q000009:adverse effects / Q000627:therapeutic use*; D010078:Oxazines / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D010078:Oxazines; D019829:Nevirapine; C098320:efavirenz