title: 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.
abstract: 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.
authors.affiliation: Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain. enegredo@ns.hugtip.scs.es
authors.forename: Eugenia
authors.initials: E
authors.lastname: Negredo
authors.forename: Luís
authors.initials: L
authors.lastname: Cruz
authors.forename: Roger
authors.initials: R
authors.lastname: Paredes
authors.forename: Lidia
authors.initials: L
authors.lastname: Ruiz
authors.forename: Carmina R
authors.initials: CR
authors.lastname: Fumaz
authors.forename: Anna
authors.initials: A
authors.lastname: Bonjoch
authors.forename: Silvia
authors.initials: S
authors.lastname: Gel
authors.forename: Albert
authors.initials: A
authors.lastname: Tuldrà
authors.forename: Montserrat
authors.initials: M
authors.lastname: Balagué
authors.forename: Susan
authors.initials: S
authors.lastname: Johnston
authors.forename: Albert
authors.initials: A
authors.lastname: Arnó
authors.forename: Antoni
authors.initials: A
authors.lastname: Jou
authors.forename: Cristina
authors.initials: C
authors.lastname: Tural
authors.forename: Guillem
authors.initials: G
authors.lastname: Sirera
authors.forename: Joan
authors.initials: J
authors.lastname: Romeu
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
mesh_terms: 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
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D010078:Oxazines; D019829:Nevirapine; C098320:efavirenz