title: Low nevirapine plasma concentrations predict virological failure in an unselected HIV-1-infected population.
abstract: OBJECTIVE
  To assess the relationship between plasma nevirapine concentrations and plasma HIV-1 RNA response in HIV-1-infected patients.
  
  
  METHODS
  An observational cohort analysis.
  
  
  METHODS
  Plasma samples were obtained on a routine basis from 189 patients receiving nevirapine 200mg twice daily, and plasma nevirapine concentrations were measured with reversed phase high performance liquid chromatography. Patients were divided into two groups based on plasma nevirapine concentrations below (and equal to) or above 3 mg/L. The association between steady-state nevirapine concentrations and plasma HIV-1 RNA was determined by multivariate analysis.
  
  
  RESULTS
  Out of 189 patients, 13 (7%) had low nevirapine plasma concentrations and 176 patients had concentrations above 3 mg/L. In total, 22 (12%) patients showed virological failure and 8 patients (4%) discontinued nevirapine because of adverse effects. The risk of failure in patients with nevirapine plasma concentrations </=3mg/L was increased (relative risk 5.0, 95% CI 1.8-13.7). Rashes and liver enzyme elevations each occurred in 8% of patients.
  
  
  CONCLUSIONS
  Low nevirapine drug concentrations are predictive of virological failure.
authors.affiliation: Department of Internal Medicine, University Hospital Rotterdam, Dijkzigt, Rotterdam, The Netherlands.
authors.forename: Theodora E M S
authors.initials: TE
authors.lastname: de Vries-Sluijs
authors.forename: Jeanne P
authors.initials: JP
authors.lastname: Dieleman
authors.forename: Dennis
authors.initials: D
authors.lastname: Arts
authors.forename: Alwin D R
authors.initials: AD
authors.lastname: Huitema
authors.forename: Jos H
authors.initials: JH
authors.lastname: Beijnen
authors.forename: Martin
authors.initials: M
authors.lastname: Schutten
authors.forename: Marchina E
authors.initials: ME
authors.lastname: van der Ende
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006716:Homosexuality; D006801:Humans; D008297:Male; D019829:Nevirapine / Q000097:blood* / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000097:blood* / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine