Successful viral suppression with subsequent efavirenz-based regimen in HIV-1-infected patients who stop nevirapine prior to discontinuation of the NRTI backbone.
OBJECTIVE
To study antiviral response of efavirenz (EFV)-based antiretroviral therapy (ART) in HIV-1-infected patients who had previously discontinued nevirapine (NVP) and continued the nucleoside reverse transcriptase inhibitor (NRTI) backbone for 7 to 14 days after stopping NVP.


METHODS
A retrospective cohort study was conducted in patients who discontinued NVP. CD4 count and plasma HIV-1 RNA levels were monitored through 48 weeks of EFV-based regimen.


RESULTS
Forty-five patients were eligible with a mean +/- SD age of 37 +/- 11 years; 60% were males. Median (interquartile range [IQR]) baseline CD4 count was 43 (19-150) cells/mm³ and median (IQR) plasma HIV-1 RNA was 5.7 (5.3-5.9) log copies/mL. Median (IQR) duration from stopping NVP to initiating EFV was 13 (7-18) days. At 48 week, 33 (73.3%) of 45 patients achieved plasma HIV-1 RNA <50 copies/mL. At week 12, 24, and 48, median CD4 counts were 193, 238, and 268 cells/mm³, respectively (P < .05). No studied risk factor was associated with achieving HIV-1 RNA <50 copies/mL at 48 weeks (P > .05).


CONCLUSIONS
The strategy of extended short half-life NRTIs in the regimen after discontinuation of NVP is justified.
Chimsuntorn
Sukanya
S
Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Tiwanon Road, Nonthaburi, Thailand.
Sungkanuparph
Somnuek
S
Manosuthi
Weerawat
W
D000328:Adult; D000480:Alkynes; D048588:Benzoxazines / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003521:Cyclopropanes; D004359:Drug Therapy, Combination / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000627:therapeutic use*; D009705:Nucleosides / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D013785:Thailand
D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D009705:Nucleosides; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine; C098320:efavirenz