Effectiveness

Nevirapine (Viramune) is able to reduce HIV-1 viral load and increase CD4 cell counts in the majority of people when taken in combination with at least two other antiretroviral drugs. Nevirapine is not active against HIV-2.

Nevirapine was licensed after three clinical trials found that the combination of nevirapine, zidovudine (AZT, Retrovir) and didanosine (ddI, Videx) brought about greater decreases in viral load and increases in CD4 cell counts than zidovudine and didanosine taken without nevirapine in people who had not taken antiretroviral therapy before. The triple combination also led to fewer cases of HIV disease progression.1 2 3

Several studies have reported that triple regimens including nevirapine are as effective as protease inhibitor-containing regimens.4 5 6 Concerns about the potency of nevirapine in people who begin treatment with high viral load have been dispelled by these studies.7

Numerous randomised trials and observational studies have compared nevirapine and efavirenz. A systematic review and meta-analysis of 38 studies found that efavirenz-based first-line antiretroviral treatment was significantly less likely to lead to virologic failure than nevirapine-based treatment (RR 0.85 [0.73-0.99]) and was more likely to achieve virologic suppression.8

Nevirapine is no longer recommended as a preferred option for first-line antiretroviral treatment in British, European, United States or World Health Organization guidelines, but owing to its low cost, it is still widely used in lower- and middle-income countries.

References

  1. d'Aquila R et al. Nevirapine, zidovudine, and didanosine compared with zidovudine and didanosine in patients with HIV-1 infection. Ann Intern Med 124: 1019-1030, 1996
  2. Montaner JSG et al. A randomized, double-blind trial comparing combinations of nevirapine, didanosine, and zidovudine for HIV-infected patients. JAMA 279: 930-937, 1998
  3. Floridia M et al. A randomized, double-blind trial on the use of a triple combination including nevirapine, a nonnucleoside reverse transcriptase inhibitor, in antiretroviral-naive patients with advanced disease. J Acquir Immune Defic Syndr Hum Retrovirol 20: 11-19, 1999
  4. Squires K et al. The Atlantic Study: a randomized, open-labeled trial comparing two protease inhibitor (PI)-sparing anti-retroviral strategies versus a standard pi-containing regimen, final 48 week data. 13th International AIDS Conference, Durban, abstract LbPeB7046, 2000
  5. Guardiola J et al. A open-label, randomized, comparative study of stavudine (d4T) + didanosine (ddI) + indinavir (IDV) versus d4T + ddI + nevirapine (NVP) in treatment of HIV-infected naive patients. 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, abstract 539, 2000
  6. Chen SY et al. Which antiretroviral regimens yield the best odds of survival in San Francisco? 15th International AIDS Conference, Bangkok, abstract MoOrC1082, 2004
  7. Podzamczer D et al. A randomized clinical trial comparing nelfinavir or nevirapine associated to zidovudine/lamivudine in HIV-infected naive patients (the Combine Study). Antivir Ther 7: 81-90, 2002
  8. Pillay P et al. Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: systematic review and meta-analysis. PLOS ONE 8(7): e68995, 2013
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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