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Introduction:
Protease inhibitors (PIs)-sparing regimens are widely used in order to
improve compliance and reduce metabolic toxicity. Regimens including
nevirapine (NVP) are useful but their long-term efficacy has not been fully
established.
Material and methods:
Prospective, observational, longitudinal study of 110 HIV-1 infected
patients with undetectable viral load (below 200 copies/ml) for at least the
previous three months who discontinued PI and begun NVP in combination with
two nucleoside analogues. Fifty-nine percent of patients were naïve when
HAART was started. The main reasons for switching were: treatment
simplification (43%), lipodystrophy and hyperlipidemia (32.5%) and renal
impairment (24.5%).
Results:
Nine
patients were lost for follow-up. All patients were alive and no-AIDS
defining conditions occurred. Sixteen patients had NVP side effects. Viral
load remained undetectable in all patients but nine (8.9%). A total of 68
patients were followed during at least 30 months. These patients had a
significant (p<0.05) increase in total mean CD4 count (from 574 to 703
cells/mL)
and a significant decrease in altered metabolic parameters: mean serum
cholesterol varied from 306 to 230 mg/dL, mean triglycerides decreased from
1390 to 457 mg/dL and mean creatinine changed from 1.7 to 1.17 mg/dL.
Conclusions:
Switching from PIs to NVP is an effective and safe option for
maintaining long-term (30 months) virological suppression and immunological
control. In addition a significant improvement in cholesterol and
triglycerides levels is observed. |
