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Background:
Comparative trials have shown that 3-drug combination regimens containing a
non-nucleoside reverse transcriptase inhibitor (NNRTI) are equivalent to or
better than those containing a protease inhibitor. In this systematic
review, we compared the efficacy of a three-drug initial regimen containing
the NNRTI efavirenz (EFV) with one containing nevirapine (NVP) in
antiretroviral-naïve patients.
Methods:
We
compared studies that included a three-drug regimen comparing two nucleoside
reverse transcriptase inhibitors (NRTI) plus EFV with two NRTIs plus NVP in
separate arms. Our primary endpoint was the proportion of
antiretroviral-naïve participants who achieved virologic suppression. We
searched AIDSDRUGS, AIDSLINE, AIDSTRIALS, specialized Cochrane Collaboration
registries, EMBASE, MEDLINE and MetaRegister of Controlled Trials for the
years 1996-2001 and searched conference abstracts through March 2003. We
compared efficacy using random-effects meta-analysis and computed Peto odds
ratios with 95% confidence intervals.
Results:
We
identified six completed studies with 3,205 antiretroviral-naïve
participants, including two randomized controlled trials (RCT) and four
cohort studies in which results were separately reported for
antiretroviral-naïve subjects. EFV-containing regimens were equivalent to
NVP-containing regimens at 24 and 48-52 weeks (OR=1.20, 95% CI=0.85, 1.69).
The results from the two RCTs (OR=1.17, 95% CI=0.90, 1.53) were similar to
those from the four court studies (OR=1.15, 95% CI=0.67, 1.97).
Conclusions:
We conclude that the short-term efficacy of EFV-containing and
NVP-containing regimens for treatment of antiretroviral-naïve patients is
equivalent. Deciding which NNRTI to use for initial therapy should be based
on differences in longer-term efficacy, adherence, toxicity, cost and
availability.
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