Long-Term Benefits of Nevirapine-Containing Regimens: Multicenter Study with 506 Patients, Followed-Up a Median of 9 Years
D. Podzamczer, J. M. Tiraboschi, J. Mallolas, J. Curto, M. A. Cardenes, E. Casas, A. Castro, S. Echevarria, M. Leal, J. C. Lopez Bernaldo de Quiros, S. Moreno, T. Puig, E. Ribera, C. Villalonga, J. L. Gomez-Sirvent, J. A. Garcia-Henarejos, J. Lopez-Aldeguer, P. Barrufet, L. Force, I. Santos and J. Sanz
Affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Objective: To evaluate long-term outcomes in patients maintaining a nevirapine (NVP)-based regimen.
Methods: Retrospective, multicenter, cohort study including patients currently receiving an NVP regimen that had been
started at least 5 years previously. Demographic, clinical, and analytical variables were recorded.
Results: Median follow-up was 8.9 (5.7-11.3) years. Baseline characteristics: 74% men, 47 years old, 36% drug users,
40% AIDS, 40% HCV+, 51.4% detectable HIV-1 viral load, CD4 count 395 (4-1,421)/μL, 19% CD4 <200/μL, 27% ALT
grade 1-2, 36% AST grade 1-2. Thirty percent ART-naïve, 83% received NVP associated with 2 nucleoside analogues
during the study period, and 17% a protease inhibitor.
A significant improvement was observed in general health status markers, including hemoglobin, platelets, and albumin,
regardless of HCV coinfection. CD4 cell gain was +218 and +322/μL after 6 and 9 years, respectively (+321 and +391 in
naive patients). Triglycerides significantly decreased in pretreated patients, whereas the percentage of patients with HDLc
<1.03 mmol/L and LDL-c >3.37 mmol/L significantly decreased in a subsample with available values. A significant
decrease in transaminases, alkaline phosphatase, and Fib4 score was observed, mainly in HCV+ and ARV-naive patients.
Conclusions: In patients who tolerate NVP therapy, (even those with HCV coinfection), long term benefits may be
significant in terms of a progressive improvement in general health status markers and CD4 response, a favorable lipid
profile, and good liver tolerability.
Keywords: Nevirapine, antiretroviral therapy, long term benefits, tolerability, liver outcome, NVP, NNRTI, CD4, naive patients, regimens.
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