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Switching from suppressive protease inhibitor-based regimens to nevirapine-based regimens: a meta-analysis of randomized controlled trials
Article first published online: 21 JUL 2008
DOI: 10.1111/j.1468-1293.2008.00627.x
© 2008 British HIV Association
Additional Information
How to Cite
Ena, J., Leach, A. and Nguyen, P. (2008), Switching from suppressive protease inhibitor-based regimens to nevirapine-based regimens: a meta-analysis of randomized controlled trials. HIV Medicine, 9: 747–756. doi: 10.1111/j.1468-1293.2008.00627.x
Publication History
- Issue published online: 9 OCT 2008
- Article first published online: 21 JUL 2008
- Received: 10 February 2008, accepted 9 May 2008
- Abstract
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Keywords:
- antiretroviral therapy/highly active;
- meta-analysis;
- nevirapine;
- protease inhibitors
Objectives
We performed a meta-analysis to assess the efficacy and safety of switching from protease inhibitor (PI)- to nevirapine (NVP)-based regimens in HIV-infected patients in whom virological suppression had been achieved.
Methods
Six trials (550 patients) were analysed. The demographics showed that 11–48% of participants were female and 40–53% had hepatitis C or B virus infection, and the mean CD4 lymphocyte count was >500 cells/μL at study entry.
Results
NVP-based regimens showed noninferiority compared with continuation of PI therapy to maintain virological suppression in ‘intention to treat’ (80 vs. 78%; P=0.35) and ‘on treatment’ analyses (91 vs. 89%; P=0.10). Overall rates of discontinuation because of adverse events were similar in the two groups (11 vs. 10%; P=0.79). However, NVP-based therapies caused more discontinuations because of liver toxicity than PI-based therapies (7 vs. 0%; P=0.0009). At the end of follow-up there was no statistical difference in CD4, cholesterol, triglyceride and body shape measurements between the two groups. Two studies reported greater improvement in quality of life in patients who were switched to the NVP group.
Conclusions
Switching from suppressive PI- to NVP-based regimens is virologically and immunologically safe; however, the risk of liver toxicity requires monitoring of clinical symptoms and liver chemistry during NVP therapy.