By Ed Susman
MEXICO CITY -- August 4, 2008 -- An efavirenz-based regimen appears more successful than a nevirapine-based regimen in the treatment of human immunodeficiency virus (HIV) in patients coinfected with tuberculosis who have already been treated with the antibiotic rifampin, according to researchers speaking here at the 17th International AIDS Conference (AIDS 2008).
"In our study, virological outcomes [for HIV] were inferior when nevirapine-based antiretroviral therapy was commenced while taking antitubercular treatment," noted study author Andrew Boulle, MB, ChB, Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. He added, however, that virological outcomes were comparable "when starting efavirenz-based therapy, or when tuberculosis developed while taking established nevirapine-based or efavirenz-based therapies."
About 16.3% of study patients who initiated nevirapine-based HIV therapy while taking rifampin experienced elevated HIV viral loads within 6 months compared with 8.35% of similar patients who initiated HIV treatment with a regimen that includes efavirenz (P < .001), Dr. Boulle noted here August 3 at a media briefing held by the Journal of the American Medical Association (JAMA). Dr. Boulle's study will appear this week in the HIV/AIDS-themed issue of JAMA on August 6, 2008.
The study retrospectively followed patients treated in the Cape Town suburb of Khayelitsha from 2001 through 2006. All patients were coinfected with HIV and tuberculosis; 209 patients were treated with nevirapine at a starting dose of 200 mg/day for the first 2 weeks, followed by 200 mg twice daily. These patients were compared with 1,074 patients treated with efavirenz (600 mg/day).
An additional 1,728 patients on nevirapine who did not have tuberculosis at the time of treatment initiation were compared with 961 patients whose treatment was initiated with efavirenz and were not being treated for tuberculosis.
The data suggest that if a choice is available between efavirenz and nevirapine -- and the patient is already being treated with rifampin -- then efavirenz would be a better choice, Dr. Boulle concluded. He noted that, in South Africa, where efavirenz is available, most clinicians have adopted that choice. Across most of southern Africa, however, the only current choice for a non-nucleoside reverse transcriptase inhibitor is nevirapine.
[Presentation title: Outcomes of Nevirapine- and Efavirenz-Based Antiretroviral Therapy When Coadministered With Rifampin-Based Antitubercular Therapy.]
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