In African women, an anti-AIDS treatment regimen that includes the drug nevirapine is as effective as a treatment regimen with the more expensive drugs, lopinavir/ritonavir, according to a study by a team of international researchers published in this week's PLoS Medicine.
This finding is important as it confirms the recommendations from the World Health Organization that an increasingly common nevirapine-based treatment regimen is an affordable and effective option for the initial treatment of HIV in resource-limited settings.
The clinical trial involved 500 HIV-infected African women who had not previously taken antiretroviral treatment in seven countries (Botswana, Kenya, Malawi, South Africa, Uganda, Zambia, and Zimbabwe). The researchers, led by Shahin Lockman from the Harvard School of Public Health, randomized half of the women to receive antiretroviral therapy containing nevirapine and half to receive antiretroviral therapy containing lopinavir/ritonavir, a more expensive combination.
The researchers found that a similar number of women died in each group and each combination was as effective at controlling the level of HIV virus. In addition, similar proportions of women in both treatment groups developed serious drug-related signs and symptoms and laboratory abnormalities.
However, whereas 14% of the women in the nevirapine group stopped treatment because of adverse effects, none of the women in the lopinavir/ritonavir group stopped treatment. Furthermore, women in the nevirapine group developed more drug resistance than women in the lopinavir/ritonavir group.
The authors say: "These data support the WHO recommendation of [nevirapine-based treatment] as an initial affordable and effective HIV treatment regimen in resource limited settings, and provide reassurance regarding the efficacy of this regimen. However, these results also underscore the importance of early toxicity monitoring with nevirapine-based regimens."
They continue: "Our findings suggest that nevirapine, with careful early toxicity monitoring, remains an acceptable choice for first-line antiretroviral therapy in resource limited settings, until better tolerated and potentially more efficacious regimens become accessible."
The authors add: "Treatment failure observed in both arms also highlights the importance of access to effective second treatment options, as well as consideration of other effective, better-tolerated first-line regimens."