AEGiS-13IAC: Efficacy of protease inhibitor switching to Nevirapine in patients on HAART with undetectable viral load.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Efficacy of protease inhibitor switching to Nevirapine in patients on HAART with undetectable viral load.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrB485)

Gorgolas M, Estrada V, Arranz A, Nodar A, Sanz J, Garcia Delgado R, Fernandez Guerrero M
M. Gorgolas, Fundacion Jimenez Diaz, Avda. Reyes Catolicos, 2, 28040 Madrid, Spain, Tel.: +34 91 550 48 83, Fax: +34 91 550 49 22, E-mail: mgorgolas@fjd.es

BACKGROUND: Highly active antiretroviral therapy with protease inhibitors has had a major impact in declining the morbidity and mortality of HIV infected patients, however PI's containing regimens are often difficult to comply with and have been associated to metabolic disorders and fat redistribution. Switching of PI's to NNRTI's might be an alternative therapy for patients unable to tolerate PI's or for those demanding more simple regimens.

METHODS: We have prospectively studied 91 patients with HIV infection whose PI was switched to nevirapine after at least 3 months of successful therapy having undetectable viral load. Sixty four percent of them were naive at the time HAART was started.

RESULTS: Seventy three patients were males (80,2%) and 18 females (19,8 %) and most of them (76,9 %) acquired the infection by the sexual route. The mean age was 39 years (range 25 to 69). The reasons for changing PI were: treatment simplification (41 pts), renal complications (24 pts), lipodystrophy (20 pts), hypertrigliceridemia (3 pts), gastro-intestinal disturbances (3 pts). The mean CD4 count at change was 601 cells (range 80 to 1500). Overall 10 patients (11 %) discontinued nevirapine: 8 (8,8 %) because of intolerance or side-effects and in only two cases (2,2 %) therapy was suspended because of sustained viral rebound at 24 and 36 weeks. These two patients returned to undetectable levels after PI reintroduction. At twelve weeks after nevirapine initiation 7 patients showed minimal viral load rebounds (range 50 to 1700 cop/ mL) returning to undetectable levels in all cases but one at 24 weeks. The mean increments of CD4 at 12, 24 and 36 weeks of nevirapine therapy were 1, 65 and 85 cells/m L respectively. The mean decrements of triglicerids at 12, 24 and 36 weeks were 125, 16 and 574 mg/dL respectively.

CONCLUSION: maintenance therapy with nevirapine after successful HAART with PI's is a safe option for HIV positive patients.

Keywords: AEGIS, Nevirapine, Antiretroviral Therapy, Highly Active, Viral Load, CD4 Lymphocyte Count, HIV Infections, Protease Inhibitors, HIV Protease Inhibitors, Lipodystrophy, Human, Male, Female
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