Studies Assess Regimens After Nevirapine

Included HIV-infected women, children with earlier exposure to single-dose nevirapine
By Eric Metcalf
HealthDay Reporter

WEDNESDAY, Oct. 13 (HealthDay News) -- In women with HIV-1 who have taken peripartum single-dose nevirapine, the use of ritonavir-boosted lopinavir with tenofovir-emtricitabine is associated with better outcomes than therapy featuring nevirapine, and in children with prior nevirapine exposure, benefits are seen with zidovudine and lamivudine plus ritonavir-boosted lopinavir, according to two studies published in the Oct. 14 issue of The New England Journal of Medicine.

In the first study, Shahin Lockman, M.D., of Brigham and Women's Hospital in Boston, and colleagues analyzed data from 241 women in Africa with earlier exposure to nevirapine who were randomized to receive tenofovir-emtricitabine and nevirapine or tenofovir-emtricitabine plus lopinavir with a low dose of ritonavir. More women in the nevirapine group reached the primary end point, which was time to virologic failure or death (26 percent versus 8 percent). In another group of women without earlier exposure to single-dose nevirapine, an equal proportion in both treatment groups had virologic failure or died.

In the second study, Paul Palumbo, M.D., of the Dartmouth Medical School in Lebanon, N.H., and colleagues analyzed data from 164 HIV-infected African children, ages 6 to 36 months, with prior exposure to single-dose nevirapine who were randomized to zidovudine and lamivudine with either nevirapine or ritonavir-boosted lopinavir. The nevirapine group was more likely to reach the primary end point, which was virologic failure or discontinuation of treatment by 24 weeks (39.6 percent versus 21.7 percent).

Both trials "strongly support the use of ritonavir-boosted lopinavir for the treatment of women and children who have had prior exposure to single-dose nevirapine," write the authors of the second study.

A number of researchers in the first study disclosed financial relationships with pharmaceutical companies, and several companies provided drugs used in the studies.

Abstract - Lockman
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Abstract - Palumbo
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