Discontinuation Rate of Nevirapine-Based Highly Active Antiretroviral Therapy

E ditor: Nevirapine-based highly active antiretroviral therapy (HAART) has been used since 1998, when the drug became commercially available in Europe. There is considerable experience of its use, and although it is not generally considered to be the preferred initial treatment in most national and international guidelines, it has a good lipid profile and, once it is tolerated by patients, the viral load seems to remain undetectable for several years. ¹ A new once a day formulation will be available in due course, which might simplify therapy and facilitate adherence. ² When deciding to start any antiretroviral therapy it would be desirable to know the expected rate of discontinuation over the years. We sought to determine the long-term discontinuation rate of a nevirapine (NVP)-based HAART.

We looked at the clinical charts of 107 patients who started a NVP-based HAART in 1998, 1999, or 2000 and followed them until May 2009. The rate of NVP discontinuation is shown in Fig. 1. Sixty percent of patients discontinued NVP during this period. The main reasons for discontinuation were (1) structured treatment discontinuation 27 patients (25%), (2) viral failure in 14 patients (13%), (3) toxicity in 11 patients (10.2%), (4) change in treatment strategy in 6 patients (5.6%), and (5) other reasons in 6 patients (5.6%). The mean age of patients was 34.8 years and 81.3% were male, most of them men who have sex with men (MSM). During follow-up three patients died due to non-AIDS-defining complications and eight patients (7.5%) developed Kaposi sarcoma. The mean CD4 cell increment during the follow-up period was 139 cells/μl. Total cholesterol and triglycerides plasma levels did not change over time.

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FIG. 1.

Kaplan-Meier graph showing the rate of NVP discontinuation during follow up.

In summary, NVP-based HAART could be an effective long-term therapy; however, at least one of four patients will discontinue this treatment due to viral failure or toxicity. The new extended-release NVP formulation is expected to facilitate patient compliance and this might have an impact on reducing the percentage of viral failure, but possibly not on toxicity discontinuations.