In
an effort to minimize toxicities associated with combination
antiretroviral therapy, researchers have conducted numerous studies looking
at switching drugs. Several of these have explored regimens that omit a specific
class of agents associated with certain side effects, for example protease-sparing
regimens to minimize blood lipid elevations or nucleoside
reverse transcriptase inhibitor (NRTI)-sparing regimens to manage lipoatrophy.
Experts
have also conducted studies of switching within drug classes, since specific agents
within the same class can cause different side effects. This is the case with
the non-nucleoside
reverse transcriptase inhibitors (NNRTIs). One such agent, efavirenz (Sustiva,
also included in the Atripla
fixed-dose combination pill) is associated with neuropsychiatric side effects
such as depression, insomnia, and unusual dreams; another, nevirapine (Viramune),
has been linked with liver toxicity in some studies.
As
reported in the July 15, 2007 issue of Clinical Infectious Diseases, European
researchers conducted a study in which HIV positive patients with dyslipidemia
(abnormal blood fat levels) switched from efavirenz to nevirapine.
As
background, the authors stated that, "Many antiretroviral therapies, including
efavirenz, are associated with increased serum concentrations of low-density lipoprotein
[LDL, or "bad"] cholesterol"; however, lipid abnormalities have
more often been linked to protease
inhibitors, while other studies have found that the incidence of such problems
does not differ based on drug class.
In
a small 52-week randomized study, the authors of the present study found that
"switching from efavirenz to nevirapine was associated with significantly
decreased LDL cholesterol levels, compared with continuation of efavirenz"
(P < 0.04).
Further,
they noted, "A switch to nevirapine was associated with no severe adverse
events."
07/10/07
Reference JJ
Parienti, V Massari, D Rey, and others. Efavirenz to nevirapine switch in HIV-1-infected
patients with dyslipidemia: a randomized, controlled study. Clinical Infectious
Diseases 45(2): 263-266. July 15, 2007.
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