Resistance
As with all other anti-HIV drugs, strains of HIV that are resistant to nevirapine (Viramune) may emerge after a period of treatment. The emergence of drug-resistant strains coincides with a fall in the effectiveness of the drug.
A single mutation in the reverse transcriptase gene is sufficient to bring about resistance to nevirapine. The commonest nevirapine-associated mutations are K103N, Y181C, G190A and Y188L[1][2]. Other nevirapine-associated mutations include V106A, Y188C, G190S and M230L.
Once resistance to nevirapine has developed, it is very likely that the virus will also be resistant to the other non-nucleoside reverse transcriptase inhibitor (NNRTI) efavirenz (Sustiva)[3][4]. Conversely, previous exposure to an NNRTI may predispose a person to fail a nevirapine-based regimen, even where standard resistance tests indicate that no NNRTI resistance is present.
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