A head to head study of nevirapine versus nelfinavir combined with AZT/3TC shows that after 24 weeks, patients receiving nevirapine had significantly better viral suppression. In the sub-group of patients with viral load above 100,000 copies at baseline, nevirapine also performed significantly better than nelfinavir.
Although the number of patients studied is small, the findings are likely to call into question recently updated US guidelines, which suggest that nevirapine is a less favoured option than efavirenz, nelfinavir or indinavir when choosing drugs for an initial HAART combination.
The Combine study randomised 142 patients to receive Combivir (AZT/3TC in a single tablet) twice daily and either 200mg of nevirapine twice daily or 1250mg of nelfinavir twice daily.
After 24 weeks, 58% of the nevirapine group had viral load below 20 copies compared with 33% of the nelfinavir group. In the sub-group with baseline viral load greater than 100,000 copies, 57% (n = 15) of the nevirapine group had viral load below 20 copies, compared with 22% (n = 22) of the nelfinavir group.
The discontinuation rate in the study due to adverse events was 16% overall; in the nevirapine group the majority of discontinuations were due to elevated liver enzymes, whilst in the nelfinavir group the majority of discontinuations were due to diarrhoea. Only two patients discontinued nevirapine due to serious rash.
Reference
Podzamcer D et al. Preliminary results of a randomised multicenter study comparing Combivir (AZT/3TC) plus nelfinavir or nevirapine in HIV-infected naïve patients (COMBINE) study. Abstract 510, Seventh Conference on Retroviruses, San Francisco, 2000.