Ward Douglas, Slim Jihad
Dupont Circle Physicians Group, Washington, DC, USA.
J Int Assoc Provid AIDS Care. 2013 May-Jun;12(3):154-6. doi: 10.1177/2325957412473648. Epub 2013 Feb 28.
Nevirapine (NVP) was the first nonnucleoside reverse transcriptase inhibitor (NNRTI) approved for the treatment of HIV infection. NVP can provide safe and efficacious viral suppression for treatment-naive patients and for virologically controlled patients "switching" from other NNRTI or protease inhibitor-based regimens. Formulations allowing once-daily dosing of antiretrovirals can significantly improve regimen adherence, which is important for maintaining virologic control, especially for NNRTI-based regimens with low barriers for genetic resistance. Randomized and controlled clinical trials have established the clinical non inferiority of a new, extended-release formulation (XR) of NVP, in both treatment-naive (VERxVE) and treatment-experienced patients (TRANxITION), where patients already stable on the immediate-release formulation of NVP were safely transitioned directly to NVP XR. As a potentially more convenient once-daily option, NVP XR may improve adherence and reduce the risk of mutant viruses, attendant virologic failure, and the spread of drug resistance.
奈韦拉平（NVP）是首个被批准用于治疗HIV感染的非核苷类逆转录酶抑制剂（NNRTI）。对于初治患者以及从其他基于NNRTI或蛋白酶抑制剂的治疗方案“转换”过来且病毒学得到控制的患者，NVP能够提供安全有效的病毒抑制作用。允许每日一次服用抗逆转录病毒药物的制剂可以显著提高治疗方案的依从性，这对于维持病毒学控制非常重要，特别是对于基于NNRTI且基因耐药屏障较低的治疗方案。随机对照临床试验已证实，一种新的奈韦拉平缓释制剂（XR）在初治患者（VERxVE）和经治患者（TRANxITION）中均具有临床非劣效性，在这些试验中，已在奈韦拉平速释制剂上病情稳定的患者被安全地直接转换为奈韦拉平XR。作为一种可能更方便的每日一次用药选择，奈韦拉平XR可能会提高依从性，并降低突变病毒风险、随之而来的病毒学失败风险以及耐药性传播风险。
