Efficacy of Nevirapine-Based HAART in HIV-1-Infected, Treatment-Naïve Persons with High and Low Baseline Viral Loads [Raffi F et al. HIV Clinical Trials 2001;2:317] The authors provide a composite analysis of six studies with a total of 416 participants who received nevirapine-based HAART. The analysis was divided into those with baseline viral loads greater than or less than 100,000 c/ml to determine the role of viral load in predicting response. The analysis at six months showed 139 of 156 (89%) in the low baseline viral load group achieved a viral load of <200-500 c/ml compared to 82 of 99 (83%) in the high baseline viral load group. The authors conclude that viral load does not affect virologic outcome in treatment naïve patients using an NVP-based HAART regimen.
Comment: Studies to date have demonstrated no difference in virologic outcome based on baseline viral load for efavirenz or lopinavir/ritonavir-based regimens in treatment-naïve patients with HIV infection. This study, although convoluted in the sense of combining results from multiple different studies, tends to support the potential value of nevirapine as well. More interesting is the overall results showing an 89% response rate, which was substantially higher than the retrospective analysis of the Moore clinic database summarized above, where the rates of response and durability of response were much less. This difference in outcome for controlled clinical trials compared to patients treated in inner city clinics is a consistent observation which, once again, emphasizes the very critical role of adherence.
posted 1/14/2002

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