HIV/AIDS HAART: Nevirapine resistance decreases survival time associated with NVP-based HAART

AIDSWEEKLY Plus; Monday, July 24, 2006
Staff Medical Writers

"Nevirapine (NVP) resistance may decrease the effectiveness of viral suppression with NVP-based antiretroviral therapy (ART) in women infected with human immunodeficiency virus (HIV) with previous exposure to single-dose NVP. However, the alternative lopinavir-ritonavir-based ART regimen is more expensive," researchers in the United States report.

According to C.B. Holmes and colleagues at Massachusetts General Hospital in Boston, "Our objectives were to project the tradeoffs regarding life expectancy, cost, and cost-effectiveness of these ART regimens for NVP-exposed, HIV-infected women in South Africa.

"We developed a simulation model in which NVP-exposed, HIV-infected South African women received 1 of 5 treatment strategies: HIV care without ART, NVP-based ART, lopinavir-ritonavir-based ART, NVP-based ART followed by lopinavir-ritonavir-based ART, or lopinavir-ritonavir-based ART followed by NVP-based ART."

"The prevalence of NVP resistance was 39%; other data were obtained from the published literature. Projected life expectancy was 43.7 months for women who did not receive ART, 77.4 months for women who received a single NVP-based regimen, and 84.5 months for women who received a single lopinavir-ritonavir-based regimen.

"NVP resistance reduced survival time by up to 11.6 months among women who received NVP-based ART. The cost-effectiveness of NVP-based ART was $800 (US dollars) per year of life saved, compared with no ART, and the cost-effectiveness of lopinavir-ritonavir-based therapy was $4400 per year of life saved, compared with NVP-based ART," scientists wrote.

The authors continued, "Lopinavir-ritonavir followed by NVP-based ART yielded the greatest life expectancy (105.4 months), had a cost-effectiveness of $2300 per year of life saved, and, if the efficacy of NVP-based regimens improved 16 months postpartum, further increased survival.

"NVP resistance substantially decreased the projected survival time associated with NVP-based ART, and lopinavir-ritonavir-based ART resulted in a superior survival time but at higher cost."

"A sequential regimen starting with lopinavir-ritonavir-based ART followed by NVP-based ART maximized projected survival and was cost effective in South Africa," Holmes concluded.

Holmes and colleagues published their study in Clinical Infectious Diseases (Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine: Balancing efficacy and cost. Clin Infect Dis, 2006;42(12):1772-1780).

For additional information, contact C.B. Holmes, Massachusetts General Hospital, Division General Med, Dept. Med, 50 Staniford St., 9th Fl, Boston, MA 02114, USA.

Publisher contact information for the journal Clinical Infectious Diseases is: University Chicago Press, 1427 E 60th St., Chicago, IL 60637-2954, USA.

Keywords: Boston, Massachusetts, United States, HIV/AIDS, Nevirapine Resistance, Life Expectancy, Cost Effectiveness, HAART.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Holmes CB, Zheng H, Martinson NA, et al., “Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine: balancing efficacy and cost”, Clin Infect Dis. 2006 Jun 15;42(12):1772-80.

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