Contemporary Role of Nevirapine in HIV Treatment

Nevirapine was the first nonnucleoside reverse transcriptase inhibitor that was approved for treatmentof HIV infection and quickly became an important component of HAART. As experience with this druggrew, potential toxicities and significant clinical benefits became apparent. With the development ofnew patient criteria based on CD4+ cell counts, new treatment initiation guidelines were developed.Incorporation of these criteria has reduced the incidence of rare but significant toxicities associatedwith nevirapine therapy to levels seen with other drugs. For treatment-naive patients who meet establishedstarting criteria, or for patients switching from other nonnucleoside reverse transcriptase inhibitor- orprotease inhibitor-based regimens, nevirapine can offer potent and durable viral suppression withsignificant clinical benefits. These benefits include the absence of central nervous system effects inpatients who are at risk for depression, minimal untoward effects on serum lipid profiles, which isespecially important for patients who have other cardiovascular disease risk factors, and relative safetyduring pregnancy for women of childbearing age. Patients who should avoid nevirapine include thosewith prior hypersensitivity reactions, those who do not meet treatment initiation criteria, those whoexperience adverse reactions during induction, and those with existing hepatotoxicity. This review focuseson current information regarding the role of nevirapine in HAART and defines patient groups whoseclinical profiles may warrant consideration of nevirapine.