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Comparative efficacy and safety of regimens including ritonavir-boosted lopinavir or nevirapine in antiretroviral-naïve HIV-1-infected individuals

Purpose of the study

Ritonavir-boosted lopinavir (LPV/r) or nevirapine (NVP) combined with two nucleosides are recommended for first-line regimens in antiretroviral-naïve HIV-1 patients. There are few comparative studies between these different class-based regimens. Efficacy and safety may vary from randomized studies to actual clinical practice.


We analyzed retrospective data from 167 HIV-1 infected antiretroviral-naïve individuals initiating LPV/r or NVP plus two nucleoside transcriptase reverse inhibitors (NRTI) (between 1999 and 2006), according to current guidelines.

Summary of results

LPV/r was given to 46.7%, whereas 53.3% received NVP. Average patient age was 42 years (range, 19-80), 23.4% were women and 72.5% Caucasians. Co-infection with hepatitis viruses was present in 34.1% of all patients. The first most frequently used NRTI backbone was zidovudine-lamivudine (84.4% all patients; 38.3% LPV/r; 46.1% NVP). An alteration on NRTI backbone without study-drug discontinuation was permitted. There were no statistically significant differences between groups in the former baseline variables. Patients receiving a LPV/r-based regimen had, in average, lower baseline T CD4 cell counts (P=0.004, Mann-Withney) and a higher viral load (P<0.0001, Mann-Withney) compared with those receiving NVP. Early response to treatment was evaluated by the number of patients with a viral load decline >1.0 log10 after one month of treatment: 91.7% for LPV/r (n=33/36) and 77.1% for NVP (n=27/35). Undetectable viral load after one year of treatment was 79.3% for LPV/r (n=46/58) and 82.8% for NVP (n=48/58); with an increase in T CD4 cell count by 8.9 and 1.9-fold for LPV/r (n=46) and NVP (n=54), respectively (P=0.003). The overall number of patients that discontinued therapy before completing one year of treatment were, respectively for LPV/r and NVP, 17.9% (n=14/78) and 23.6% (n=21/89). Toxicity was the most referred reason for study-drug discontinuation in both groups. After one year of treatment, toxicity grade III/IV blood biochemistry analyzed values (serum transaminases, total cholesterol, HDL, LDL and triglycerides) were 10.2% (n=27/264) for LPV/r and 8.33% (24/288) for NVP, compared to 6.44% (n=17/264) and 7.99 % (n=23/288) on baseline.


LPV/r seems to have a better early response and immunological improvement. However, excluding the early discontinuation of therapy due to toxicity, NVP seems to have a lesser toxicity impact in the long-term.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Pereira, A., Lopes da Cruz, J., Carvalho, C. et al. Comparative efficacy and safety of regimens including ritonavir-boosted lopinavir or nevirapine in antiretroviral-naïve HIV-1-infected individuals. JIAS 13 (Suppl 4), P11 (2010).

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  • Viral Load
  • Nucleoside
  • Nevirapine
  • High Viral Load
  • Nucleoside Transcriptase Reverse Inhibitor