Treatment of HIV-infected patients with a combination of efavirenz, nevirapine and nucleoside reverse transcriptase inhibitors

Recently, the results of the 2NN study have been reported [1]. This study was an open-label, randomized, comparative trial of first-line antiretroviral therapy with regimens based on stavudine (d4T) plus lamivudine (3TC) plus either efavirenz (EFV), nevirapine (NVP) or both nonnucleoside reverse transcriptase inhibitors (NNRTIs) taken simultaneously (the 2NN group), with a dose adjustment of 800mg of EFV dosed with 400mg NVP once a day (qd). There was no statistically significant difference reported between the results for EFV and NVP, but the 2NN group showed lower treatment efficacy because of increased adverse events. On the basis of these results, use of NVP plus EFV is not recommended. In this context, we report the findings of a pilot study conducted to investigate both the tolerance and the efficacy of NVP and EFV in combination with nucleoside reverse transcriptase inhibitors (NRTIs), either in protease inhibitor (PI)-sparing regimens or as a second-line therapy in patients with failing PI-based regimens.