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Meta-Analysis
. 2013 Oct 7;8(10):e76587.
doi: 10.1371/journal.pone.0076587. eCollection 2013.

Nevirapine-based regimens in HIV-infected antiretroviral-naive patients: systematic review and meta-analysis of randomized controlled trials

Paweł Kawalec  1 , Joanna Kryst, Alicja Mikrut, Andrzej Pilc
Affiliations
Meta-Analysis

Nevirapine-based regimens in HIV-infected antiretroviral-naive patients: systematic review and meta-analysis of randomized controlled trials

Paweł Kawalec et al. PLoS One. .

Abstract

Background: Nevirapine belongs to the group of non-nucleoside reverse transcriptase inhibitors (NNRTIs) and is commonly administered in first-line treatment of HIV infection.

Objective: Systematic review and meta-analysis was undertaken to compare effectiveness of nevirapine-based regimens with other antiretroviral schedules used as an initial treatment of HIV-infected antiretroviral-naive subjects.

Methods: Electronic databases (PubMed, EMBASE, the Cochrane Library, Trip Database) were searched up to 28 December 2012 for randomized controlled trials (RCTs) published as a full text and regarding nevirapine-based regimens used as a initial treatment for HIV infection. Meta-analysis was performed with RevMan(®) V 5.2 software.

Results: Twelve RCTs were included in the systematic review and all of them were suitable for meta-analysis. Results of the meta-analysis have shown that nevirapine, efavirenz, and ritonavir-boosted protease inhibitor, added to the background regimens, were equally effective in terms of reaching undetectable plasma HIV RNA level as well as risk of disease progression or death. Compared with ritonavir-boosted protease inhibitor-based regimens, nevirapine-based regimens statistically significantly increased the risk of discontinuation of assigned treatment (RR=3.10; 95% CI: 1.14-8.41; p<0.05).

Conclusions: Despite limited RCTs data available for particular comparisons, our results suggest that nevirapine-based regimens may be considered for first-line treatment of HIV-infected adults, due to their comparable efficacy to the other currently recommended initial antiretroviral therapies.

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Conflict of interest statement

Competing Interests: We have no conflicts of interest to disclose in relation to this study. We would like to emphasize that three of the authors of the article are employed in Centrum HTA Sp z o.o. Sp komandytowa but that fact does not alter our adherence to all the PLoS One policies on sharing data and materials because the Centrum HTA was never involved in assessment of any of antiretroviral drugs; what is more Centrum HTA never co-operated with Boehringer Ingelheim which is trade owner of nevirapine (trade name Viramune). Authors of the article have no private or professional connection with neither Boehringer Ingelheim nor another pharmaceutical company involved in HIV drug investigation, development or manufacturing.

Figures

Figure 1
Figure 1. PRISMA flow diagram for selection of studies identified in the systematic review.
Figure 2
Figure 2. Forest plot of comparison: nevirapine vs 1 NNRTI (efavirenz) added to the background regimen.
Figure 3
Figure 3. Forest plot of comparison: nevirapine vs bPI added to the background regimen.
See this image and copyright information in PMC

References

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