Nevirapine or Efavirenz

Which Is Best for Women of Childbearing Age?

Mauro Schechter, MD, PhD


AIDS Clinical Care 

In This Article

Abstract and Introduction


Current recommendations favor nevirapine, but the results of a modeling study seem to favor efavirenz.


The WHO recommends that first-line antiretroviral therapy (ART) in resource-limited settings contain either efavirenz or nevirapine. These two drugs have similar virologic efficacy but distinct disadvantages. Nevirapine is associated with more treatment-limiting side effects, which could lead to earlier regimen switches and thus decrease long-term survival. However, efavirenz is potentially teratogenic, which is a major concern in many resource-limited settings, because women of childbearing age make up a large proportion of the HIV-infected population, fertility rates are high, and effective, affordable contraception is not widely available. Currently, nevirapine is preferred over efavirenz for women of childbearing age, but the results of a new modeling study seem to favor efavirenz.

Researchers used a computer simulation model to project maternal survival and infant birth defects in a cohort of 100,000 women starting ART with efavirenz-based-regimens and 100,000 starting ART with nevirapine-based regimens. Demographic characteristics as well as morbidity and mortality rates were derived from four studies conducted in Côte d'Ivoire. Birth defect rates were based on data from the U.S. Antiretroviral Therapy Pregnancy Registry.

The model indicated that 10 years after ART initiation, 911 more women would be alive in the efavirenz cohort than in the nevirapine cohort, with only 59 more birth defects in efavirenz-exposed infants. In other words, for every one additional birth defect seen in the efavirenz cohort, 15 additional women survived. The robustness of the model was supported by extensive sensitivity analyses.


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