Abstract and Introduction
Only a few studies have been conducted on the virologic efficacy of this regimen, and they generally showed poor results.
Current WHO guidelines recommend four options for initial HIV treatment: tenofovir + 3TC + nevirapine, tenofovir/FTC + nevirapine, tenofovir + 3TC + efavirenz, and tenofovir/FTC/efavirenz. However, concerns have been raised about whether these four regimens are equally effective.
Investigators conducted a systematic review of all published or presented studies that involved at least one WHO-recommended first-line regimen. Of the 206 relevant publications identified, 34 met inclusion criteria.
Tenofovir + 3TC + nevirapine was found to be the least-studied regimen and also the one with the poorest results: Of the three studies available, two were prospective trials involving <100 patients. Both were terminated early because of high rates of virologic failure and drug resistance with this regimen. In the third study (a large, retrospective cohort study), tenofovir + 3TC + nevirapine was associated with a higher rate of virologic failure than either AZT/3TC + nevirapine or tenofovir/FTC/efavirenz.
Tenofovir/FTC + nevirapine was evaluated in nine studies (6 prospective); one showed reduced effectiveness with this regimen, and another was stopped prematurely because of a large number of virologic failures.
The two efavirenz-based regimens, especially tenofovir/FTC/efavirenz, were well studied and showed better efficacy than the other regimens, with a lower risk of resistance at the time of treatment failure.
AIDS Clinical Care © 2012 Massachusetts Medical Society