Good study design and subset/sensitivity analyses can help address the potential limitations of retrospective cohort studies, as was the case in this study. These data — drawn from more than 20,000 patients starting ART — provide convincing evidence that, for most patients, efavirenz is preferred over nevirapine. As with any ART decision, of course, individual patient characteristics and situations may override general recommendations, and nevirapine remains an effective, important option for initial treatment in selected patients. For the majority of patients, however, efavirenz appears to be the better option.
AIDS Clinical Care © 2012 Massachusetts Medical Society