oa SA Pharmaceutical Journal - Nevirapine and its impact on the lipid profiles of HIV-infected patients : medfile® : clinical review
The focus of several studies has been the relationship between antiretroviral therapy and cardiovascular disease, in particular the outcome of atherosclerosis in HIV-infected patients with low HDL-c levels. HIV-disease itself results in changes in the lipid metabolism. Reduced HDL-c in untreated HIV-infection is partially corrected after the initiation of ART, but longterm treatment may lower HDL-c again and in addition raises other cholesterol fractions even further.
It has however been established that NNRTIs, such as nevirapine and efavirenz, increase HDL-c levels potently. Nevirapine has been documented to increase HDL-c and improve TC/HDL-c ratio more so than does efavirenz. The less atherogenic lipid profile of nevirapine may make it a suitable component in first-line regimens for HIV-positive patients with multiple risk factors of CHD, such as low HDL-c.
In second-line regimens nevirapine has also been found effective. In treatmentexperienced patients, the PI component could be substituted for nevirapine in order to simplify treatment and to improve PI-initiated lipid abnormalities, but correction of all the cholesterol fractions may not be accomplished.
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