Nevirapine more like to suppress VL than Efavirenz?

[Matty the Damned]

Some fairy from what used to be called the AIDS Council of NSW (ACON) thinks so:

The goal of HIV treatment is to reduce the amount of HIV in your blood to ‘undetectable’, thus enabling your CD4 count to increase and your immune system to return to optimal function. An undetectable result does not necessarily mean that there is no HIV in your blood, or other parts of your body, rather the test used cannot detect (find) any HIV in your blood.

Most tests used in pathology labs have a ‘sensitivity’ or ability to detect HIV at 40 or 50 ‘copies’ 1 per ml or drop of blood. This means such tests cannot detect HIV below these levels, so someone with an undetectable result could still have active HIV in their blood below these levels. In recent years, new and more highly sensitive HIV viral load tests have been developed that can detect a viral load below one copy/ml. Although being undetectable at less than 1 copy/ml could be considered to be zero in plasma, or the liquid part of blood, HIV can still ‘hide out’ in parts of the body called reservoirs. Examples of these reservoirs include the brain, gut and the lymph nodes.

The rest can be read here.

It's interesting that ACON still puts these articles out, given that they abandoned their commitment to HIV positive people a few years back. Maybe that's why it's been published by PLWHA (NSW).

These days ACON prefers to focus on "gay and lesbian health", whatever that might mean.

In any event our correspondent, ever intrepid, manages to honour the great ACON tradition of saying not a whole lot:

It’s currently unclear what the benefits are of having a viral load of zero. However, it’s known that even low levels of HIV can cause inflammation and that this can increase the risk of some serious illnesses, for example cardiovascular disease and some cancers. Therefore including Nevirapine in your combination could in theory reduce the risk of developing these health issues. It is also theorised that the lower someone’s viral load the less chance they have of passing on HIV during unprotected sex, in the absence of another STI or lesion (cut or sore) to the genitals.

Who woulda thunk it?

MtD

[newt]

It's the nevirapine, stoopid (original but rather good IMHO)

- matt

[eric48]

The Good viramune penetration has drawn a bit more attention recently and is a reason why some lead doctors, who, in my area, were notorious for being anti NVP and pro-PI are making a remarkable U-turn.

My doc mentioned this with a smile because he says he was being mocked by fellow docs for prescribing (still) viramune and is happy to see it back as more fashionable.

Good viramune penetration was the deciding factor for putting me on Viramune in the first place

recent study shows that Viramune users have a 80% chance to reach VL down to one after being UD for a while.

(note EFV results was 50% on the top of my mind)

the original scientific paper is here:

http://www.ncbi.nlm.nih.gov/pubmed/21157295

Higher efficacy of nevirapine than efavirenz to achieve HIV-1 plasma viral load below 1 copy/ml.)

Viramune is not for everyone though, some people can't stand it.

For those who can pass the initial phase where very adverse SE are sometimes observed, it is very well tolerated, and there are some benefits:

-once daily
- low cost
- has a generic
- will go off patent in 2012
- increases HDL

For those who can't (rash, liver damage), it seems to be a devastating experience

Hence some docs like it, some don't

All  my 3 meds, it is the one I feel the most comfortable with.

It will also draw more attention as part of maintenance strategy (switch-to)  

Eric (currently at VL 24 after 10 months into treatment)
(and who was scared like shit to be started on this one...)