Can nevirapine be safely substituted for other agents in those with high CD4 cell counts and virologic suppression?
This question was addressed by the observational Dutch cohort study ATHENA, presented by Ferdinand Wit. The concern of course is when nevirapine is started in ART-naive patients with high CD4 cell counts (>250 females, >400 males) there is excessive hepatotoxicity which can be severe. But does this carry over to individuals who are already virologically suppressed, and are switched to nevirapine? One published study from the EuroSida cohort (Antiviral Therapy 12:335, 2007) showed that switching to nevirapine with high CD4 cell counts was significantly safer in ART-experienced patients than in ART-naives. This was particularly true during the first 3 months of therapy. Similarly, the presentation from ATHENA reached similar conclusions. Those with low CD4 cell counts when ART was initiated, but who had high CD4 counts at the time of switching, tolerated the switch to nevirapine as well as ART-naive subjects with low CD4 counts whose initial therapy included nevirapine. These observation
