HIGH-DOSE NEVIRAPINE - SAFETY, PHARMACOKINETICS, AND ANTIVIRAL EFFECT IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Nevirapine, a potent nonnucleoside reverse transcriptase inhibitor, produces a transient antiviral effect at less than or equal to 200 mg/day due to the selection of resistant virus. To examine if higher levels of nevirapine could produce sustained antiviral activity, its safety, pharmacokinetics, and antiviral activity at 400 mg/day were studied in 21 patients. There was a rapid reduction in immune complex-dissociated p24 antigen and serum human immunodeficiency virus RNA concentration in all patients, and 8 of 10 patients had >50% reduction at 8 weeks. Nevirapine-resistant virus was isolated from all subjects tested at 12 weeks: The mean plasma trough level (4.0 mu g/mL [15.8 mu M]) exceeded the mean IC50 of resistant virus. Rash developed in 48% of patients and was a dose-limiting toxicity factor in 6. These data suggest that clinical testing of potent antiviral compounds that select for drug-resistant virus is justified to determine if serum levels of drug sufficient to overcome resistant virus can be attained.