SENC (Spanish Efavirenz vs. Nevirapine Comparison) trial: A randomized, open-label study in HIV-infected naive individuals

Purpose: A randomized, open-label, pilot study was undertaken to explore the antiviral activity and tolerability of two nonnucleoside reverse transcriptase inhibitors (NNRTIs), nevirapine (NVP) and efavirenz (EFV). Method: HIV-infected antiretroviral-naive adults with CD4 counts > 100 cells/mm³ and detectable plasma HIV RNA below 100,000 copies/mL were randomized to receive didanosine (ddl) and stavudine (d4T) plus either NVP or EFV. Assessments were made every 12 weeks. Primary endpoints were the proportion of patients reaching plasma HIV RNA <50 copies/mL and/or developing NNRTI-related toxicities leading to drug discontinuation. Baseline characteristics were comparable for participants in the EFV (n = 31) and NVP arms (n = 36). Results: At 48 weeks, 23/31 (74%) patients in the EFV group and 23/36 (64%) in the NVP group had <50 HIV RNA copies/mL (intention-to-treat analysis). Adverse events led to NNRTI discontinuation in 4 and 3 patients in the EFV and NVP arms, respectively. There were no statistically significant differences between groups regarding any primary endpoint. NVP and EFV along with two NRTIs may be equally well tolerated and effective at achieving <50 HIV RNA copies/mL in naive patients with CD4 counts >100 cells/mm³ and HIV RNA <10⁵ copies/mL. Conclusion: A much larger study is needed to demonstrate any significant differences between NVP and EFV, if they exist at all.