Efficacy and durability are particularly important when choosing highly active antiretroviral therapy (HAART) for treatment-naive patients with HIV, alongside long-term safety and tolerability, special circumstances (such as pregnancy) and risk of cardiovascular disease. Regimens containing non-nucleoside reverse transcriptase inhibitors (NNRTIs), including nevirapine (NVP), are as effective as efavirenz, and avoiding NVP in patients with CD4 cell counts >250 cells/mL (women) or >400 cells/mL (men) can prevent hepatotoxicity. In women who become pregnant while already on HAART, the current regimen should be maintained unless it involves potentially teratogenic drugs. Pregnancy is not an independent risk factor for developing liver enzyme elevations or rash with NVP. High levels of low-density lipoprotein (LDL) cholesterol should be controlled to a target, with HAART modified if it is suspected to be increasing the LDL. The European AIDS Clinical Society rate NVP as the drug with the lowest metabolic impact among the NNRTIs and other classes of antiretroviral therapy.
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