***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: ABSTRACT Background Patients infected with HIV-1 initiating antiretroviral therapy ( ART ) containing a non-nucleoside reverse transcriptase inhibitor ( NNRTI )  show presumably fewer atherogenic lipid changes than those initiating most ARTs containing a protease inhibitor . We analysed whether lipid changes differed between the two most commonly used NNRTIs , nevirapine ( NVP ) and efavirenz ( EFV ) . Methods and Findings Prospect i ve analysis of lipids and lipoproteins was performed in patients enrolled in the NVP and EFV treatment groups of the 2NN study who remained on allocated treatment during 48 wk of follow-up . Patients were allocated to  NVP ( n = 417 ) , or EFV ( n = 289 ) in combination with stavudine and lamivudine . The primary endpoint was percentage change over 48 wk in high-density lipoprotein cholesterol ( HDL-c ) , total cholesterol ( TC ) , TC : HDL-c ratio , non-HDL-c , low-density lipoprotein cholesterol , and triglycerides . The increase of HDL-c was significantly larger for patients receiving NVP ( 42.5 % ) than for patients receiving EFV ( 33.7 % ; p = 0.036 ) , while the increase in TC was lower ( 26.9 % and 31.1 % , respectively ; p = 0.073 ) , result ing in a decrease of the TC : HDL-c ratio for patients receiving NVP ( −4.1 % ) and an increase for patients receiving EFV ( + 5.9 % ; p < 0.001 ) . The increase of non-HDL-c was smaller for patients receiving NVP ( 24.7 % ) than for patients receiving EFV ( 33.6 % ; p = 0.007 ) , as were the increases of triglycerides ( 20.1 % and 49.0 % , respectively ; p < 0.001 ) and low-density lipoprotein cholesterol ( 35.0 % and 40.0 % , respectively ; p = 0.378 ) . These differences remained , or even increased , after adjusting for changes in HIV-1 RNA and CD4 + cell levels , indicating an effect of the drugs on lipids over and above that which may be explained by suppression of HIV-1 infection . The increases in HDL-c were of the same order of magnitude as those seen with the use of the investigational HDL-c-increasing drugs . Conclusion NVP-containing ART shows larger increases in HDL-c and decreases in TC : HDL-c ratio than an EFV-containing regimen . Based on these findings , protease-inhibitor-sparing regimens based on non-nucleoside reverse transcriptase inhibitor , particularly those containing NVP , may be expected to result in a reduced risk of coronary heart disease OBJECTIVE This prospect i ve , observational , study evaluates the clinical outcomes , drug utilization patterns , and adherence to treatment of patients on highly active anti retroviral therapy ( HAART ) at a government institution in Kerala , India . METHODS Patients who met criteria for treatment of HIV/AIDS were enrolled into the study , given free NNRTI-based combination therapy , and were followed for a period of 6 months . Data regarding demographics , clinical outcome , laboratory results , drug utilization , adherence and adverse effects were collected . Analysis was conducted utilizing descriptive statistics , anova , Fisher-exact , and t-test . RESULTS One hundred and forty-two patients with HIV-1 were enrolled in the study into three treatment groups . The mean age was 37.88 years , 64 % of the patients were male , and 92 % were married . Group 1 was given zidovudine , lamivudine , and nevirapine [ n = 52 ( 37 % ) ] , group 2 was given lamivudine , stavudine , and nevirapine [ n = 51 ( 36 % ) ] , and group 3 was given lamivudine , stavudine , and efavirenz [ n = 39 ( 27 % ) ] . The increase in CD4 was 107.46 ( SD : 106.25 ) . Mean medication adherence for the 104 patients who completed the study , was 90.7 % ; for group 1 : 92.06 % , group 2 : 93.37%1 , and group 3 : 85.71 % ( P > 0.05 ) . Forty ( 38 % ) patients have at least one adverse event to HARRT , with headache being the most common side effect ( 11.5 % ) . Mortality rate was 3.5 % during the course of the study . CONCLUSION Provision of free NNRTI-based combination therapy to patients in Kerala , India , result ed in greater than 90 % adherence leading to better clinical outcomes in terms of increasing CD4 counts and low mortality , for patients consistently attending a treatment clinic Objectives : We wished to determine the efficacy of nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens in antiretroviral-naive patients commencing highly active antiretroviral therapy ( HAART ) and to evaluate the effect of calendar year , nucleoside analogue reverse transcriptase inhibitor ( NRTI ) backbone , sex , and ethnicity on treatment outcome . Methods : Antiretroviral-naive individuals commencing efavirenz or nevirapine with dual-nucleoside analogue backbones were identified from a prospect i ve data base . Virological success was defined as HIV viral load < 500 copies per milliliter . Treatment failure was defined as a switch or discontinuation of NNRTI or documented virological failure ( 2 measurements with viral load > 500 copies/mL ) . Results : From a cohort of 994 individuals , 73 % commenced efavirenz- and 27 % nevirapine-containing regimens . We found no differences between the 2 treatment groups for the time to virological success ( proportion with virological success : efavirenz 71 % , nevirapine 72 % , P = 0.77 ) or treatment failure ( proportion failing treatment : efavirenz 23 % , nevirapine 26 % , P = 0.58 ) . There was a significant difference in the calendar year for commencing HAART for the time to virological success and treatment failure ( P < 0.001 ) . In the multivariable model , the likelihood of virological success for stavudine/lamivudine was 52 % [ relative hazard ( RH ) 1.52 , 95 % confidence interval ( CI ) 1.17 to 1.97 , P = 0.002 ] . The nonthymidine analogue backbones as a group seemed to be least likely associated with virological success ( RH 0.62 , 95 % CI 0.48 to 0.80 , P < 0.001 ) . This was however largely driven by tenofovir/didanosine being significantly associated with treatment failure ( RH 6.48 , 95 % CI 3.81 to 11.0 , P < 0.001 ) . Sex and ethnicity were not associated with treatment outcome . Conclusions : We found no significant differences between nevirapine and efavirenz for the time to virological success or treatment failure . Calendar year of commencing HAART and NRTI backbones were significant predictors of virological success and treatment failure , explaining differences in data to the 2NN study . The weaker the NNRTI ( or the weaker the protease inhibitor ) the more important the NRTI backbone becomes Objectives and Design We used data from a r and omized trial of HIV-tuberculosis co-infected patients in Mozambique to determine the incidence and predictors of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome ( IRIS ) occurring within 12 weeks of starting antiretroviral therapy , and to evaluate its association with patient outcome at 48 weeks . Methods HIV-tuberculosis co-infected and antiretroviral therapy-naïve adults with less than 250 CD4/mm3 were r and omized to a nevirapine or efavirenz-based antiretroviral therapy initiated 4 to 6 weeks after starting tuberculosis treatment , and were then followed for 48 weeks . Tuberculosis cases were diagnosed using WHO guidelines , and tuberculosis-IRIS by case definitions of the International Network for the Study of HIV-associated IRIS . Results The 573 HIV-tuberculosis co-infected patients who initiated antiretroviral therapy had a median CD4 count of 92 cells/mm3 and HIV-1 RNA of 5.6 log10 copies/mL. Mortality at week 48 was 6.1 % ( 35/573 ) . Fifty-three ( 9.2 % ) patients presented a tuberculosis-IRIS within 12 weeks of starting antiretroviral therapy . Being female and having a low CD4 count , high HIV-1 RNA load , low body mass index and smear-positive pulmonary tuberculosis were independently associated with tuberculosis-IRIS . After adjustment for baseline body mass index , CD4 count and hemoglobin , occurrence of tuberculosis-IRIS was independently associated with 48-week mortality ( aOR 2.72 95%CI 1.14 - 6.54 ) . Immunological and HIV-1 virological responses and tuberculosis treatment outcomes were not different between patients with and without tuberculosis-IRIS . Conclusion In this large prospect i ve cohort , tuberculosis-IRIS occurrence within 12 weeks of starting antiretroviral therapy was independently associated with the mortality of HIV-tuberculosis co-infected patients at 48 weeks post antiretroviral therapy initiation OBJECTIVE The relationships between adverse events ( AEs ) and plasma concentrations of  nevirapine ( NVP )  and efavirenz ( EFV ) were investigated as part of the large , international , r and omized 2NN study . METHODS Treatment-naive , HIV-1-infected patients received NVP ( once or twice daily ) , EFV or their combination , each in combination with lamivudine and stavudine . Blood sample s were collected on day 3 and weeks 1 , 2 , 4 , 24 and 48 . Concentrations of NVP and EFV were quantitatively assessed by a vali date d HPLC assay . Individual Bayesian estimates of the area under the plasma concentration-time curve over 24 h ( AUC24h ) , and minimum and maximum plasma concentrations ( Cmin and Cmax ) as measures for drug exposure of NVP and EFV , were generated using a previously developed population pharmacokinetic model . Pharmacokinetic parameters were compared for patients with and without central nervous system ( CNS ) and psychiatric AEs , hepatic events , liver enzyme elevations ( LEEs ) and rash . Furthermore , it was investigated whether a clear cut-off for a pharmacokinetic parameter could be identified above which the incidence of AEs was clearly increased . AEs were also related to demographic parameters and baseline characteristics . RESULTS In total , from 1077 patients , NVP ( 3024 sample s ) and EFV ( 1694 sample s ) plasma concentrations and AE data ( 825 observations ) were available . For all patients Cmin , Cmax and AUC24h were determined . When corrected for known covariates of gender , CD4 cell count at baseline , region , hepatitis coinfection and possible interactions between these factors , no significant associations between AEs and any tested exposure parameter of NVP was observed . Also , no target Cmin value , above which patients were at increased risk for AEs , could be established . On the other h and , geographical region , hepatitis coinfection , CD4 cell count and gender were found to be significantly related with the incidence of CNS and psychiatric AEs , hepatic events , LEEs and rash during the treatment with NVP . The occurrence of elevated liver enzymes during the first 6 weeks in the EFV-containing arm was significantly ( P = 0.036 ) correlated to the exposure of EFV ( Cmin ) . Only hepatitis coinfection impacted on LEEs during the first 6 weeks of treatment . With an EFV Cmin above 2.18 mg/l during the induction phase , patients were 4.4 ( range 1.3 - 15.5 ) times more at risk for elevated liver enzymes . No other correlations between AEs and EFV pharmacokinetics or patient characteristics could be identified . CONCLUSIONS Pharmacokinetic parameters of NVP did not have a relationship to AEs in the 2NN trial when corrected for known covariates . The value of periodical drug monitoring of NVP as a way to prevent toxicity is therefore limited . Treating physicians should instead focus on factors that are more predictive of AEs ( gender , CD4 count and hepatitis coinfection ) . High EFV Cmin levels result ed in elevated liver enzyme values during the first 6 weeks of treatment . Regular measurement of  EFV levels and liver enzymes at the start of therapy may therefore be advised CONTEXT Rifampicin-based antitubercular therapy reduces the plasma concentrations of nevirapine and efavirenz . The virological consequences of these interactions are not well described . OBJECTIVE To assess the effectiveness and tolerability of concomitant efavirenz- or nevirapine-based combination antiretroviral therapy and rifampicin-based antitubercular therapy . DESIGN , SETTING , AND PARTICIPANTS C 
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There were little or no differences in the primary outcomes for patients who were concurrently receiving treatment for tuberculosis .
Authors ' conclusions Both drugs have similar benefits in initial treatment of HIV infection when combined with two NRTIs .
The adverse events encountered affect different systems , with EFV more likely to cause central nervous system adverse events and NVP more likely to raise transaminases , cause neutropenia and rash .