EFV and NVP are both equally effective in the suppression of HIV infection when compared as part of a three-drug combination.

The introduction of highly active antiretroviral therapy as treatment for HIV infection has greatly reduced mortality and morbidity for adults and adolescents living with HIV around the world. The recommended initial treatments for HIV infection include two drugs from a class of drugs known as nucleoside reverse transcriptase inhibitors (NRTI) and one from a related class of drugs called non-nucleoside reverse transcriptase inhibitors (NNRTI). The two NNRTIs currently in use are nevirapine (NVP) and efavirenz (EFV). NVP can cause liver damage and severe rash, both of which can be fatal. EFV may also cause a rash, impair mental function, and cause foetal malformations. The purpose of this review is to assess which of these two medications is better for initial treatment of HIV infection. We identified seven randomised controlled trials. A review of these trials shows that both drugs are equally effective in suppressing HIV infection but cause different side effects. Based on limited data, it appears that EFV is slightly less likely to cause side effects and more likely to prevent death than NVP. Future studies and recommendations should focus on specific toxicities and risk of resistance when comparing these two medications.