How do nevirapine's side effects and CD4 restrictions impact its use in China's HIV treatment market?

How do nevirapine's side effects and CD4 restrictions impact its use in China's HIV treatment market?
Nevirapine remains a key component in China's national free HIV treatment program, but its clinical role is narrowing due to safety concerns. The drug carries significant risks of severe rash and hepatotoxicity, with guidelines recommending avoidance in male patients with CD4 counts above 400 cells/µL and female patients above 250 cells/µL due to elevated liver damage risk. Co-infection with hepatitis B or C also precludes its use. These restrictions, combined with the availability of better-tolerated integrase inhibitors like dolutegravir and bictegravir through medical insurance, are pushing nevirapine toward second-line or special populations, such as those with neurological involvement where its blood-brain barrier penetration offers advantages. Domestic combination products like Jiweijiu (nevirapine+zidovudine+lamivudine) still rely on it, but prescribing is increasingly cautious.