The presence of high rates of NNRTI
resistance mutations conferring resistance to ETR in nearly 50% of subjects is likely to reflect virological failure on first- or second-line NNRTI
-based ART regimens.
Other new INSTIs, NNRTIs
and PIs are currently being evaluated in phase I/II studies, as are improved formulations for delivery, such as injectable ARVs, including cabotegravir and rilpivirine.
Brazilian treatment guidelines recommend NNRTI
based regimens as first line ART since 2000, earlier than the ART scale up in other low/middle-income countries, (19,20) and this may have negatively impacted the emergence of NNRTI
TDR in our setting.
This limitation can be justified by standard criteria currently using the protocol for treatment of adult HIV positive patients, which recommends that the initiation of ART is performed with 2 NRTI + NNRTI
, particularly EFZ600 + ATC.
If the severe rash was due to EFV, neither NNRTI
should be given again and a protease-inhibitor based regimen used instead.
drug resistant mutations in the RT gene at baseline and follow up NNRTI
mutations ART regimen K103 N Y181 C Y188C Baseline (N = 8) Nil Nil Nil Post Sd-NVP (N = 12) 3 1 1 * * 1 woman had more than one mutation at follow up
-naive patients with no NNRTI
and at least 2 fully active NRTIs on genotyping, a simple switch to 2 NRTIs + NNRTI
may be appropriate.
Efficacy and tolerability of TMC125 in HIV patients with NNRTI
and PI resistance at 24 weeks: TMC125-C223.
DPC 083 - has excellent activity against resistant strains of virus, including virus resistant to other NNRTIs
Four of the patients taking NNRTI
regimens switched to PI therapy later in pregnancy, said Dr.
I found this particularly interesting because the current protease inhibitors and some NNRTI
drugs are known to cause abnormal redistribution of body fat and potentially fatal liver toxicities.
Capravirine is an NNRTI
in phase III clinical trials by Agouron Pharmaceuticals.
Working with the manufacturer, researchers from the California Collaborative Treatment Group tested 164 patients and detected NNRTI
hypersusceptibility in 24%.
This marks the first time the panel has suggested a combination regimen containing an NNRTI
as a preferred first-line treatment option.