7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)

Abstract

WEAB0105 - Oral Abstract


Long term therapeutic success of etravirine in switch and naive patients

Presented by Lauren Bull (United Kingdom).

L. Bull, M. Bower, M. Nelson


Chelsea and Westminster Hospital, London, United Kingdom

Background: Etravirine is a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) that is effective in those naïve to therapy, those requiring salvage therapy and those experiencing toxicity to efavirenz.
Methods: We identified HIV infected individuals who commenced etravirine and two nucleoside reverse transciptase inhibitors (NRTI's), and undertook a retrospective case review of the success of this therapeutic approach to 1 December 2012.
Results: 389 individuals commenced a regimen of 2 NRTIs (TFV+FTC 87%, ABC+3TC 11%, other 2%) and etravirine. 345 had an undetectable viral load, < 50 copies/ml, at commencement and 44 a detectable viral load (median 44296 copies/ml, range 508-1819837). Of the 345 with undetectable viral load; 210 switched from Atripla, 38 individuals switched from other efavirenz containing regimens. 67 switched from protease inhibitors (PI's). 246 switched due to central nervous system side effects. The reasons for switch from PI's were predominantly adverse drug reactions (ADR's) including diarrhoea (14), weight gain (11), and drug interactions (8). In individuals switched with an undetectable viral load- at 3 months 281/285 (99%) on therapy continued with an undetectable viral load. At six months 99% maintained an undetectable viral load and 96%, 97% ,97%, 100%, 100% at 1,2, 3, 4 and 5 years. 86 individuals stopped etravirine. 63 of these had been on efavirenz previously and 31 (50%) of these stopped etravirine due to continuation of the same symptoms perceived to be due to efavirenz. The others developed new ADR's. Three stopped etravirine with viraemia, one developed resistance to etravirine (181C). In individuals who commenced etravirine with a detectable viral load; 24/44 had possible efavirenz ADR's. 27/44 fully suppressed their viral load on etravirine and remained suppressed for a median of 1 year (range three months to 3 years). 4 stopped due to an ADR and 5 for drug interactions. 6 switched due to continued viraemia, all were non-compliant with their medications with 1 developing resistance to the NRTI component of the regimen and four to etravirine.
Conclusions: Our cohort demonstrates that etravirine is well tolerated and effective in individuals requiring a switch in therapy. Developing etravirine resistance is rare in individuals developing viraemia.


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