Open AccessFirst line etravirine use in naïve patients: real‐world data in a UK centre
Author(s) -
Ward C,
Shaw J,
Ahmad S
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18245
Subject(s) - medicine , efavirenz , tolerability , emtricitabine , etravirine , entecavir , abacavir , hepatitis b , viral load , men who have sex with men , pharmacy , antiretroviral therapy , lamivudine , human immunodeficiency virus (hiv) , gastroenterology , virology , chronic hepatitis , adverse effect , family medicine , virus , syphilis
Etravirine (ETV) is licensed in the UK for treatment‐experienced patients and existing data suggest ETV is an effective switch for patients intolerant of efavirenz (EFV). ETV has a favourable tolerability profile and therefore may be an attractive non‐nucleoside reverse transcriptase inhibitor (NNRTI) option in first line therapy. We present data of ETV use as a once‐daily first‐line treatment option in naïve patients. 26 treatment‐naïve patients commenced on ETV were identified through pharmacy records up until May 2012. Demographic data were collected with information on hepatitis B and C status, CD4, viral load (VL), liver function and lipids. Patients were followed for 6‐monthly intervals and outcomes recorded. Of the 26 patients identified 25 were male and one female. 19 identified as men who have sex with men (MSM), 4 heterosexual and 3 bisexual. 19 were white British and 3 black African. There were no hepatitis B or C co‐infections. ETV was prescribed as 400 mg once daily, co‐prescribed with Truvada in 24 (92.3%) patients, Kivexa in one patient, and tenofovir/abacavir combination in one patient. 3 (11.5%) patients discontinued ETV therapy, 2 due to erythematous rashes in the first 16 days and one after 5 months due to reports of unpalatability. 10 (38.5%) patients chose to dissolve ETV. Median CD4 count at ETV initiation was 326 and median VL was 30,000c/ml. 6 (23.1%) patients had a starting VL>100,000. 6‐month follow‐up data for 19 (73.1%) patients showed a median CD4 of 461 and 18 (94.7%) patients had a VL<40c/mL. One patient had a viral load of 53c/ml with a reduction from a baseline of>1,000,000c/ml. 12‐month data for 17 (65.4%) patients revealed a median CD4 count of 518 and all with VLs <40c/ml at a year. 18‐month follow‐up data of 11 (42.3%) patients showed a median CD4 of 587 and 9 with a VL<40c/ml. 2 patients had a detectable VL due to documented poor adherence. There was no significant change in median alanine transaminase (ALT), bilirubin, total cholesterol, high density lipoprotein or triglycerides from baseline to 6‐, 12‐ or 18‐month levels. Patient preference was towards a once‐daily treatment for ETV. The availability of 200mg tablets and the ease of dissolvability have further increased acceptability. VL suppression was excellent with 100%<40c/ml at 12 months without any virological failures or significant adverse events. This data has shown that ETV is a highly acceptable, effective and well tolerated first‐line treatment option.