Etravirine with 2 NRTIs: an effective switch option for ARV simplification and side effect management

Etravirine (ETV) has been approved for use in treatment‐experienced patients based on results of the Duet clinical trials [1]. Less experience exists with ETV in earlier stages of treatment. ETV has a favorable genetic barrier, lipid profile, and little associated CNS toxicity. These characteristics make ETV attractive as a switch strategy for simplification and/or management of side effects. A retrospective chart review was conducted at a large urban HIV clinic in Toronto. All patients who were switched to ETV plus 2 nucleosides and whose viral load (VL) was <200 copies/ml at the time of switch were included. Maintenance of viral suppression, CD4 and lipid changes at 24 weeks and reason for switch to ETV are reported. Seventy‐three patients (67 male) were identified. Mean age was 46±10 and mean duration of HIV infection was 11.7±7.4 years. Switches were from efavirenz=29, atazanavir=23, lopinavir=16, other=5. Duration of prior regimen was long; median 195 weeks. CNS and GI intolerance were the most common reasons for switches. At the time of analysis, 63 patients had reached week 24. Three patients had discontinued ETV prior to week 24, 3 LTF/U, 4 had <24 weeks follow‐up. 92% (67/73) maintained VL suppression (ITT); failures were 6 patients who stopped/lost‐to‐follow‐up prior to week 24. On treatment, CD4 increased and lipid decreased changes as seen below. All patients who switched due to CNS side effects had subjective improvement.Baseline Change from baseline to week 24 (OT, n=63) P valueCD4 (cells/mm 3 ) 632±269 +49±137 <0.01 Total cholesterol (mmol/L) 4.76±1.11 −0.57±0.77 <0.01 HDL (mmol/L) 1.20±0.36 −0.05±0.21 0.06 LDL (mmol/L) 2.71±1086 −0.40±0.73 <0.01 Triglycerides (mmol/L) 2.06±1.86 −0.55±1.76 0.02Switch to ETV plus 2 nucleosides maintained viral suppression, improved lipid profiles and improved side effect profile in this selected group of patients. 48 week f/u will be presented.