7th International AIDS Society Conference, Kuala Lumpur, June 2013:
For HIV-positive people currently on treatment who may need help with better controlling their blood fat levels, switching to the NNRTI etravirine (Intelence) may offer them an option. A retrospective British study followed 389 people between 2008–2012 who had switched to etravirine from regimens with efavirenz (Sustiva) or various protease inhibitors.
Most people (88%) had undetectable viral loads and averaged 505 CD4s before the switch. The others had average viral loads of 44,296 and CD4 counts of 300. The most common reason for switching from efavirenz was neurological side effects. The most common reasons for switching from protease inhibitors were gut issues (like diarrhea), drug interactions and concerns about cardiovascular problems. 98% took either Truvada or Epzicom as the NRTI backbone with etravirine.
As for changes in blood fats, people experienced improvements in their various lipid levels. Significant decreases occurred in triglyceride levels, total cholesterol and LDL (low-density lipoprotein) or “bad cholesterol”. The HDL (high-density lipoprotein) level or “good cholesterol” also decreased but only slightly, although the ratio of LDL-to-HDL improved.
For those with undetectable viral loads before the switch, 99% continued to be suppressed 6 months after. This high rate continued through 5 years (96–100%), although the study followed fewer people as the years went on. Average CD4 counts increased to above 650 after 3 and 4 years of follow-up.
For those with detectable viral loads before the switch, 61.3% had undetectable levels at 6 months. However, 86 people stopped etravirine due to side effects similar to efavirenz, including 31 who actually had been on efavirenz. Three people who were originally undetectable became detectable while on etravirine.
For people who have high cholesterol and triglyceride levels, switching to etravirine may be an option for them and still stay undetectable.
ABSTRACTS
L Bull, M Bower, an M Nelson. Long term therapeutic success of etravirine in switch and naive patients. 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013.
R Calin, MA Valantin, A Simon A, et al. Raltegravir/etravirine dual therapy as a virologically safe treatment option in suppressed HIV-1-infected patients without previous NNRTI failure. 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013.
For more detailed discussion on this topic, go to HIVandHepatitis.com.