Etravirine (TMC-125): The evidence for its place in the treatment of HIV-1 infection

ravirine (TMC-125): The evidence for its place in the treatment of HIV-1 infection Review (3930) Total Article Views Authors: Hans-Jürgen Stellbrink Published Date July 2009 Volume 2009:4 Pages 149 - 158 DOI: http://dx.doi.org/10.2147/CE.S6009 Hans-Jürgen Stellbrink Infektionsmedizinisches Centrum Hamburg (iCH), Hamburg, Germany Introduction: Etravirine is a novel nonnucleoside reverse transcriptase inhibitor (NNRTI) specifically designed to suppress the replication of viruses resistant to the three currently approved NNRTIs efavirenz, nevirapine, and delavirdine. Aims: To assess the evidence for the place of etravirine in the treatment of HIV-1 infection. Evidence review: In combination with a ritonavir-boosted protease inhibitor etravirine has demonstrated high antiviral activity against strains exhibiting up to three NNRTI resistance mutations. The drug appears to be well tolerated, with only nausea and rash occuring significantly more frequently with etravirine compared with placebo. Of note, neuropsychologic side effects that frequently limit the use of efavirenz were not reported more frequently with etravirine. Place in therapy: Given its high activity against most NNRTI-resistant strains and its very good tolerability, etravirine is of high value for pretreated patients with NNRTI resistance and protease inhibitor exposure. Efforts should be made to demonstrate activity in switching strategies (due to toxicity) and earlier lines of failure or in the setting of primary NNRTI resistance in order to explore the potential of the drug beyond salvage therapy.