news: treatment Raltegravir versus efavirenz at 192 weeks
Raltegravir, an integrase inhibitor whose use is limited to the most treatment- experienced patients in London has demonstrated better efficacy in people starting therapy compared to a treatment regimen containing efavirenz (Sustiva) at 192 weeks of treatment. In total 76.2% of those taking raltegravir had a viral load <50 copies at 192 weeks compared with 67% of those taking efavirenz. CD4 gains were higher among those treated with raltegravir too; at 360 versus 300 cells.
New Gilead/Janssen Etravirine matches 3-in-1 pill to be launched Efavirenz The next-generation non-nucleoside this month
The U.S. Food and Drug Administration recently approved a new once-daily all-in-one pill for people starting HIV treatment. The pill contains tenofovir and emtricitabine (the two drugs in the Truvada combination pill) plus a new NNRTI called rilpivirine. Two recent trials showed that rilpivirine works as well as efavirenz (Sustiva) for people starting therapy, but causes fewer side effects, especially neuropsychiatric symptoms such as dizziness and abnormal dreams. Overall, at 48 weeks, 83% of people taking rilpivirine and 81% taking efavirenz had a viral load less 50 copies/mL. The most common side effects in the rilpivirine arm were insomnia and headaches. Some studies indicate that rilpivirine may not work as well for people who start therapy with a high HIV viral load (> 100,000 copies/mL). The new combination tablet is to be licensed in Europe later this month. It will be called Eviplera. 48 Autumn 2011
reverse transcriptase inhibitor (NNRTI) etravirine (Intelence) works as well as the widely-used NNRTI efavirenz (also known as Sustiva and part of the Atripla combination tablet) but with fewer central nervous system side effects. 157 people who were starting HIV treatment with a viral load greater than 5,000 copies/mL received either 400 mg once-daily etravirine or 600 mg once-daily efavirenz, both in combination with 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs); either tenofovir/emtricitabine (Truvada), abacavir/lamivudine (Kivexa), or zidovudine/lamivudine (Combivir). More patients developed treatment failure (7) and drug resistance (3) on efavirenz compared with etravirine (4 experienced treatment failure and no resistance was documented). Only 6.3% of those receiving etravirine reported ongoing neuropsychiatric side effects compared with 21.5% of those taking efavirenz.