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Just Read Your Latest Blog Entry
Apr 25, 2011

I just read your blog about the new NNRTI expected to come to market in the near future nicked-named B-tripla. By the way, I enjoyed the story. I'm not sure if that was totally real or exaggerated for entertainment purposes. In any event, it made it more interesting.

Anyway, if someone and a genotype that showed resistance to Sustiva and Viramune, would B-Tripla be out, too? I'm learning about all the meds, classes, resistance issues. I thought if someone became resistant to one NNRTI, then it would knock them all out. I would assume this would be the case with B-Tripla and any possible future NNRTI's? Sorry, I can't remember the exact name of the drug--ripla--something??

Response from Dr. Frascino


The new drug is rilpivirine (brand name not yet established). The "B-tripla" was meant just as a funny takeoff on "Atripla," because if the FDA approves the co-formulation of rilpivirine with tenofovir and emtricitabine, the combination will be in direct competition with Atripla (efavirenz, tenofovir and emtricitabine). (See below)

The resistance profile of rilpivirine appears to suggest that it will have activity against NNRTI-resistant virus. However, the FDA may only approve it initially for naive patients. One problem with rilpivirine resistance is that it develops more rapidly than efavirenz resistance. Also, rilpivirine resistance causes cross-resistance to Intelence, which isn't the case with Atripla.

The cross-resistance you mention is most likely K103N, which can cause cross-resistance between Viramune and Sustiva. However, Intelligence (etravirine) is a "second generation" NNRTI and works in most cases when Viramune and Sustiva have failed (developed resistance). Other second generation NNRTIs are in development. Stay tuned to The Body. We'll keep you posted on promising new medications as they are developed, tested and, hopefully, approved.

Dr. Bob

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