March 28, 2012
Etravirine is a non-nucleoside reverse transcriptase inhibitor (a "non-nuke" or NNRTI). These drugs stop HIV from multiplying by preventing the reverse transcriptase enzyme from working. This enzyme changes HIV's genetic material (RNA) into the form of DNA. This step has to occur before HIV's genetic code gets inserted into an infected cell's genetic codes.
There are no absolute rules about when to start ART. You and your health care provider should consider your CD4 cell count, your viral load, any symptoms you are having, and your attitude about taking HIV medications. Fact Sheet 404 has more information about guidelines for the use of ARVs.
If you take etravirine with other ARVs, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer.
Fact Sheet 126 for more information on resistance.
Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance." Cross-resistance between efavirenz, delavirdine and nevirapine (all NNRTIs) develops very easily. If you develop resistance to one of these NNRTIs, you probably won't be able to use any of them in your ART. However, etravirine has shown that it can control HIV that has developed some resistance to other NNRTIs.
Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.
It is recommended that you take etravirine following a meal. Do not take it on an empty stomach. If you have trouble swallowing etravirine, you can dissolve the tablets in water.
No dose adjustments are recommended for patients with mild liver problems or with kidney problems.
The most common side effects are rash and nausea. Rashes usually occurred during the second week of treatment with etravirine. In rare cases the rash can be severe, even fatal. This reaction is called Stevens-Johnson syndrome. Patients should stop taking etravirine immediately if they have a severe rash. Some patients also experienced abdominal pain and vomiting.
Drugs to watch out for include other ARVs, including all protease inhibitors. Also be careful with drugs to treat tuberculosis (see Fact Sheet 518), for erectile dysfunction (such as Viagra), for heart rhythm (antiarrhythmics) or angina. Interactions are also possible with several drugs to lower cholesterol. Make sure that your health care provider knows about ALL drugs and supplements you are taking.
Etravirine does not appear to affect blood levels of oral contraceptives, antacids or methadone. Etravirine slightly decreases levels of buprenorphine. Although no dose adjustments are necessary, patients taking etravirine and buprenorphine should be monitored carefully.
The herb St. John's Wort (See Fact Sheet 729) lowers the blood levels of some nonnucleoside reverse transcriptase inhibitors. Do not take it with Etravirine.
This article was provided by AIDS InfoNet. Visit AIDS InfoNet's website to find out more about their activities and publications.