For the purposes of this study, the following definitions were used: a first-line treatment regimen refers to the first ART regimen (comprising three or more ARV drugs) that a child or adolescent was initiated on; a second-line treatment regimen refers to a single-class switch from NNRTI
to PI or vice versa, regardless of NRTI changes; and a third-line treatment regimen refers to an ART regimen that includes one or more of the ARVs DRV/r, RAL and ETR, even though the child or adolescent may have received less than two, or three or more, previous ART regimens.
These include exposure to nevirapine or efavirenz for PMTCT, with expected universal selection of NNRTI
mutations in the exposed, and even modest rates of RMs in the unexposed (a reported rate of 24% in a PMTCT-unexposed population in South Africa (SA)).
The other patient, with RHI, had interrupted PrEP use 140 days before seroconversion (after almost one year on PrEP), and at baseline presented DRMs for both NRTI (TAMS: M41L, D67N, T215S/C, K219Q) and NNRTI
PI mutations detected were L90M, L10F, NRTI mutations included M41L, A62V, M184V, D67N, L210W, T215Y and K219N and NNRTI
mutations were K101Q and Y181I.
Several comparative studies involving treatment-naive patients showed that rates of viral success (measured by the proportion of viral undetectability) in regimens containing two NRTIs + NNRTI
were mostly equivalent than rates obtained in groups using regimens containing PI or PI / r (BARTLETT et al.
If ANY systemic features are noted the NNRTI
should be stopped immediately and the patient treated supportively until the rash recovers.
There were no major NNRTI
mutations observed in any of the patients at baseline.
Rather use an NNRTI
if the patient is on inhaled or nasal steroids, or consult the HIV Clinicians Society if this is not feasible.
However, this has not been an issue for similar drugs, such as the NNRTIs
based in Cork, Ireland and now part of Johnson & Johnson, is a "second generation" NNRTI
(non-nucleoside reverse transcriptase inhibitor)--an antiretroviral in the same class as efavirenz (brand name Sustiva, or Stochrin in many countries) or nevirapine (Viramune).
The FDA approves the NNRTI
There are at least 14 antiretroviral drugs of the NNRTI
class, currently under investigation.