Using of nevirapine is associated with intermediate and reduced response to etravirine among HIV-infected patients who experienced virologic failure in a resource-limited setting

Abstract

Background: Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens have been extensively used for treatment of HIV infection in resource-limited settings. Treatment options after failing an initial regimen are limited because of cross-resistance of NNRTIs.

Objective: To determine the factors associated with reduced response to etravirine among patients with virological failure.

Study design: A retrospective study was conducted. We stratified patients into two groups by the total weighted scores of etravirine-resistance-associated mutations (ETV-RAMs), highest response (score 0-2, N=123) and intermediate and reduced response (score > or =2.5, N=61). Factors associated with a score of > or =2.5 were evaluated.

Results: There were 184 patients with mean (SD) age of 42 (9) years old and 60% were males. Of all, 68% used NNRTI in the failing regimen and 51% used stavudine/lamivudine as a backbone. Common ETV-RAMs included Y181C (27%), G190A (17%), and K101E (10%). Higher proportion of K101E, K101P, Y181C, G190S, and M230L were found in patients with a score of > or =2.5 (p<0.05, all). By univariate logistic regression, using protease inhibitor (OR 0.22, 95% CI 0.07-0.67), nevirapine (OR 10.56, 95% CI 4.04-27.74), and efavirenz (OR 2.91, 95% CI 1.01-2.51) in the current regimen were associated with a score of > or =2.5. By multiple logistic regression, only using nevirapine was associated with a score of > or =2.5 (OR 7.61, 95% CI 2.40-24.06).

Conclusions: Using nevirapine in the failing regimen was associated with intermediate and reduced response to ETV. The recommendation of using nevirapine as a preferred NNRTI should be re-considered in resource-limited settings where efavirenz is accessible.