Unlike other nonnucleoside reverse transcriptase inhibitors, etravirine is only approved for use in treatment-experienced patients.\r\nIn the DUET 1 and 2 trials, 1203 highly treatment-experienced patients were randomized to etravirine or placebo, in combination\r\nwith darunavir/ritonavir and optimized background treatment. In these trials, etravirine showed significantly higher rates of\r\nHIV RNA suppression when compared with placebo (61% versus 40% at Week 48). There was no significant rise of lipids or\r\nneuropsychiatric adverse events, but there was an increase in the risk of rash with etravirine treatment. In the SENSE trial, which\r\nevaluated etravirine and efavirenz in 157 treatment-na�¨ive patients in combinationwith 2 nucleoside analogues, there was a lower risk\r\nof lipid elevations and neuropsychiatric adverse events with etravirine when compared to efavirenz. Etravirine has been evaluated\r\nin three randomized switching studies. In the SSAT029 switch trial, 38 patients who had neuropsychiatric adverse events possibly\r\nrelated to efavirenz showed an improvement in these after switching to etravirine. The Swiss Switch-EE recruited 58 individuals\r\nwithout neuropsychiatric adverse events who were receiving efavirenz, and no benefit was shown when switching to etravirine. In\r\nthe Spanish ETRA-SWITCH trial (?? = 46), there were improvements in lipids when individuals switched froma protease inhibitor\r\nto etravirine. These switching trials were conducted in patients with full HIV RNA suppression: <50 copies/mL and with no history\r\nof virological failure or resistance to therapy. The results from these three randomized switching studies suggest a possible new\r\nrole for etravirine, in combination with two nucleoside analogues, as a switching option for those with HIV RNA suppression but\r\nwho are reporting adverse events possibly related to antiretroviral therapy. However a large well-powered trial would need to be\r\nconducted to strengthen the evidence from the pilot studies conducted so far.
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