There are currently three licensed non-nukes (non-nucleoside reverse transcriptase inhibitors, or NNRTIs) available:
The most commonly used drugs in this class are efavirenz and nevirapine. However, delavirdine is increasingly being considered for study as a booster for protease inhibitors (PIs) because it can block the activity of liver enzymes that break down PIs.
Researchers in British Columbia, Canada, studied the effect of switching subjects who used efavirenz or nevirapine to delavirdine or simply adding delavirdine to a pre-existing regimen that included PIs. The main purpose of this study was to assess delavirdine's impact on levels of PIs in the blood.
Researchers reported results on 15 male subjects whose previous treatment regimens were failing. All subjects received Kaletra (lopinavir/ritonavir) twice daily with or without the following PI:
All subjects also received various nukes and delavirdine 600 mg twice daily. Technicians performed an extensive analysis of blood.
A total of six subjects left the study due to side effects from delavirdine — mostly nausea and diarrhea. In general, switching from efavirenz or nevirapine to delavirdine resulted in higher levels of lopinavir, ritonavir, amprenavir and saquinavir. In subjects who had not recently used another non-nuke, adding delavirdine to their regimens did not consistently raise PI levels.
This type of study, although designed to assess changes in drug levels in the blood, illustrates the complex treatment regimens that some PHAs must take in order to suppress their viral load and maintain or increase their CD4+ cell counts. Further study of such regimens is needed to find out about their toxicities and long-term benefits.
REFERENCE
Harris M, Alexander C, Ting L, et al. Delavirdine effects on exposure to ritonavir-boosted protease inhibitors. 3rd International Workshop on Clinical Pharmacology of HIV Therapy, 11-13 April 2002, Washington D.C. Poster 7.15.
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