Although rilpivirine-based ART was very well tolerated, 10% of the patients starting this regimen experienced virologic failure, and a substantial proportion of these developed the E138K mutation, which affects susceptibility to all other members of the NNRTI class. (Notably, this mutation occurs rarely with other NNRTIs, although three cases have been reported in patients failing etravirine.) Thus the trade-off: Rilpivirine-based ART is better tolerated than efavirenz-based ART, but it also carries a higher risk of virologic failure, with classwide resistance implications. Clinicians must weigh such considerations and treat each patient individually.
AIDS Clinical Care © 2012 Massachusetts Medical Society