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Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) for HIV

Examples

Generic Name Brand Name
delavirdine Rescriptor
efavirenz Sustiva
etravirine Intelence
nevirapine Viramune
rilpivirine Edurant

Combination medicines

Generic Name Brand Name
efavirenz, emtricitabine, tenofovir Atripla
emtricitabine, rilpivirine, and tenofovir Complera

These medicines may be available in other combinations to treat HIV infection.

How It Works

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) are antiretroviral medicines. They prevent the human immunodeficiency virus (HIV) from multiplying. When the amount of virus in the blood is kept at a minimum, the immune system has a chance to recover and grow stronger.

Why It Is Used

The use of three or more antiretroviral medicines (highly active antiretroviral therapy, or HAART) is the usual treatment for HIV infection.

The combination of medicines used for HAART will depend on your health, other conditions you might have (such as hepatitis), and results of testing. Talk to your doctor about the best treatment plan for you.

The U.S. National Institutes of Health (NIH) recommends that people begin treatment for HIV as soon as they know that they are infected.1 Treatment is especially important for pregnant women, people who have other infections (such as tuberculosis or hepatitis), and people who have symptoms of AIDS.

You may also want to start HIV treatment if your sex partner does not have HIV. Treatment of your HIV infection can help prevent the spread of HIV to your sex partner.2

The U.S. National Institutes of Health recommends one of the following programs for people who start treatment for HIV:2

  • Efavirenz + tenofovir + emtricitabine
  • Ritonavir-boosted atazanavir + tenofovir + emtricitabine
  • Ritonavir-boosted darunavir + tenofovir + emtricitabine
  • Raltegravir + tenofovir + emtricitabine
Click here to view a Decision Point.HIV: When Should I Start Antiretroviral Medicines for HIV Infection?
Click here to view an Actionset.HIV: Taking Antiretroviral Drugs

How Well It Works

When compared with people who are given single- or double-medicine therapy, people who are given triple-medicine therapy (HAART):

  • Have a greater reduction in viral load.
  • Have better immune system recovery (measured by increased CD4+ cell counts).
  • Are less likely to develop resistance to their medicines.
  • Are likely to live longer.

Antiretroviral therapy can also decrease symptoms of HIV infection, such as fever, weakness, and weight loss.

The rate at which antiretrovirals decrease viral loads is affected by:2

  • CD4+ cell counts at the start of treatment.
  • Viral load at the start of treatment.
  • The dosage of the medicines.
  • Whether medicines are taken exactly as prescribed.
  • Whether antiretroviral medicines have been taken before.
  • Whether opportunistic infections are present.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Common side effects of these medicines include:

  • Headache.
  • Nausea, vomiting, and diarrhea.
  • Rash.
  • Dizziness.
  • Vivid dreams and trouble sleeping.

In rare cases, nevirapine causes liver damage that can be severe and life-threatening. Regular blood tests may be needed to watch for liver problems.

Etravirine can cause a rare, but severe, skin reaction.

Side effects of any combination medicine can include the side effects of any of the single medicines in the combination.

Side effects usually are not as bad after your body has adjusted to the medicine. Report all side effects to your doctor. He or she may be able to help you reduce side effects by giving you other medicines.

Many people think that antiretroviral medicines always have severe side effects. In fact, only a few people experience severe side effects.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Resistance to single-medicine NNRTI treatment develops quickly. For this reason, they should be used only in combination with other antiretroviral medicines to treat HIV infection or to prevent or delay the development of resistance.

Things to think about when choosing a combination of medicines include:

  • The ability of the medicines to reduce your viral load.
  • The likelihood that you will develop resistance to the medicines. If you have already been treated with a certain antiretroviral medicine, you may already know whether you are resistant to medicines in that class.
  • Side effects and your willingness to tolerate them.
  • The cost of treatment.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2012). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf.
  2. U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2011). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Peter Shalit, MD, PhD - Internal Medicine
Last Revised May 17, 2012

Last Revised: May 17, 2012

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Peter Shalit, MD, PhD - Internal Medicine

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