Intelence (etravirine) is a non-nucleoside reverse transcriptase inhibitor (NNRTI) drug used to treat HIV-1 infection in combination with other antiretroviral drugs. It is indicated in treatment-experienced patients age two years and up.
Dosage and administration
Dosage for adults and children weighing 30kg and up is 200mg orally twice daily. Dosage for children and adolescents under 30kg is weight-based, and is detailed in the product monograph.
Intelence is also indicated for post-exposure prophylaxis after occupational exposure to HIV, in combination with other drugs detailed in the product monograph. According to current guidelines, individuals occupationally exposed to HIV should receive three-drug prophylaxis for 28 days. Treatment should begin as soon as possible after exposure, as effectiveness of prophylaxis is considerably diminished after 36 to 72 hours. Intelence can be dissolved in water for patients who are unable to swallow tablets. Instructions for this process are given in the product monograph. Intelence should be taken after meals.
Intelence does not require dose adjustment for mild to moderate hepatic impairment (Child-Pugh Class A or B). Safety data is not available for severe hepatic impairment (Child-Pug Class C). Dose adjustments are not necessary in renal failure, and Intelence is probably not dialyzed significantly.
Intelence has been associated with severe and potentially life-threatening skin reactions which include, but are not limited to:
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- erythema multiforme)
This medication should be discontinued if a serious hypersensitivity reaction occurs.
Co-infection with hepatitis B virus (HBV) and HIV requires special attention, and all patients who test positive for HIV infection should be screened for comorbid HBV infection. Co-infected patients should be started on an antiretroviral regimen targeting both viruses, regardless of CD4 counts or HBV viral loads. Current HIV treatment guidelines outline drug regimens and prescribing considerations. Treatment should be continued indefinitely to achieve HIV suppression and prevention of HBV activation. Co-infected patients will require vaccination against hepatitis A and HBV, and should avoid alcohol.
Current HIV treatment guidelines recommend testing HIV-positive patients for hepatitis C virus (HCV), and regular ongoing testing for those deemed to be at high risk. If HIV/HCV co-infection is identified, consideration should be given to treating both infections concurrently.
Pregnancy and lactation
Highly active retroviral combination treatment should be used in all pregnant women, regardless of viral load and CD4 count. There is insufficient data to conclude whether treatment with Intelence during pregnancy increases the risk of birth defects. Current guidelines should be consulted when treating women in pregnancy. Intelence is known to accumulate and secrete in breast milk, and should not be used in breast-feeding women. The CDC recommends that all HIV-positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
Other adverse reactions and drug-drug interactions are listed in the product monograph, and should be reviewed by all prescribers.
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