inPractice® - Replacing a PI With a NRTI or NNRTI

Patients who are currently receiving a suppressive regimen of 2 NRTIs plus a PI and who harbor NRTI resistance mutations are at increased risk of virologic failure from switching to an NNRTI^{[Martínez 2003]}
- NNRTIs have a low genetic barrier to resistance and must be supported by an active background regimen rather than one that has been weakened by the presence of NRTI resistance
In the SPIRIT trial, switching from ritonavir-boosted PI–based regimens to single-tablet emtricitabine/rilpivirine/tenofovir DF was noninferior to continued boosted PI–based therapy in patients with no history of previous treatment failure^{[Palella 2014]}