In contrast, AEs that were moderate or severe in intensity occurred at similar rates between the two treatment groups. It should be noted that patients were either staying on NVP IR, which they had already been taking (sometimes for several years), or Afatinib mouse switching to an investigational product – the NVP XR qd formulation. A weakness of the trial was its open-label design and it is possible that the differences in mild and moderate AE rates resulted from such an open-label, change-over design. Supporting this speculation

is the observation that AE rates were very similar between the NVP XR and NVP IR groups in the VERxVE trial, which had a double-blind, double-dummy design. There was a nonsignificant trend towards lower AE rates for NVP XR 400 mg qd compared with NVP IR 200 mg bid at the 48-week analysis [13]. It has been observed in clinical studies that treatment-naïve patients with higher CD4 cell counts have a greater risk of hepatic events when they have a detectable VL (≥ 50 copies/mL) in addition to CD4 cell counts above the thresholds of 400 cells/μL for men and 250 cells/μL for women. Consequently, it is recommended

that treatment-naïve women with a CD4 count >250 cells/μL and men with a CD4 count >400 cells/μL should not take NVP [12, 18]. However, the TRANxITION study involved treatment-experienced Epacadostat patients with suppressed VL (< 50 copies/mL); therefore, these patients

could be considered suitable candidates regardless of CD4 cell count [12]. Furthermore, the study population had been receiving NVP for at least 18 weeks at the time they began the trial. The mean baseline CD4 cell count for patients in both treatment groups was >500 cells/μL, and continued to increase to week 24. Unlike treatment-naïve patients who are initiating therapy with NVP, cutaneous and hepatic hypersensitivity reactions were infrequent in the TRANxITION trial, suggesting that there is no increased risk of an immune-mediated reaction in those who switched between the two NVP formulations. In conclusion, the results at week 24 of follow-up for this switch study demonstrate that NVP XR 400 mg Cediranib (AZD2171) qd was noninferior to NVP IR 200 mg bid in terms of virological efficacy in NVP treatment-experienced patients, and was well tolerated. This study supports the switch from NVP IR bid to the NVP XR qd formulation in patients who are virologically suppressed. These data are important as NVP is a widely used antiretroviral medication with which patients and physicians are familiar, and this new, once-daily, extended-release formulation is a more convenient presentation and a useful addition to HIV-1 therapy. The authors wish to thank all the investigators involved in the study. This study was sponsored and financed by Boehringer Ingelheim. Editorial assistance was provided by Ghzaleh Masnavi at EuroRSCG Life, UK.