A 45 years male HIV-1 positive was staed on a cA regimen of Tenofovir-Emtricitabine-Eirenz. After 9 months, he developed Eirenz resistance which lead to failure of therapy. Which of following drug of the same class can be used in place of Eirenz?

**Core Concept**
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are a class of antiretroviral medications used in the treatment of HIV-1 infection. Eirenz is a first-generation NNRTI that inhibits HIV-1 replication by binding to the reverse transcriptase enzyme. However, resistance to Eirenz can lead to treatment failure.

**Why the Correct Answer is Right**
The correct answer is a second-generation NNRTI, which can be used in place of Eirenz due to its different binding site on the reverse transcriptase enzyme. This reduces the likelihood of cross-resistance with Eirenz. The correct answer also has a similar efficacy profile and tolerability to Eirenz.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it is a protease inhibitor, a different class of antiretroviral medication that targets a different step in the HIV-1 replication cycle.
**Option B:** This option is incorrect because it is a nucleoside reverse transcriptase inhibitor (NRTI), which has a different mechanism of action and is not a suitable replacement for Eirenz.
**Option C:** This option is incorrect because it is a fusion inhibitor, which targets a different step in the HIV-1 replication cycle and is not a suitable replacement for Eirenz.

**Clinical Pearl / High-Yield Fact**
When switching from Eirenz to a new NNRTI, it's essential to consider the patient's resistance profile to avoid cross-resistance and ensure optimal treatment outcomes.

**Correct Answer:** C. Efavirenz

✓ Correct Answer: B. Etravirine