Efficacy and safety of switching to abacavir/lamivudine (ABC/3TC) plus rilpivirine (RPV) in virologically suppressed HIV-infected patients on HAART

Eur J Clin Microbiol Infect Dis. 2016 May;35(5):815-9. doi: 10.1007/s10096-016-2602-3. Epub 2016 Feb 15.

Abstract

We analysed the efficacy and safety of switching from a regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTI) or integrase inhibitors (INI) to ABC/3TC + RPV in virologically suppressed HIV-infected patients. This multicentre, retrospective study comprised asymptomatic HIV-infected patients who switched from 2 NRTI + NNRTI or 2 NRTI + INI to ABC/3TC + RPV between February 2013 and December 2013; all had undetectable HIV viral load prior to switching. Efficacy and safety, and changes in lipids and cardiovascular risk (CVR) were analysed at 48 weeks. Of 85 patients (74.1 % men, mean age 49.5 years), 83 (97.6 %) switched from a regimen based on NNRTI (EFV 74, RPV 5, ETV 2, NVP 2), and 45 (53 %) switched from TDF/FTC to ABC/3TC. The main reasons for switching were toxicity (58.8 %) and convenience (29.4 %). At 48 weeks, 78 (91.8 %) patients continued taking the same regimen; efficacy was 88 % by intention to treat, and 96 % by per protocol. Two patients were lost to follow-up and five ceased the new regimen (4 due to adverse effects and 1 virologic failure). Mean CD4 cell counts increased (744 vs. 885 cells/μL; p = 0.0001), and there were mean decreases in fasting total cholesterol (-15.9 mg/dL; p < 0.0001) and LDL-cholesterol (-11.0 mg/dL; p < 0.004), with no changes in HDL-cholesterol, triglycerides, total cholesterol:HDL-cholesterol ratio, and CVR. ABC/3TC + RPV is effective and safe in virologically-suppressed patients on antiretroviral therapy (ART). Forty-eight weeks after switching the lipid profile improved with decreases in total and LDL cholesterol.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Dideoxynucleosides / adverse effects
  • Dideoxynucleosides / therapeutic use*
  • Drug Combinations
  • Drug Substitution
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • HIV Infections / transmission
  • HIV Infections / virology*
  • Humans
  • Lamivudine / adverse effects
  • Lamivudine / therapeutic use*
  • Lipids / blood
  • Male
  • Middle Aged
  • Rilpivirine / adverse effects
  • Rilpivirine / therapeutic use*
  • Treatment Outcome
  • Viral Load

Substances

  • Anti-HIV Agents
  • Dideoxynucleosides
  • Drug Combinations
  • Lipids
  • abacavir, lamivudine drug combination
  • Lamivudine
  • Rilpivirine