Antiviral therapy 2017 08 11() doi 10.3851/IMP3188
Few data are available about efficacy and durability of simplification from multi-tablet antiretroviral regimens to co-formulated efavirenz(EFV)/emtricitabine(FTC)/tenofovir(TDF) versus rilpivirine(RPV)/emtricitabine/tenofovir in virologically-suppressed HIV-1-infected patients.
We retrospectively analyzed HIV-infected patients with HIV-RNA<50copies/mL switching to co-formulated EFV/FTC/TDF or RPV/FTC/TDF at 5 Italian centers. Patients were followed from time of switch until regimen discontinuation or a maximum of 3-years follow-up. Time to treatment discontinuation (TD) and virological failure (VF, defined as two consecutive HIV-RNA>50copies/mL or a single determination >1000copies/mL) and their predictors were investigated.
1560 patients were reviewed of which 1097 (70%) switching to EFV/FTC/TDF and 463 (30%) to RPV/FTC/TDF. During follow-up, VF and TD occurred in 44(4%) and 242(22%) patients in EFV/FTC/TDF and in 29(6%) and 50(11%) patients in RPV/FTC/TDF, respectively. The 3-years estimated probability of remaining free from VF was 96.2% with EFV/FTC/TDF vs 92.7% with RPV/FTC/TDF (p=0.003). At multivariate analysis, regimen type (EFV/FTC/TDF vs RPV/FTC/TDF aHR 0.24, p=0.004) and time of virological suppression (aHR 0.85, p=0.048) were the only independent predictors of VF. The estimated 3-years probability of remaining free from TD was 77.4% with EFV/FTC/TDF vs 88.4% with RPV/FTC/TDF (p=0.001). Predictors of TD were female sex, switching from PI-based regimens, older age, shorter time of virological suppression and regimen type (EFV/FTC/TDF vs RPV/FTC/TDF aHR 2.48, p<0.001). RPV/FTC/TDF showed a safer lipid profile and a greater increase in creatinine. CONCLUSIONS
Both regimens showed good safety and efficacy in this real-life setting, although switch to RPV/FTC/TDF seemed better tolerated while EFV/FTC/TDF was associated with a lower probability of VF.