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Rilpivirine use in the Swiss HIV cohort study: a prospective cohort study.

Rilpivirine use in the Swiss HIV cohort study: a prospective cohort study.
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Sculier D, Gayet-Ageron A, Battegay M, Cavassini M, Fehr J, Hirzel C, Schmid P, Bernasconi E, Calmy A, ,


Sculier D, Gayet-Ageron A, Battegay M, Cavassini M, Fehr J, Hirzel C, Schmid P, Bernasconi E, Calmy A, , (click to view)

Sculier D, Gayet-Ageron A, Battegay M, Cavassini M, Fehr J, Hirzel C, Schmid P, Bernasconi E, Calmy A, ,

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BMC infectious diseases 2017 07 0617(1) 476 doi 10.1186/s12879-017-2579-2

Abstract
BACKGROUND
Rilpivirine is safe and effective in HIV-naïve patients with low baseline HIV-RNA or in switch strategy. It offers the advantages of few drug-drug interactions and a favourable toxicity profile. We aimed to determine the reasons for prescribing the rilpivirine (RPV)/tenofovir disoproxil (TDF)/emtricitabine (FTC) co-formulation within the Swiss HIV Cohort Study and to assess its effectiveness and safety over a 24 months period.

METHODS
All individuals enrolled in the Swiss HIV Cohort Study who initiated a RPV/TDF/FTC co-formulation between April 2013 and March 2014 were included. Primary outcomes were the HIV-RNA viral load (copies/mL) and CD4 cell count (cells/mm(3)) at 6, 12 and 24 months. Reasons for a switch to RPV/TDF/FTC were evaluated through a standardized questionnaire. We also assessed discontinuation and reasons for discontinuation of RPV/TDF/FTC until October 30, 2015.

RESULTS
Of 644 individuals who started the RPV/TDF/FTC co-formulation, only 7.5% were treatment-naïve. At 24 months, viral suppression (HIV-RNA <50 copies/mL) was achieved in 100% and 96.7% of cART-naïve and cART-experienced patients respectively. The switch to RPV was mainly done for simplification (44.6%) and to overcome central nervous system toxicity symptoms due to efavirenz (24%). Six months after switch, 74.8% of patients reported an improvement of psycho-neurological symptoms with continued improvement at 12 months for almost 80%. However, one quarter of patients reported a discontinuation of RPV/TDF/FTC on October 30, 2015 after a median time of 18.4 months. Reasons for discontinuation included physician decision (5.3%) and side-effects (3.9%) mainly related to the central nervous system and to renal toxicity. CONCLUSION
The RPV/TDF/FTC co-formulation was safe and effective throughout 24 months of follow-up but barely prescribed for HIV-naïve patients. Despite excellent virological suppression among both treatment-naïve and -experienced patients, we observed a high rate of treatment discontinuation.

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