Efficacy and safety of a switch to rilpivirine-based regimens in treatment-experienced HIV-1-infected patients: a cohort study.

Rilpivirine(RPV) is a second-generation once-daily non- nucleoside reverse transcriptase inhibitor(NNRTI) which has shown non-inferior antiviral activity to efavirenzin treatment-naive patients. Data in treatment-experienced patients are more limited. We wished to assess the efficacy and safety of a switch to RPV-based regimens in well-suppressed treatment-experienced patients.Between September 2012 and June 2013, all antiretroviral therapy (ART)-experienced HIV-1-infected patients with a plasma HIV RNA level <50 copies/ml, and switching to an RPV-based regimen, were analysed in this retrospective observational monocentric cohort study. The primary end point was the proportion of patients with virologicalsuccess defined as a plasma HIV RNA level <50 copies/ml at 12 months using the FDA snapshot algorithm.A total of 281 participants were studied and 97% received a combination of RPV/ tenofovirdisoproxil fumarate/ emtricitabine. At month 12, the rate of virologicalsuccess was 59% and increased to 72% using available data beyond month 12. Sixteen (6%) patients experienced virologicalfailure, which was associated with the presence of the M184V/I resistance mutationin prior genotypes (P=0.02) and the use of a non-NNRTI as third agent before the switch (P=0.03). RPV-based regimens were overall well tolerated and only 23 (8%) patients discontinued ART because of adverse events, mostly neuropsychiatric adverse events. Switching to RPV was associated with significant but modest improvement of the lipid profile.In patients fully suppressed on ART, a switch to an RPV-based regimen should only be considered in the absence of prior virologicalfailure or resistance mutationsto nucleoside reverse transcriptase inhibitorsand NNRTIs to avoid virologicalfailures.