title: Efficacy and safety of a switch to rilpivirine-based regimens in treatment-experienced HIV-1-infected patients: a cohort study.
abstract: Rilpivirine (RPV) is a second-generation once-daily non-nucleoside reverse transcriptase inhibitor (NNRTI) which has shown non-inferior antiviral activity to efavirenz in 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 virological success 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/tenofovir disoproxil fumarate/emtricitabine. At month 12, the rate of virological success was 59% and increased to 72% using available data beyond month 12. Sixteen (6%) patients experienced virological failure, which was associated with the presence of the M184V/I resistance mutation in 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 virological failure or resistance mutations to nucleoside reverse transcriptase inhibitors and NNRTIs to avoid virological failures.
authors.affiliation: Department of Infectious Diseases, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Diderot, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Gazaignes
authors.forename: Matthieu
authors.initials: M
authors.lastname: Resche-Rigon
authors.forename: Caroline
authors.initials: C
authors.lastname: Gatey
authors.forename: Chloe
authors.initials: C
authors.lastname: Yang
authors.forename: Blandine
authors.initials: B
authors.lastname: Denis
authors.forename: Julien
authors.initials: J
authors.lastname: Fonsart
authors.forename: Kristell
authors.initials: K
authors.lastname: Desseaux
authors.forename: Michel
authors.initials: M
authors.lastname: Guionie
authors.forename: Willy
authors.initials: W
authors.lastname: Rozenbaum
authors.forename: Constance
authors.initials: C
authors.lastname: Delaugerre
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Molina
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral; D012189:Retrospective Studies; D000068696:Rilpivirine / Q000627:therapeutic use*; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D000068696:Rilpivirine