title: Improvement of lipid profiles when switching from efavirenz to rilpivirine in HIV-infected patients with dyslipidemia.
abstract: Rilpivirine (RPV) is a non-nucleoside reverse transcriptase inhibitor, which has better lipid profiles than efavirenz (EFV) in treatment naïve patients. However, the data on treatment experience are limited especially in dyslipidemic HIV patients; thus, we aimed to assess the change of lipid profiles after switching from EFV to RPV in these patients. In this prospective, open-label, cohort study, we enrolled HIV-1 infected adults who had received at least 6 months of EFV-based regimen, with HIV RNA <50 copies/mL for ≥6 months prior to switching. The objectives of this study were to analyze lipid changes and to evaluate the efficacy, safety, tolerability at 24 weeks after switching therapy. Fifty-three patients were enrolled and completed the study. At week 24, a significant decrease in the mean (95% confident interval, CI) total cholesterol (-28.06 mg/dL, 95%CI -35.20 to -20.91, p < 0.0001), LDL-cholesterol (-20.96 mg/dL, 95%CI -28.12 to -13.80, p < 0.0001), high-density lipoprotein (HDL)-cholesterol (-5.11 mg/dL, 95%CI -7.79 to -2.44, p < 0.0001), and triglyceride (-29.79 mg/dL. 95%CI -52.39 to -7.19, p = 0.011) levels were observed. One patient had virologic rebound with HIV RNA of 114 copies/mL at week 24. Three (5.7%) patients had grade 2 elevations of liver enzymes. None of the patients discontinued RPV during the study. Switching from EFV-based therapy to RPV-based regimen improved lipid profiles in fully suppressed HIV patients with dyslipidemia. This treatment should be considered in these patients.
authors.affiliation: 1 Division of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Department of Medicine, Khon Kaen University , Khon Kaen, Thailand.
authors.forename: Pornpimol
authors.initials: P
authors.lastname: Thamrongwonglert
authors.forename: Ploenchan
authors.initials: P
authors.lastname: Chetchotisakd
authors.forename: Siriluck
authors.initials: S
authors.lastname: Anunnatsiri
authors.forename: Piroon
authors.initials: P
authors.lastname: Mootsikapun
mesh_terms: D000480:Alkynes; D048588:Benzoxazines / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D003521:Cyclopropanes; D050171:Dyslipidemias / Q000139:chemically induced*; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008055:Lipids / Q000097:blood*; D012367:RNA, Viral / Q000097:blood; D000068696:Rilpivirine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D008055:Lipids; D012367:RNA, Viral; D000068696:Rilpivirine; C098320:efavirenz
keywords: dyslipidemia; efavirenz; rilpivirine; switching therapy