title: Switch from unboosted protease inhibitor to a single-tablet regimen containing rilpivirine improves cholesterol and triglycerides.
abstract: This study aimed to evaluate the efficacy, tolerability and potential savings of combined antiretroviral therapy (cART) simplification from an unboosted protease inhibitor (PI) regimen with atazanavir or fosamprenavir to a single-tablet regimen (STR) based on rilpivirine/emtricitabine/tenofovir disoproxil fumarate (RPV/FTC/TDF) among HIV-1-infected patients with HIV-1 RNA <50 copies/mL. This was a retrospective, multicentre, open-label, 12-week trial. Plasma HIV-1-RNA levels, CD4+ cell counts, cholesterol, triglycerides, bilirubin, glycaemia, creatinine and physical examination were performed at baseline and at scheduled follow-up. All patient costs were calculated and were estimated for 52 weeks of therapy. Fifty-one patients were enrolled [28 male (54.9%)]. At baseline, 30 patients (58.8%) were treated with FTC/TDF, 20 (39.2%) with abacavir/lamivudine and 1 (2.0%) with lamivudine/zidovudine. Thirty-three patients (64.7%) received atazanavir. All patients maintained HIV-RNA <50 copies/mL; the median CD4+ cell count remained stable. Mean triglycerides decreased from 124 mg/dL (range, 39-625) at enrolment to 108.7 mg/dL (range, 39-561) at study end (P = 0.25). At baseline, mean cholesterol was 172.8 ± 38.1 mg/dL and decreased to 161.9 ± 38.6 mg/dL (P = 0.038); likewise, median total bilirubin decreased from 1.07 mg/dL (range, 0.2-4.7) to 0.6 mg/dL (range, 0.13-3.1) (P <0.001). cART-related annual cost reduction with a STR was €3155.47 per patient (-24%). Non-cART patient management expenses were €402.68 vs. €299.10 for atazanavir or fosamprenavir and STR regimens, respectively. Switching to RPV/FTC/TDF from an unboosted PI in virologically suppressed HIV-infected patients is safe and is associated with a reduction in triglycerides, cholesterol and cART-related costs.
authors: Infectious Diseases Clinic, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University of Genoa, L.go Rosanna Benzi 10, Genoa 16132, Italy.
authors: Antonio
authors: A
authors: Di Biagio
authors: Infectious Diseases Clinic, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University of Genoa, L.go Rosanna Benzi 10, Genoa 16132, Italy. Electronic address: niccolo.riccardi@yahoo.it.
authors: Niccolò
authors: N
authors: Riccardi
authors: Infectious Diseases Clinic, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University of Genoa, L.go Rosanna Benzi 10, Genoa 16132, Italy.
authors: Lucia
authors: L
authors: Taramasso
authors: Infectious Diseases Unit, Ospedale Luigi Sacco, Milan, Italy.
authors: Amedeo
authors: A
authors: Capetti
authors: Infectious Diseases Unit, Ospedali Galliera, Genoa, Italy.
authors: Giovanni
authors: G
authors: Cenderello
authors: Department of Health Science, Biostatistics, University of Genoa, Genoa, Italy.
authors: Alessio
authors: A
authors: Signori
authors: Infectious Diseases Unit, Ospedali di Busto Arsizio, Varese, Italy.
authors: Paola
authors: P
authors: Vitiello
authors: Infectious Diseases Unit, Ospedale di Spezia, Italy.
authors: Michele
authors: M
authors: Guerra
authors: Infectious Diseases Unit, Ospedale di Santa Maria della Misericordia, University of Perugia, Perugia, Italy.
authors: Giuseppe Vittorio
authors: GV
authors: de Socio
authors: Infectious Diseases Unit, Ospedali Galliera, Genoa, Italy.
authors: Giovanni
authors: G
authors: Cassola
authors: Infectious Diseases Unit, Ospedali di Busto Arsizio, Varese, Italy.
authors: Tiziano
authors: T
authors: Quirino
authors: Infectious Diseases Clinic, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University of Genoa, L.go Rosanna Benzi 10, Genoa 16132, Italy.
authors: Claudio
authors: C
authors: Viscoli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics; D018791:CD4 Lymphocyte Count; D002784:Cholesterol / Q000097:blood*; D050171:Dyslipidemias / Q000139:chemically induced; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015497:HIV-1 / Q000302:isolation & purification; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D000068696:Rilpivirine / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics; D013607:Tablets / Q000008:administration & dosage*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D013607:Tablets; D014280:Triglycerides; D002784:Cholesterol; D000068696:Rilpivirine
keywords: Cholesterol; Rilpivirine; Ritonavir-sparing; Switch; Triglycerides; Unboosted protease inhibitor