Abstract
BackgroundThe anti-retroviral combination of abacavir/lamivudine plus rilpivirine (ABC/3TC/RPV) is not recommended by international guidelines as the first-line regimen. However, it is potent, well-tolerated, and affordable, especially in resource-limited settings. This study evaluates the efficacy and safety of ABC/3TC/RPV as an initial regimen for treatment-naïve HIV-1 infected patients.MethodsA retrospective study was conducted in the largest HIV care centre in Singapore, with data collected June 2011 to September 2017. All treatment-naïve HIV-1 infected adults prescribed ABC/3TC as part of their initial anti-retroviral therapy regimen were included. The third drug was a non-nucleoside reverse-transcriptase inhibitor (NNRTI) such as RPV or efavirenz (EFV), or boosted protease-inhibitor (PI). Patients were followed up for 48 weeks. The primary end-point was the percentage of patients achieving virologic suppression, analysed using on-treatment analysis. Secondary outcomes included CD4-count change, treatment discontinuation and treatment-related adverse events.Results170 patients were included in the study, 66 patients in the RPV group, 104 patients in the comparator group (EFV or boosted PI). 96% (n = 24) in the RPV group and 87% (n = 26) in the comparator group achieved viral suppression at 48 weeks (p = 0.28). Median (interquartile range) time to viral suppression was similar: 17 (14–24) weeks in the RPV group, and 21 (13–26) weeks in the comparator group. There were no statistically significant differences in the CD4 count between the two groups. 14% (n = 9) of patients on RPV discontinued treatment before 48 weeks, compared to 30% (n = 31) from the comparator group (p = 0.053). Of these, 23 discontinuations were due to drug adverse effects, and only 1 attributed to RPV (p < 0.01). One patient in each group had virologic failure.ConclusionRPV is effective, safe and considerably more tolerable than compared to NNRTI or boosted PI in ABC/3TC-containing regimens for treatment-naïve patients. It offers an affordable and attractive option, especially in resource-limited settings.
Highlights
The anti-retroviral combination of abacavir/lamivudine plus rilpivirine (ABC/3TC/RPV) is not recommended by international guidelines as the first-line regimen
Similar recommendations have been put forth by the United States Department of Health and Human Services (DHHS) and European AIDS Clinical Society (EACS) guidelines [2, 3]. These changes have largely been driven by increasing concerns of the rising human immunodeficiency virus (HIV) drug resistance to nucleoside reverse-transcriptase inhibitor (NNRTI), especially in Africa [4]
In Asia, the prevalence of pre-treatment NNRTI resistance is considerably lower, with the yearly increase in the odds of pre-treatment drug resistance reported as 11% (2–20%) [4]
Summary
The anti-retroviral combination of abacavir/lamivudine plus rilpivirine (ABC/3TC/RPV) is not recommended by international guidelines as the first-line regimen. It is potent, well-tolerated, and affordable, especially in resource-limited settings. Similar recommendations have been put forth by the United States Department of Health and Human Services (DHHS) and European AIDS Clinical Society (EACS) guidelines [2, 3]. These changes have largely been driven by increasing concerns of the rising HIV drug resistance to NNRTIs, especially in Africa [4]. Many factors have to be considered when selecting a cART regimen, such as virologic efficacy, adverse effect profile, comorbid conditions, drug interactions, pill burden, cost and access [2, 3]
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