Efficacy and improvement of lipid profile after switching to rilpivirine in resource limited setting: real life clinical practice

Abstract

Background Long-term success of cART is possible if the regimen is convenient and less-toxic. This study assessed the efficacy and safety of switching from a first-line NNRTI or boosted PI-based regimens to RPV-based regimens among virologically suppressed participants in resource-limited setting (RLS). Methods This is a prospective cohort study. Participants with plasma HIV-RNA < 50 copies/mL receiving cART were switched from a PI- or NNRTI-based, to a RPV-based regimen between January 2011 and April 2018. The primary endpoint was the proportion of patients with plasma HIV-1 RNA level < 50 copies/mL after 12 months of RPV. The secondary endpoint was the virological response at 24 months and safety endpoint (change in lipid profiles and kidney function from baseline to 12 months). Results A total of 320 participants were enrolled into the study. The rationale for switching to RPV was based on toxicity of the current regimen (57%) or desire to simplify cART (41%). Totally, 177 (55%) and 143 (45%) participants were on NNRTI and boosted PI, respectively, prior to switching to RPV. After 12 months, 298 (93%) participants maintained virological suppression. There were significant improvements in the lipid parameters: TC (− 21 (IQR − 47 to 1) mg/dL; p < 0.001), LDL (− 14 (IQR − 37 to 11) mg/dL; p < 0.001) and TG (− 22 (IQR − 74 to 10) mg/dL; p < 0.001). Also, there was a small but statistically significant decrease in eGFR (− 4.3 (IQR − 12 to 1.1) mL/min per 1.73m2; p < 0.001). Conclusions In RLS where integrase inhibitors are not affordable, RPV-based regimens are a good alternative option for PLHIV who cannot tolerate first-line NNRTI or boosted PI regimen, without prior NNRTI/PI resistance. Trial registration HIV-NAT 006 cohort, clinical trial number: NCT00411983

Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents

“…The greater increase in HDL associated with NNRTI may reduce the overall CVD risk [10,12,36]. In addition, RPV, the most used NNRTI in this study, is associated with a better lipid profile compared with EGV/c and DTG [37] and olderclass NNRTI [20,38]. In the present analysis, dyslipidemia was less common in participants taking RPV than in those taking DTG.…”

“…Most participants were male (72.4%), had prior ARTexposure (57.7%), and were of white ethnicity (72.5%) (Table 1). The median age [interquartile range (IQR)] was 43 (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51) years.…”

Doravirine/lamivudine/tenofovir disoproxil fumarate-induced hypertriglyceridemia in a newly diagnosed AIDS patient

“…Single-tablet regimens, such as DOR/3TC/TDF, favor compliance and are generally well tolerated. When compared with drug regimens containing protease inhibitors, ART including nonnucleoside reverse transcriptase inhibitor (NNRTIs) such as doravirine show a significant improvement in triglyceride levels, representing a good therapeutic option in patients with impaired lipid profile [ 7 ]. However, in rare cases, DOR/3TC/TDF can be associated with severe hypertriglyceridemia, as shown in our report.…”

The Application of Machine Learning in Clustering Borderline Mild Cognitive Impairment among Aging Thai People Living with HIV

“…The HIV-NAT 006 study is an ongoing, prospective, clinic-based cohort that enrolled adults living with HIV (aged ≥18 years) since 1996 (NCT00411983) and have enrolled over 2000 participants as of 2021. [37][38][39][40][41] Therefore, all participants in our study had baseline data prior to and the current data after the MoCA in the HIV-NAT 207 study, conducted between 2015 and 2017. Among many laboratory parameters and other investigations performed in the HIV-NAT 207 study was the Thai-validated version of MoCA, which was used to assess cognitive performance.…”