Thamrongwonglert Pornpimol, Chetchotisakd Ploenchan, Anunnatsiri Siriluck, Mootsikapun Piroon
1 Division of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Department of Medicine, Khon Kaen University , Khon Kaen, Thailand.
HIV Clin Trials. 2016 Feb;17(1):12-6. doi: 10.1080/15284336.2015.1112480. Epub 2016 Jan 7.
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.
利匹韦林（RPV）是一种非核苷类逆转录酶抑制剂，在初治患者中，其血脂情况优于依非韦伦（EFV）。然而，关于治疗经验的数据有限，尤其是在血脂异常的HIV患者中；因此，我们旨在评估这些患者从EFV转换为RPV后血脂情况的变化。在这项前瞻性、开放标签的队列研究中，我们纳入了接受基于EFV方案治疗至少6个月、转换治疗前HIV RNA＜50拷贝/mL且持续≥6个月的HIV-1感染成人。本研究的目的是分析血脂变化，并评估转换治疗24周后的疗效、安全性和耐受性。53名患者入组并完成了研究。在第24周时，观察到总胆固醇（平均[95%置信区间，CI] -28.06mg/dL，95%CI -35.20至-20.91，p＜0.0001）、低密度脂蛋白胆固醇（-20.96mg/dL，95%CI -28.12至-13.80，p＜0.0001）、高密度脂蛋白（HDL）胆固醇（-5.11mg/dL，95%CI -7.79至-2.44，p＜0.0001）和甘油三酯（-29.79mg/dL，95%CI -52.39至-7.19，p = 0.011）水平显著下降。1例患者在第24周时出现病毒学反弹，HIV RNA为114拷贝/mL。3例（5.7%）患者出现2级肝酶升高。在研究期间，没有患者停用RPV。从基于EFV的治疗转换为基于RPV的方案可改善血脂得到充分抑制的血脂异常HIV患者的血脂情况。这些患者应考虑采用这种治疗方法。
