Rilpivirine/tenofovir/emtricitabine fixed‐dose combination is an efficacious and well‐tolerated “switch” regimen for patients on therapy

The rilpivirine/tenofovir/emtricitabine fixed‐dose combination (RTE FDC) (Complera, Eviplera) is a potent convenient, well‐tolerated antiretroviral regimen. While it is officially indicated only for treatment‐naïve patients, it is attractive for use as a regimen to switch to for patients experiencing toxicities or side effects, or who simply want a regimen with fewer pills. This is a retrospective review of patients who switched to RTE FDC from other antiretroviral regimens in a large HIV specialty private practice. 111 patients were identified who switched to RFE FDC from other regimens who had at least six months follow‐up (median 8 months). 44 were previously taking the efavirenz/tenofovir/emtricitabine fixed‐dose combination (ETE FDC) (Atripla), 24 nevirapine with NRTIs, 16 protease‐based regimens, 10 on raltegravir with NRTIs, and 17 on various other regimens. Patients had been on therapy for a median of 6.25 years. 86 patients had an HIV PCR<20 at the time of switch, 21 had low grade positive PCRs (<400) and 4 patients switched after an interruption in therapy with viral loads of 5880–88,000. Median CD4 cell count at the time of switch was 663 (range 142–2244). 14 patients had previously failed treatment and had resistance mutations; 4 with M184V, 5 with K103N, but none with rilpivirine nor tenofovir‐specific resistance mutations. One patient discontinued RFE FDC after a single PCR of 520; all others have remained undetectable at most recent visit (91<20, 19<400). Median CD4 cell count on the most recent visit is 656. Creatinine (first visit after switch) increased by a mean of 0.04 mg/dl (0.05 in those switching from a non‐tenofovir containing regimen, 0.04 in those switching from a tenofovir containing regimen). There was no significant change in LFTs. Mean cholesterol decreased by 18 mg/dl (23 in those switching from ETE FDC, 12 from protease inhibitors, 27 from nevirapine and 2 from raltegravir). Six patients co‐infected with hepatitis B remain with an undetectable hepatitis B PCR. Patients were asked to complete a questionnaire, rating their new and old regimens on a scale of one (bad) to ten (good) (Table). For appropriate patients wishing to switch their treatment regimen for toxicity, side‐effects or even just pill burden, RTE FDC is an efficacious, well tolerated, convenient alternative.RTE FDC Old regimenNo side effects 9.6 8.3 Ease of administration 9.5 8.6 No problem with food requirement 8.98.7