Durability of rilpivirine-based versus integrase inhibitor-based regimens in a large cohort of naïve HIV-infected patients starting antiretroviral therapy

OBJECTIVE: Comparisons between rilpivirine (RPV) and integrase strand transfer inhibitors (INSTIs) in antiretroviral therapy (ART)-naïve HIV-infected individuals are currently lacking. Aim of the study was to compare, in an observational cohort setting, the durability of treatment of RPV- and INSTI-based first-line regimens. METHODS: Patients who started first-line ARTs based on RPV or on INSTIs, with HIV-RNA 200 cells/μL, were included. The primary endpoint was the cumulative probability of treatment failure (TF = virological failure [confirmed HIV-RNA >50 copies/mL] or discontinuation of the anchor drug in the regimen), as assessed by Kaplan-Meier method. A multivariable Cox regression was used to control for potential confounding. RESULTS: Of 1991 patients included, 986 started ART with a RPV- and 1,005 with an INSTI-based regimen. The median (IQR) follow-up was 20 (10, 35) months. The cumulative two-years probability of TF with RPV (9.1% [95% 7.2, 11.1]) was lower than that observed in the INSTI group (16.6% [13.8, 19.4], p=0.0002) but not when comparing with dolutegravir (DTG) alone. Starting ART with an INSTIs-based regimen vs. RPV was associated with a higher risk of TF after controlling for potential confounding factors (AHR [95%CI]: 1.64 [1.28, 2.10]; p