How to pronounce Emtricitabin Rilpivirin
The authors retrospectively evaluated data from patients in the Frakfurt HIV cohort who underwent ART with RPV between March 2011 and December 2015. The primary endpoint was the proportion of patients who discontinued RPV-based therapy by week 48. The virological response rate with VL <50 copies / ml as the cut-off value was determined as part of an FDA snapshot analysis at week 48.
Data from 188 patients were analyzed, 33% were women. 74% of the patients were treatment-experienced and 26% were treatment-naive.
The proportion of discontinuations was significantly higher in women (23%) than in men (12%) (odds ratio [OR] 2.24 [95% CI 1.02-4.91]).
However, there were no significant gender differences in the drop-out rates between pretreated and naive patients (25% versus 16% or 23% versus 12%).
There was a higher rate of discontinuations due to virologic failure at week 48 in white ("Caucasian") women compared to non-white women (36% versus 16%; OR 1.33 [95% CI 0.20-8.71 ]), but this was not significant with a p-value of 0.071.
The authors come to the conclusion that the overall response rates to RPV-based RT were high in therapy-experienced and therapy-naive patients, but the proportion of discontinuations was significantly higher in women. The total number of patients with virologic failure was small at 16%. Race seems to affect the effectiveness of RPV-based ART, as white women had higher rates of virologic failure than non-white women. In the opinion of the authors, it should therefore be an interdisciplinary approach to identify and reduce potential barriers to successful ART in white HIV-infected women.
Since the difference in drop-out rates due to virological failure between white and non-white women was not significant, I see a bit of buzzword bingo practiced here by the authors. : devil:
Physicians should generally identify potential barriers to successful ART in their patients, regardless of race, ethnicity, gender, hair color, beard length and other parameters.
Rilpivirine is a second-generation once-daily non-nucleoside reverse transcriptase inhibitor (NNRTI) which has shown high overall response rates in treatment-naïve patients without sex and gender specific differences in clinical trials. Sex and gender specific data in treatment experienced patients receiving a rilpivirine based regimen are still limited. We conducted a 48 week efficacy and safety analysis in naïve and treatment experienced men and women using retrospective data from the HIV Center of the Universityhospital Frankfurt.
Materials and methods
Between March 2011 and December 2015 all patients from the Frankfurt HIV Cohort receiving a rilpivirine based regimen were analyzed in this retrospective observational study. The primary endpoint was the proportion of patients with any discontinuation of a rilpivirine based therapy at week 48. Furthermore virological response rates (FDA snapshot analysis; HIV-1 RNA <50 copies / mL) were assessed at Week 48.
A total of 188 patients (33% female) were included in the analysis. 74% were treatment-experienced and 26% naïve. Regarding sex differences the proportion of discontinuations was significantly higher in women than in men (23% vs. 12%; p = 0.028; ODDS ratio = 2.24; CI 1.02 - 4.91). There was no significant sex difference regarding discontinuations between treatment-experienced and naïve patients (25% vs. 16% and 23% vs. 12%, respectively). Virologic response rates (FDA snapshot analysis; HIV-1 RNA <50 copies / mL) were assessed at week 48 and revealed a higher rate of discontinuations due to virological failure in caucasian women vs. non-caucasian women (36% vs. 16% ; p = 0.071; ODDS ratio = 1.33; CI 0.20 - 8.71).
While overall response rates to rilpivirine based regimens were high for both treatment-experienced and naïve patients the proportion of discontinuations was significantly higher in female patients. The total number of patients with virological failure was low (16%); race appeared to influence the efficacy of a rilpivirine based ART as caucasian women showed a higher rate of virological failure than non-caucasian women. Therefore it should be an interdisciplinary approach to identify and reduce possible barriers to successful antiretroviral treatment in caucasian female HIV positive patients.
Sex and gender differences in Rilpivirine based ART - data from the HIV center university Frankfurt: professionalabstracts.com/doeak2019/iplanner/#/grid
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