BACKGROUND The anti-retroviral combination of abacavir/lamivudine plus rilpivirine (ABC/3TC/RPV) is not recommended by international guidelines as the first-line regimen. However, it is potent, well-tolerated, and affordable, especially in resource-limited settings. This study evaluates the efficacy and safety of ABC/3TC/RPV as an initial regimen for treatment-naïve HIV-1 infected patients. METHODS A retrospective study was conducted in the largest HIV care centre in Singapore, with data collected June 2011 to September 2017. All treatment-naïve HIV-1 infected adults prescribed ABC/3TC as part of their initial anti-retroviral therapy regimen were included. The third drug was a non-nucleoside reverse-transcriptase inhibitor (NNRTI) such as RPV or efavirenz (EFV), or boosted protease-inhibitor (PI). Patients were followed up for 48 weeks. The primary end-point was the percentage of patients achieving virologic suppression, analysed using on-treatment analysis. Secondary outcomes included CD4-count change, treatment discontinuation and treatment-related adverse events. RESULTS 170 patients were included in the study, 66 patients in the RPV group, 104 patients in the comparator group (EFV or boosted PI). 96% (n = 24) in the RPV group and 87% (n = 26) in the comparator group achieved viral suppression at 48 weeks (p = 0.28). Median (interquartile range) time to viral suppression was similar: 17 (14-24) weeks in the RPV group, and 21 (13-26) weeks in the comparator group. There were no statistically significant differences in the CD4 count between the two groups. 14% (n = 9) of patients on RPV discontinued treatment before 48 weeks, compared to 30% (n = 31) from the comparator group (p = 0.053). Of these, 23 discontinuations were due to drug adverse effects, and only 1 attributed to RPV (p < 0.01). One patient in each group had virologic failure. CONCLUSION RPV is effective, safe and considerably more tolerable than compared to NNRTI or boosted PI in ABC/3TC-containing regimens for treatment-naïve patients. It offers an affordable and attractive option, especially in resource-limited settings.

中文翻译：

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阿巴卡韦/拉米夫定加利比韦林作为未接受过HIV-1感染的成年人的一线治疗方案的疗效和安全性。

背景技术国际准则不建议将阿巴卡韦/拉米夫定加利比韦林（ABC / 3TC / RPV）的抗逆转录病毒药物作为一线治疗方案。但是，它是有效的，耐受性良好且价格合理的，尤其是在资源有限的环境中。这项研究评估了ABC / 3TC / RPV作为未接受过HIV-1感染的患者的初始治疗方案的疗效和安全性。方法回顾性研究在新加坡最大的HIV护理中心进行，收集了2011年6月至2017年9月的数据。所有未接受过HIV-1感染的成年人都将ABC / 3TC处方作为其初始抗逆转录病毒治疗方案的一部分。第三种药物是非核苷逆转录酶抑制剂（NNRTI），例如RPV或依非韦伦（EFV）或增强的蛋白酶抑制剂（PI）。对患者进行了48周的随访。主要终点是通过治疗时分析进行病毒抑制的患者百分比。次要结果包括CD4计数变化，治疗中止和与治疗相关的不良事件。结果该研究包括170例患者，RPV组66例，对照组104例（EFV或强化PI）。RPV组中96％（n = 24），比较组中87％（n = 26）在48周时达到病毒抑制（p = 0.28）。抑制病毒的中位时间（四分位间距）相似：RPV组为17（14-24）周，比较组为21（13-26）周。两组之间的CD4计数无统计学差异。RPV的患者中有14％（n = 9）在48周前中断治疗，相比之下，比较组的这一比例为30％（n = 31）（p = 0.053）。在这些药物中，有23种因药物不良反应而停药，只有1种药物归因于RPV（p <0.01）。每组一名患者发生病毒学衰竭。结论与单纯使用AB​​C / 3TC的方案中的NNRTI或增强PI相比，RPV有效，安全且耐受性强。它提供了一个负担得起且有吸引力的选项，尤其是在资源有限的环境中。