P18. Treatment outcome for HIV-1 infected patients in Sweden on Eviplera

Amanda Häggblom1,2, Catharina Maijgren Steffensson1,3, Veronica Svedhem Johansson1,2, Göran Skoglund3
Affiliates: 1Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden, 2Department of Infectious Diseases, County Council of Gävleborg, Gävle, Sweden 3Gilead Sciences Sweden, Solna, Sweden

Background
Time on treatment and viral failure have been analysed among HIV infected patients on Eviplera (EVP) in Sweden. A cohort with 368 patients, 99 treatment naïve and 269 treatment experienced, has been followed for 2 years.

Methods
The data was collected from the National Quality Register InfCareHIV, which includes all patients diagnosed with HIV-1 in Sweden. Chi2-test and Wilcoxon rank-sum test were used to compare baseline characteristics between treatment naïve and treatment experienced patients.

Results
Among the 368 patients, 73% (269) were treatment experienced, 27% (99) were treatment naïve at initiation and 71% (263) were male. Treatment experienced patients were older, had higher CD4-T cell count at treatment initiation and lower viral load.

Eviplera in treatment naïve patients
After two years of follow up of the naïve patients, 19 (19%) had discontinued on EVP. Of the 19 patients, 5 (5%) had developed a VF and 14 (14%) discontinued of unknown reasons. Most of the discontinuations happened before 1 year, only 4 of the 19 discontinued EVP after 1 year of treatment. None of the patients developed any resistance-associated mutation to EVP.

Eviplera in treatment experienced patients
The majority of the patients who switched to EVP were previously on treatment with an efavirenz based regimen. Previous treatment before switch to EVP included NNRTIs + NRTIs in 53%, PIs + NRTIs in 36%, INIs + NRTIs in 4% and other combinations in 7% of the patients. Regarding the NRTIs, TDF + FTC were used in 66% and ABC + 3TC in 22%, 3TC + ZDV in 5% and in 7% of the patients other combinations were used.
Of the experienced patients, 187 (69.5%) were still suppressed on EVP after two years. Of the patients who discontinued EVP, 16 (6%) had developed a virologic failure and 66 (24,5%) discontinued for unknown reasons. Most of the discontinuations happened during the first year, only 23 (8,6%) discontinued after 1 year of EVP.
Two patients had resistance-associated mutations to EVP. One of them had no resistance test before start on EVP and had previously been on EFV+ABC+3TC. The other patient had developed an E138Q mutation during treatment with EVP, which is associated with resistance to rilpivirine.

Conclusions
EVP was associated with high rates of virologic suppression 81% and 69.5% in treatment naïve and experienced patients, respectively, after two years follow up. There are low rates of viral failure and DRM development for both treatment naïve and treatment experienced patients on EVP.

* Eviplera is a single tablet regimen (STR ) containing tenofovir disoproxil fumarate, emtricitabine and rilpivirine to be taken once daily in adults infected with human immunodeficiency virus-1 (HIV-1) without known mutations associated with resistance to the NNRTI class or tenofovir or emtricitabine, and with a plasma viral load ≤ 100 000 HIV -1 RNA copies/ml.