The efficacy of first-line ART regimens based on RPV in HIV-infected patients with pre-existing E138A mutation in reverse transcriptase

Introduction: It was previously shown that the presence of the E138A mutation is associated with resistance to rilpivirine (RPV). Detection of this mutation is considered as contraindication for RPV use within the first-line ART. It is a lack of knowledge regarding efficacy of first-line RPV-based ART in patients bearing HIV with E138A mutation. In absence of HIV genotyping in naïve patients it may influence the clinical decisions. Methods: We have collected all available patients unconventionally treated with RPV and carefully analyzed the ART efficacy in E138A carriers from the EuResist database. The viral load data in patients with E138A mutation at baseline was extracted from the database. Due to uniqueness of these cases only 11 HIV infected patients were found. The virologic outcome was analyzed according to the national and international ART guidelines. Results: The full virologic efficacy of the first-line RPV-based ART regimen was demonstrated in 11 out of 11 patients according to all guidelines. Conclusions: Our data suggest that the influence of the pre-existing E138A mutation on the sensitivity to RPV is very low or insignificant. The results support importance of investigation of polymorphic pre-existing HIV drug mutations for ART efficacy.