Hepatic Safety of Rilpivirine/Emtricitabine/Tenofovir Disoproxil Fumarate Fixed-Dose Single-Tablet Regimen in HIV-Infected Patients with Active Hepatitis C Virus Infection: The hEPAtic Study

PLoS One. 2016 May 19;11(5):e0155842. doi: 10.1371/journal.pone.0155842. eCollection 2016.

Abstract

Objectives: The aim of this study was to evaluate the frequency of transaminase elevations (TE) and total bilirubin elevations (TBE) during the first year of therapy with a single tablet regimen including RPV/FTC/TDF (EPA) in HIV/hepatitis C virus (HCV)-coinfected subjects in clinical practice.

Methods: In a retrospective analysis, HIV/HCV-coinfected subjects who started EPA at 17 centres throughout Spain were included as cases. Subjects who started an antiretroviral therapy (ART) other than EPA during the study period at the same hospitals were randomly selected as controls in a 1:2 ratio. Primary outcome variables were grade (G) 3-4 TE and G4 TBE.

Results: Of the 519 subjects included, 173 individuals started EPA. Nine (5.2%) subjects of the EPA group and 49 (14.2%) controls were naïve to ART. The median (Q1-Q3) follow-up was 11.2 (9.7-13.9) months. TE was observed in 2 [1.2%; 95% confidence interval (CI): 0.14%-4.1%] subjects receiving EPA and 11 (3.2%; 95%CI: 1.6%-5.6%) controls (p = 0.136), all events were G3. No patient discontinued ART due to TE. One (0.6%; 95%CI: 0.01%-3.1%) subject on EPA and 8 (2.3%; 95%CI: 1%-4.5%) subjects in the control group developed TBE (p = 0.141), without developing any other hepatic event during follow-up. Three (2.3%) subjects with cirrhosis versus 10 (3.1%) without cirrhosis showed G3-4 TE (p = 0.451).

Conclusion: The frequency of severe liver toxicity in HIV/HCV-coinfected subjects receiving EPA under real-life conditions is very low, TE were generally mild and did not lead to drug discontinuation. All these data suggest that EPA can be safely used in this particular subpopulation.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Retroviral Agents / administration & dosage
  • Antiviral Agents / administration & dosage*
  • Bilirubin / metabolism
  • Case-Control Studies
  • Coinfection / drug therapy
  • Coinfection / virology
  • Drug Therapy, Combination
  • Emtricitabine / administration & dosage*
  • Female
  • Fibrosis / drug therapy
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Hepacivirus
  • Hepatitis C / complications
  • Hepatitis C / drug therapy*
  • Hospitalization
  • Humans
  • Liver / drug effects*
  • Liver / enzymology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rilpivirine / administration & dosage*
  • Spain
  • Tablets
  • Tenofovir / administration & dosage*
  • Transaminases / metabolism

Substances

  • Anti-Retroviral Agents
  • Antiviral Agents
  • Tablets
  • Tenofovir
  • Transaminases
  • Rilpivirine
  • Emtricitabine
  • Bilirubin

Grants and funding

KN is the recipient of a Miguel Servet research grant from the Instituto de Salud Carlos III (grant number CP13/00187). AR-J is the recipient of a post-doctoral extension grant of the Fundación Progreso y Salud of the Junta de Andalucía (grant number RH-0024-2013). JM is the recipient of a grant from the Servicio Andaluz de Salud de la Junta de Andalucía (B-0037). JAP is the recipient of an intensification grant from the Instituto de Salud Carlos III (grant number Programa-I3SNS). This work was partially funded by Gilead Sciences SL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.