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Rilpivirine in the treatment of HIV infection: evidence from the ECHO and THRIVE studies

Pedro Cahn

Rilpivirine (RPV) is a once-daily (qd) non-nucleoside reverse transcriptase inhibitor that was evaluated in antiretroviral treatment-naive, HIV-1-infected adults (with two nucleotide reverse transcriptase inhibitors) in two international, double-blind, double-dummy, Phase III trials (ECHO and THRIVE). Both trials met their primary objective of demonstrating noninferior efficacy of RPV 25-mg qd versus efavirenz 600-mg qd regarding the proportion of patients with a confirmed response (viral load <50 copies/ml, intention-to-treat time-to-loss-of-virologic-response) at week 48. Pooled trial responses were 84 versus 82%, respectively. While RPV was associated with more virologic failures overall (9 vs 5%) and conveyed a greater risk of resistance-associated mutations developing, in patients with baseline viral load ≤100,000 copies/ml, virologic failures rates were similar (4 vs 3%). RPV was associated with fewer discontinuations due to adverse events (2 vs 7%) and a better tolerability profile, particularly regarding neurologic/psychiatric events and rash. qd RPV is a valuable option for antiretroviral treatment-naive patients, particularly those with viral load ≤100,000 copies/ml.