Switching EFV/FTC/TDF to B/F/TAF or generic EFV/FTC/TDS in virologically suppressed adults with human immunodeficiency virus: a 96-week retrospective cohort

BACKGROUND:

Drastic cuts to the Mexican health budget led to a governmental decision to switch patients from EFV/FTC/TDF to either B/F/TAF or generic EFV/FTC/TDS. While tenofovir disoproxil succinate is approved in some countries, no information is available regarding its efficacy in maintaining virologic control. We aimed to describe the rates of virologic suppression after 96 weeks of said switch.

METHODS:
A retrospective cohort with data gathered from files at CAPASITS Nuevo León. Participants were �18 years and had plasma HIV-1 RNA <50 copies/mL while taking EFV/FTC/TDF for at least 6 consecutive months. This study was approved by UANL and Secretaría de Salud Nuevo León ethics committees.
The primary objective was determining the proportion of participants who maintained HIV- 1 <50 copies/mL at Week 96 after switch. We included subjects who reached 96 weeks with their new therapy between May 1st and October 30th, 2021. Demographics were analyzed using descriptive statistics and a Fisherâ??s exact test with an α of 0.05 for the primary objective.

RESULTS: Out of 421 files reviewed from patients receiving either B/F/TAF or EFV/FTC/TDS, 358 met inclusion criteria. Authors aimed to gather information from 129 patients per group, but maintaining recruitment for six more months would render less than ten additional cases. Completion of 96- week period was achieved by 266 and 92 patients receiving B/F/TAF and EFV/FTC/TDS respectively.
Baseline demographics for both groups are described in Table 1. HIV-1 RNA < 50 copies/mL was maintained in 93.9% (250/266) of B/F/TAF and 85.8% (79/92) of the EFV/FTC/TDS arm (8.1% difference; P =.01). Median CD4 cell difference was -33 cells/mL in the B/F/TAF group and 15 for the patients receiving EFV/FTC/TDS.



B/F/TAF

EFV/FTC/TDS

Pvalue

Age in years [Median (IQR)]

51.5 (39.2-57)

37 (30-42)

<.001

Gender (Cisgender Women % / Transgender Women % /
Cisgender Men%)

24.8/10.5/64.6%

31.5/0/68.4%

<.001 for Transgender Women

Years taking ARV [Median (IQR)]


6.9 (5.2-10.8)

5.9 (4.5-7.7)

<.001

Patients with additional previous ARV before EFV/FTC/TDF [n (%)]

66/266 (24.8)

13/92 (14.1)

.02

At least one blip during the 96- week period [n (%)]

51/266 (19.1)

33/92 (35.8)

.002



CONCLUSIONS:
While generic EFV/FTC/TDS might represent more than 50% savings, B/F/TAF maintained more patients undetectable than EFV/FTC/TDS. A nearly universal integrase inhibitor approach for switching patients with previous virologic control while taking EFV/FTC/TDF might be pricier but allows for fewer patients to develop virologic failure and blips.

L.Y. Zuluaga Jaramillo * (1), L.G. Castillo Reyna (2), A. Camacho Ortiz (3), L.M. Nuzzolo Shihadeh (4), A. Balderas Sarmiento (5), E. Perez Alba (6)
(1) Universidad Autónoma de Nuevo León, Infectology Service of the University Hospital "Dr. José Eleuterio González", Monterrey, Mexico, (2) Universidad Autónoma de Nuevo León, Undergraduate and Postgraduate Professor at "Dr. Jose Eleuterio González" Hospital and Coordinator of the Center for the Prevention and Care of HIV/AIDS, Monterrey, Mexico, (3) Universidad Autónoma de Nuevo León, Head of the Infectology Service of the University Hospital "Dr. José Eleuterio González", Monterrey, Mexico, (4) Universidad Autónoma de Nuevo León, Coordinator of the Infectology Undergraduate Program at the "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico, (5) Universidad Autónoma de Nuevo León, General Medicine, Monterrey, Mexico, (6) Universidad Autónoma de Nuevo León, Fellow Coordinator for Infectious Diseases, Monterrey, Mexico