Efficacy and effect on lipid profiles of switching to ainuovirine-based regimen versus continuing efavirenz-based regimen in people with HIV-1: 24-week results from a real-world, retrospective, multi-center cohort study

• Published in: Antimicrobial agents and chemotherapy 2024-04, Vol.68 (4), p.e0166823-e0166823
• Main Authors: Wang, Chunmei, Yu, Xiaoli, Ke, Yingchun, Fu, Yanhua, Luo, Yanhe, Li, Ying, Bi, Yanmei, Chen, Xingqiong, Li, Linghua, Zhao, Xiuhong, Chen, Zhong
• Format: Article
• Language: English
• Subjects: Alkynes - pharmacology; Alkynes - therapeutic use; Anti-HIV Agents - pharmacology; Anti-HIV Agents - therapeutic use; Antiviral Agents; Benzoxazines - pharmacology; Benzoxazines - therapeutic use; Cholesterol, LDL; Conduct of Scientific Research; Cyclopropanes - pharmacology; HIV Infections - drug therapy; HIV-1; Humans; Retrospective Studies
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/aac.01668-23

Ainuovirine (ANV), a novel non-nucleoside reverse-transcriptase inhibitor (NNRTI), was approved in China in 2021. In a previous randomized phase 3 trial, ANV demonstrated non-inferior efficacy relative to efavirenz (EFV) and was associated with lower rates of dyslipidemia. In this study, we aimed to explore lipid changes in treatment-experienced people with human immunodeficiency virus (HIV)-1 (PWH) switching to ANV from EFV in real world. At week 24, 96.65% of patients in the ANV group and 93.25% in the EFV group had HIV-1 RNA levels below the limit of quantification (LOQ). Median changes from baseline in CD4 +T cell counts (37.0 vs 36.0 cells/µL, = 0.886) and CD4+/CD8 +ratio (0.03 vs 0.10, = 0.360) were similar between the two groups. The ANV group was superior to the EFV group in mean changes in total cholesterol (TC, -0.06 vs 0.26 mmol/L, = 0.006), triglyceride (TG, -0.6 vs 0.14 mmol/L, < 0.001), high-density lipoprotein cholesterol (HDL-C, 0.09 vs 0.08 mmol/L, = 0.006), and low-density lipoprotein cholesterol (LDL-C, -0.18 vs 0.29 mmol/L, < 0.001) at week 24. We also observed that a higher proportion of patients demonstrated improved TC (13.55% vs 4.45%, = 0.015) or LDL-C (12.93% vs 6.89%, = 0.017), and a lower proportion of patients showed worsened LDL-C (5.57% vs 13.52%, = 0.017) with ANV than with EFV at week 24. In conclusion, we observed good efficacy and favorable changes in lipids in switching to ANV from EFV in treatment-experienced PWH in real world, indicating a promising switching option for PWH who may be more prone to metabolic or cardiovascular diseases.