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初始高效抗逆转录病毒疗法对HIV感染未来治疗方案的影响。

The impact of initial highly active antiretroviral therapy on future treatment sequences in HIV infection.

作者信息

Klein Marina B, Willemot Patrick, Murphy Tanya, Lalonde Richard G

机构信息

Department of Medicine, Divisions of Infectious Diseases/Immunodeficiency, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

出版信息

AIDS. 2004 Sep 24;18(14):1895-904. doi: 10.1097/00002030-200409240-00005.

Abstract

OBJECTIVES

To determine whether the initial use of non-nucleoside reverse transcriptase inhibitors (NNRTI) or protease inhibitors (PI) differentially influences subsequent HIV therapy.

DESIGN

A cohort study using a prospective clinical database in a university-based HIV clinic.

SUBJECTS

A total of 440 HIV-seropositive patients, naive or nucleoside experienced, initiating therapy with either an NNRTI or PI between January 1998 and July 2003 and followed to December 2003.

MAIN OUTCOME MEASURES

Time until stopping the first regimen and until exposure to all antiretroviral classes (excluding tenofovir and enfuvirtide) according to the type of initial regimen.

RESULTS

A total of 291 subjects initiated HAART with PI and 149 with NNRTI; median follow-up 3.1 and 2.3 years, respectively. Subjects starting NNRTI remained on their initial regimens longer (median time to change 2.1 versus 1.6 years; log rank P = 0.03). Overall, subjects initiating NNRTI-based regimens were less likely to alter their therapy. Previous nucleoside exposure was an important predictor of treatment modification. Subjects initiating NNRTI-based HAART were also less likely to experience virological failure than those initiating PI-based HAART. Individuals starting with NNRTI were exposed to fewer regimens (15 versus 25% received three or fewer regimens), and showed a trend towards lower rates of three-class exposure (7 versus 12%).

CONCLUSION

There is a high rate of treatment modification among patients initiating HAART. The initial use of NNRTI-based HAART was associated with more durable treatment and lower rates of virological failure, which may translate into a reduced need for multiple salvage therapies.

摘要

目的

确定非核苷类逆转录酶抑制剂(NNRTI)或蛋白酶抑制剂(PI)的初始使用是否会对后续的HIV治疗产生不同影响。

设计

一项队列研究,使用大学附属HIV诊所的前瞻性临床数据库。

研究对象

共有440名HIV血清阳性患者,包括初治患者或曾接受核苷类药物治疗的患者,于1998年1月至2003年7月间开始使用NNRTI或PI进行治疗,并随访至2003年12月。

主要观察指标

根据初始治疗方案的类型,计算停止首个治疗方案的时间以及接触所有抗逆转录病毒药物类别(不包括替诺福韦和恩夫韦肽)的时间。

结果

共有291名受试者开始使用PI进行高效抗逆转录病毒治疗(HAART),149名使用NNRTI;中位随访时间分别为3.1年和2.3年。开始使用NNRTI的受试者在初始治疗方案上的持续时间更长(中位换药时间为2.1年对1.6年;对数秩检验P = 0.03)。总体而言,开始使用基于NNRTI方案的受试者更改治疗方案的可能性较小。既往核苷类药物暴露是治疗方案更改的重要预测因素。开始使用基于NNRTI的HAART的受试者发生病毒学失败的可能性也低于开始使用基于PI的HAART的受试者。以NNRTI开始治疗的个体接触的治疗方案较少(15%对25%接受三种或更少的治疗方案),并且在接受三类药物治疗的比例上有降低趋势(7%对12%)。

结论

开始HAART治疗的患者中治疗方案更改率较高。初始使用基于NNRTI的HAART与更持久的治疗和更低的病毒学失败率相关,这可能意味着减少了多次挽救治疗的需求。

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