Lee Katherine J, Dunn David, Gilson Richard, Porter Kholoud, Bansi Loveleen, Hill Teresa, Phillips Andrew N, Sabin Caroline A, Schwenk Achim, Leen Clifford, Delpech Valerie, Anderson Jane, Gazzard Brian, Johnson Margaret, Easterbrook Philippa, Walsh John, Fisher Martin, Orkin Chloe
AIDS. 2008 Oct 1;22(15):1943-50. doi: 10.1097/QAD.0b013e32830e4cf3.
To describe the time from first viral rebound on highly active antiretroviral therapy to first treatment change, identify factors associated with more rapid switching, and investigate whether treatment changes are in line with treatment guidelines.
A multicentre cohort study.
We described the time to first treatment switch among individuals experiencing confirmed virological rebound after initiating highly active antiretroviral therapy; factors associated with more rapid switching were identified using proportional hazards regression and predictors of a switch in line with guidelines were identified using logistic regression.
Thirty-four percent of the 694 patients experiencing virological rebound remained on a failing regimen for more than 6 months. Factors associated with more rapid switching were lower CD4 cell count (hazard ratio, 0.84 /100 cells/mul higher, P < 0.001), higher viral load (1.29 /log10 copies/ml higher, P < 0.001), older age (1.06 /5 years older, P = 0.07), and changing/adding drugs to the regimen prior to rebound (1.16, P = 0.16). Two hundred and eighteen of the 394 treatment changes (55%) were in line with guidelines; those receiving nonnucleoside reverse transcriptase inhibitor-containing regimens were more likely to make changes in line with guidelines (adjusted odds ratio, 2.80, P < 0.001), whereas those who had previously added drugs to their regimen were less likely to make changes in line with guidelines (0.15, P = 0.001).
A substantial minority of patients remain on a failing highly active antiretroviral therapy regimen for periods of 6 months or longer without adding new drugs. Changes made are often not in line with treatment guidelines, raising concerns about the development of resistance and long-term clinical outcomes in these individuals.
描述从高效抗逆转录病毒治疗首次病毒反弹到首次治疗变更的时间，确定与更快换药相关的因素，并调查治疗变更是否符合治疗指南。
一项多中心队列研究。
我们描述了开始高效抗逆转录病毒治疗后出现确诊病毒学反弹的个体首次治疗换药的时间；使用比例风险回归确定与更快换药相关的因素，使用逻辑回归确定符合指南的换药预测因素。
694例出现病毒学反弹的患者中，34%在治疗失败的方案上维持超过6个月。与更快换药相关的因素包括较低的CD4细胞计数（每100个细胞/微升增加，风险比为0.84，P<0.001）、较高的病毒载量（每log10拷贝/毫升增加1.29，P<0.001）、年龄较大（每5岁增加，风险比为1.06，P=0.07）以及在反弹前改变/添加方案中的药物（风险比为1.16，P=0.16）。394次治疗变更中有218次（55%）符合指南；接受含非核苷类逆转录酶抑制剂方案的患者更有可能做出符合指南的变更（调整后的优势比为2.80，P<0.001），而之前在方案中添加过药物的患者做出符合指南变更的可能性较小（优势比为0.15，P=0.001）。
相当一部分患者在高效抗逆转录病毒治疗方案失败的情况下，持续6个月或更长时间而不添加新药。所做的变更往往不符合治疗指南，这引发了对这些个体耐药性发展和长期临床结局的担忧。
