INSERM U897, Université Victor Segalen Bordeaux 2, Bordeaux, France.
AIDS. 2010 Jan 2;24(1):93-9. doi: 10.1097/QAD.0b013e32832ec1c3.
To determine the rates and causes of first antiretroviral treatment changes in HIV-infected adults in Côte d'Ivoire.
We evaluated adults who initiated antiretroviral treatment in an outpatient clinic in Abidjan. We recorded baseline and follow-up data, including drug prescriptions and reasons for changing to alternative first-line regimens (drug substitution for any reason but failure) or second-line regimens (switch for failure).
Two thousand and twelve HIV-infected adults (73% women) initiated antiretroviral treatment. At baseline, 9% of all patients were on treatment for tuberculosis and 3% of women were pregnant. First-line antiretroviral treatment consisted of two nucleoside reverse transcriptase inhibitors (58% stavudine-lamivudine, 42% zidovudine-lamivudine) and efavirenz (63%), nevirapine (32%) or indinavir (5%). Median follow-up time was 16.9 months. During this time, 205 (10%) patients died and 261 (13%) were lost to follow-up. Overall, the rate of treatment modifications was 20.7/100 patient-years. The most common modifications were drug substitutions for intolerance (12.4/100 patient-years), pregnancy (4.5/100 patient-years) and tuberculosis (2.5/100 patient-years). The rates of intolerance-related substitutions were 17.9/100 patient-years for stavudine, 6.3/100 patient-years for nevirapine, 3.9/100 patient-years for zidovudine and 0.1/100 patient-years for efavirenz. Twenty percent of efavirenz substitutions resulted from pregnancy and 18% of nevirapine substitutions were related to tuberculosis treatment.
During the first months following antiretroviral treatment initiation, a third of all treatment changes occurred for reasons other than intolerance to the drug or treatment failure. In Africa, drug forecasting is crucial to ensuring the success of HIV treatment programmes. Drugs that do not require interruptions during pregnancy or tuberculosis treatment should be made more readily available as first-line drugs in sub-Saharan Africa.
确定科特迪瓦感染艾滋病毒的成年人首次抗逆转录病毒治疗改变的发生率和原因。
我们评估了在阿比让的一个门诊诊所开始抗逆转录病毒治疗的成年人。我们记录了基线和随访数据，包括药物处方和改变为替代一线方案（因任何原因而非失败而进行药物替代）或二线方案（因失败而转换）的原因。
2012 名感染艾滋病毒的成年人（73%为女性）开始接受抗逆转录病毒治疗。在基线时，所有患者中有 9%正在接受结核病治疗，3%的女性怀孕。一线抗逆转录病毒治疗由两种核苷逆转录酶抑制剂（58%司他夫定-拉米夫定，42%齐多夫定-拉米夫定）和依非韦伦（63%）、奈韦拉平（32%）或茚地那韦（5%）组成。中位随访时间为 16.9 个月。在此期间，205 名（10%）患者死亡，261 名（13%）患者失访。总体而言，治疗改变的发生率为 20.7/100 患者年。最常见的改变是因不耐受（12.4/100 患者年）、怀孕（4.5/100 患者年）和结核病（2.5/100 患者年）进行药物替代。因不耐受而进行药物替代的发生率为司他夫定 17.9/100 患者年，奈韦拉平 6.3/100 患者年，齐多夫定 3.9/100 患者年，依非韦伦 0.1/100 患者年。20%的依非韦伦替代是由于怀孕，18%的奈韦拉平替代与结核病治疗有关。
在抗逆转录病毒治疗开始后的头几个月，三分之一的治疗改变是由于对药物或治疗失败之外的原因。在非洲，药物预测对于确保艾滋病毒治疗方案的成功至关重要。在撒哈拉以南非洲，应该更容易获得不需要在怀孕期间或结核病治疗期间中断的药物作为一线药物。
