Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, AL, USA.
J Acquir Immune Defic Syndr. 2010 Feb;53(2):215-21. doi: 10.1097/QAI.0b013e3181bc0f10.
Whereas access to antiretroviral therapy (ART) for HIV-infected individuals in the developing world is increasing, data on factors impacting initial regimen durability are lacking.
Retrospective review patients starting initial ART at Instituto de Medicine Tropical (Lima, Peru) April 1, 2004 to December 30, 2007. Survival methods (Kaplan-Meier, Cox proportional hazard) assessed factors associated with regimen durability including an interaction term between nucleoside reverse transcriptase inhibitor backbone and time.
Decreased initial regimen durability was observed with weight <60 kg [hazards ratio (HR) = 1.77; 95% confidence interval (CI) = 1.25-2.51], CD4 <200 (HR = 1.73; 95% CI = 1.03-2.91), and zidovudine (AZT) use at <120 days (HR = 2.09; 95% CI = 1.22-3.57). In contrast, after 120 days, AZT use decreased risk of discontinuation (HR = 0.52; 95% CI = 0.28-0.95). Early (<120 days) toxicity-related discontinuation of AZT containing regimens was observed in 44% of patients <50 kg at baseline vs. 14% of those >70 kg. An increased risk of early toxicity-related discontinuation of AZT-containing regimens was observed for baseline weight <60 kg (HR = 2.52; 95% CI = 1.46-4.35).
Lower baseline weight and lower CD4 values at ART initiation were associated with decreased regimen durability. Compared with didanosine/stavudine, AZT use initially increased, then subsequently (>120 days) lowered hazards for regimen discontinuation. Weight <60 kg was associated with an increased risk of toxicity-related AZT discontinuation. As ART use expands globally, further study into maximally durable, least toxic regimens, and the role of weight-based AZT dosing is imperative.
尽管发展中国家艾滋病毒感染者获得抗逆转录病毒疗法（ART）的机会在增加，但缺乏关于影响初始方案耐久性的因素的数据。
回顾性分析 2004 年 4 月 1 日至 2007 年 12 月 30 日在利马 Instituto de Medicine Tropical 开始初始 ART 的患者。使用生存方法（Kaplan-Meier、Cox 比例风险）评估与方案耐久性相关的因素，包括核苷逆转录酶抑制剂骨干与时间之间的交互项。
体重<60kg [危险比（HR）=1.77；95%置信区间（CI）=1.25-2.51]、CD4<200（HR=1.73；95%CI=1.03-2.91）和齐多夫定（AZT）使用<120 天（HR=2.09；95%CI=1.22-3.57）与初始方案耐久性降低有关。相比之下，在 120 天后，AZT 的使用降低了停药风险（HR=0.52；95%CI=0.28-0.95）。在基线时体重<50kg 的患者中，有 44%因早期（<120 天）与毒性相关而停用 AZT 方案，而体重>70kg 的患者中只有 14%因早期毒性相关而停药。基线体重<60kg 时，AZT 方案因早期毒性相关而停用的风险增加（HR=2.52；95%CI=1.46-4.35）。
较低的基线体重和较低的 CD4 值与方案耐久性降低有关。与地达诺辛/司他夫定相比，AZT 的初始使用增加，然后（>120 天）降低了方案停药的风险。体重<60kg 与因毒性相关而停用 AZT 的风险增加有关。随着 ART 在全球范围内的使用不断扩大，需要进一步研究最持久、毒性最小的方案，以及体重为基础的 AZT 剂量的作用。
