University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07101, USA.
AIDS Patient Care STDS. 2010 Feb;24(2):87-96. doi: 10.1089/apc.2009.0259.
A randomized, open-label, multicenter study was conducted to evaluate the therapeutic switch to a single-tablet formulation of efavirenz/emtricitabine/tenofovir DF (EFV/FTC/TDF) among virologically suppressed, HIV-1-infected subjects. Eligible subjects on stable antiretroviral therapy (ART) with HIV-1 RNA less than 200 copies per milliliter for 3 months or more were stratified by prior protease inhibitor (PI)- or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy and randomized (2:1) to EFV/FTC/TDF or to stay on their baseline regimen (SBR). Patient-reported measures were quality of life (QOL; SF-36 [version 2]), treatment adherence (visual analogue scale), preference of medication (POM), perceived ease of the regimen for condition (PERC), and a 20-item HIV symptom index. Overall, 203 subjects were randomized to EFV/FTC/TDF and 97 to SBR. Fifty-three percent of subjects had previously received a PI-based regimen; 47% an NNRTI-based therapy. Throughout the study, SF-36 summary scores did not differ significantly from baseline, regardless of previous ART or treatment allocation. Adherence was 96% or more in both groups at baseline and all subsequent study visits. At study conclusion, the EFV/FTC/TDF regimen was considered easier to follow than prior regimens by 97% and 96% of subjects previously receiving PI-based and NNRTI-based therapies, respectively. Overall, 91% of subjects switched to EFV/FTC/TDF indicated a preference over their prior therapy. Switching to EFV/FTC/TDF was associated with transient worsening/emergence of dizziness and sustained improvements in several other HIV-related symptoms. In conclusion, switching virologically suppressed, HIV-1-infected subjects from PI-based or NNRTI-based regimens to EFV/FTC/TDF was associated with maintained QOL and treatment adherence, and improved ease of use and treatment satisfaction.
一项随机、开放标签、多中心研究评估了在病毒学抑制的 HIV-1 感染受试者中,将依非韦伦/恩曲他滨/替诺福韦酯(EFV/FTC/TDF)单一片剂转换为治疗方案的效果。符合条件的受试者正在接受稳定的抗逆转录病毒治疗(ART),HIV-1 RNA 小于 200 拷贝/毫升持续 3 个月或以上,按之前基于蛋白酶抑制剂(PI)或非核苷类逆转录酶抑制剂(NNRTI)的治疗进行分层,并随机(2:1)分配至 EFV/FTC/TDF 组或继续使用其基线方案(SBR)。患者报告的测量指标包括生活质量(QOL;SF-36[版本 2])、治疗依从性(视觉模拟量表)、药物偏好(POM)、治疗方案对疾病的感知便捷性(PERC)和 20 项 HIV 症状指数。总体而言,203 名受试者被随机分配至 EFV/FTC/TDF 组,97 名受试者被分配至 SBR 组。53%的受试者之前接受过 PI 为基础的治疗方案;47%的受试者接受 NNRTI 为基础的治疗方案。在整个研究过程中,SF-36 综合评分与基线相比没有显著差异,无论之前的 ART 或治疗分配如何。两组在基线和所有后续研究访视时的依从性均为 96%或更高。研究结束时,97%和 96%之前接受 PI 为基础和 NNRTI 为基础治疗方案的受试者分别认为 EFV/FTC/TDF 方案比之前的方案更容易遵循。总体而言,91%的受试者表示更倾向于转换为 EFV/FTC/TDF。转换为 EFV/FTC/TDF 与头晕恶化/出现有关,与其他一些 HIV 相关症状的持续改善有关。总之,将基于 PI 或 NNRTI 的方案转换为 EFV/FTC/TDF 可使病毒学抑制的 HIV-1 感染受试者保持生活质量和治疗依从性,并提高使用的便捷性和治疗满意度。