Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Braz J Infect Dis. 2012 Jan-Feb;16(1):27-33.
Finding a better first antiretroviral regimen is one of the strategies used to improve span and quality of life of HIV/AIDS patients. 891 patients were followed during 24 months or until interruption/abandonment of treatment, changing regimen or death. At the end of 6 months, 69% of the patients were still being treated with the first regimen, 54% at 12 months, 48% at 18 months and 39% at 24 months. AZT-3TC-EFV was the most prescribed regimen and with the lesser discontinuation. NNRTI regimens showed high effectiveness and durability compared to PI regimens. Irregular medication dispensation was the only risk factor for failure/interruption of treatment in multivariate analyses. Intolerance/adverse effects were mainly responsible for first regimen discontinuation, followed by abandonment/non-adherence and virologic failure. Results showed significant difference between causes of interruption of first HAART with higher percentage of intolerance/adverse effects with PI regimens and higher immunologic failure with NNRTI regimens. Even with the availability of more potent and tolerable drugs, lack of adherence to HAART and high level of adverse effects are still the most important barriers to prolonged success of treatment. This study adds relevant information about durability and effectiveness of HAART in the first decade of its use in Brazil.
寻找更好的一线抗逆转录病毒治疗方案是改善 HIV/AIDS 患者生存时间和生活质量的策略之一。891 例患者接受了 24 个月或直至中断/放弃治疗、改变治疗方案或死亡的随访。6 个月结束时，69%的患者仍在使用一线方案治疗，12 个月时为 54%，18 个月时为 48%，24 个月时为 39%。AZT-3TC-EFV 是最常开的方案，中断率最低。与 PI 方案相比，NNRTI 方案具有更高的有效性和持久性。不规则用药是多变量分析中治疗失败/中断的唯一危险因素。不耐受/不良反应主要是导致一线抗逆转录病毒治疗方案中断的原因，其次是放弃/不依从和病毒学失败。结果显示，PI 方案组因不耐受/不良反应导致中断的比例较高，NNRTI 方案组因免疫失败导致中断的比例较高，这与中断一线 HAART 的原因存在显著差异。即使有更有效和耐受性更好的药物，缺乏对 HAART 的依从性和不良反应的高发生率仍然是治疗长期成功的最重要障碍。本研究为巴西使用 HAART 的第一个十年中 HAART 的持久性和有效性提供了相关信息。
