Division of International and Environmental Health, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland.
J Acquir Immune Defic Syndr. 2012 Sep 1;61(1):41-8. doi: 10.1097/QAI.0b013e3182632540.
Tenofovir (TDF) is increasingly used in second-line antiretroviral treatment (ART) in sub-Saharan Africa. We compared outcomes of second-line ART containing and not containing TDF in cohort studies from Zambia and the Republic of South Africa (RSA).
Patients aged 16 years and older starting protease-inhibitor-based second-line ART in Zambia (1 cohort) and RSA (5 cohorts) were included. We compared mortality, immunological failure (all cohorts), and virological failure (RSA only) between patients receiving and not receiving TDF. Competing risk models and Cox models adjusted for age, sex, CD4 count, time on first-line ART, and calendar year were used to analyze mortality and treatment failure, respectively. Hazard ratios (HRs) were combined in fixed-effects meta-analysis.
1687 patients from Zambia and 1556 patients from RSA, including 1350 (80.0%) and 206 (13.2%) patients starting TDF, were followed over 4471 person-years. Patients on TDF were more likely to have started second-line ART in recent years and had slightly higher baseline CD4 counts than patients not on TDF. Overall, 127 patients died, 532 were lost to follow-up, and 240 patients developed immunological failure. In RSA, 94 patients had virologic failure. Combined HRs comparing TDF with other regimens were 0.60 (95% confidence interval [CI]: 0.41 to 0.87) for immunologic failure and 0.63 (0.38-1.05) for mortality. The HR for virologic failure in RSA was 0.28 (0.09-0.90).
In this observational study, patients on TDF-containing second-line ART were less likely to develop treatment failure than patients on other regimens. TDF seems to be an effective component of second-line ART in southern Africa.
替诺福韦（TDF）在撒哈拉以南非洲地区越来越多地用于二线抗逆转录病毒治疗（ART）。我们比较了赞比亚和南非共和国（RSA）的队列研究中包含和不包含 TDF 的二线 ART 的结果。
纳入了在赞比亚（1 个队列）和 RSA（5 个队列）开始基于蛋白酶抑制剂的二线 ART 的年龄在 16 岁及以上的患者。我们比较了接受和未接受 TDF 的患者的死亡率、免疫失败（所有队列）和病毒学失败（仅 RSA）。使用竞争风险模型和 Cox 模型，分别调整年龄、性别、CD4 计数、一线 ART 时间和日历年来分析死亡率和治疗失败。固定效应荟萃分析合并了危险比（HR）。
来自赞比亚的 1687 名患者和来自 RSA 的 1556 名患者，包括 1350 名（80.0%）和 206 名（13.2%）开始使用 TDF 的患者，随访时间超过 4471 人年。接受 TDF 的患者更有可能在最近几年开始二线 ART，并且基线 CD4 计数略高于未接受 TDF 的患者。总的来说，有 127 名患者死亡，532 名患者失访，240 名患者发生免疫失败。在 RSA，有 94 名患者发生病毒学失败。比较 TDF 与其他方案的合并 HR 为免疫失败 0.60（95%置信区间[CI]：0.41 至 0.87），死亡率为 0.63（0.38 至 1.05）。RSA 病毒学失败的 HR 为 0.28（0.09 至 0.90）。
在这项观察性研究中，接受 TDF 联合二线 ART 的患者发生治疗失败的可能性低于接受其他方案的患者。TDF 似乎是南部非洲二线 ART 的有效组成部分。
