Infectious Diseases, IRCCS San Martino Hospital-IST, Genoa, Italy.
J Antimicrob Chemother. 2013 Jan;68(1):200-5. doi: 10.1093/jac/dks339. Epub 2012 Aug 21.
To explore the durability of three first-line tenofovir/emtricitabine-based regimens in combination with atazanavir/ritonavir, efavirenz or lopinavir/ritonavir in HIV-1-infected patients.
A retrospective, longitudinal, multicentre analysis of adult patients enrolled in the Antiretroviral Resistance Cohort Analysis (ARCA), a national prospective observational cohort of HIV-1-infected patients followed up at more than 100 clinical and laboratory units in Italy. Patients eligible were those starting first-line antiretroviral therapy between 1 June 2004 and 15 April 2011 and who were followed up for at least 6 months. The primary endpoint was durability, defined as the time from antiretroviral therapy initiation to first treatment modification. Time-dependent events were analysed by the Kaplan-Meier approach and the Cox proportional hazard model.
There are 26,000 HIV-infected patients in the ARCA database, of whom 1654 met study inclusion criteria. Six hundred and thirty-nine (38.6%) received efavirenz, 321 (19.4%) received atazanavir/ritonavir and 694 (41.9%) received lopinavir/ritonavir as a first-line regimen. Over a total observation period of 88 months, equivalent to more than 2805 person-years of follow-up, 618 patients underwent treatment modification. Lopinavir/ritonavir, given twice daily, was associated with a higher discontinuation rate than efavirenz- and atazanavir-based regimens [hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.56-2.15, P = 0.001]. Comparing the once-daily regimens, the rate of discontinuation of efavirenz was higher than that of atazanavir/ritonavir (HR 1.39, 95% CI 1.06-1.83, P = 0.016).
Significant differences in treatment duration were observed among the three studied regimens. Once-daily regimens exhibited greater durability than the twice-daily regimen. Among the specific regimens examined, tenofovir/emtricitabine plus atazanavir/ritonavir showed the greatest durability.
探索替诺福韦/恩曲他滨为基础的三种一线方案与阿扎那韦/利托那韦、依非韦伦或洛匹那韦/利托那韦联合治疗在 HIV-1 感染者中的持久性。
这是一项回顾性、纵向、多中心分析，纳入了参与抗逆转录病毒耐药性队列分析（ARCA）的成年患者，这是一个在意大利 100 多个临床和实验室单位对 HIV-1 感染者进行随访的全国前瞻性观察队列。符合条件的患者为 2004 年 6 月 1 日至 2011 年 4 月 15 日期间开始一线抗逆转录病毒治疗，随访至少 6 个月。主要终点是持久性，定义为从抗逆转录病毒治疗开始到首次治疗改变的时间。通过 Kaplan-Meier 方法和 Cox 比例风险模型分析时间依赖性事件。
ARCA 数据库中有 26000 名 HIV 感染者，其中 1654 名符合研究纳入标准。639 名（38.6%）接受依非韦伦治疗，321 名（19.4%）接受阿扎那韦/利托那韦治疗，694 名（41.9%）接受洛匹那韦/利托那韦治疗作为一线方案。在总共 88 个月的观察期内，相当于超过 2805 人年的随访，618 名患者进行了治疗调整。与依非韦伦和阿扎那韦/利托那韦为基础的方案相比，每日两次给予洛匹那韦/利托那韦与更高的停药率相关[风险比（HR）1.83，95%置信区间（CI）1.56-2.15，P=0.001]。比较每日一次的方案，依非韦伦的停药率高于阿扎那韦/利托那韦（HR 1.39，95%CI 1.06-1.83，P=0.016）。
三种研究方案的治疗持续时间存在显著差异。每日一次的方案比每日两次的方案具有更高的持久性。在研究的具体方案中，替诺福韦/恩曲他滨联合阿扎那韦/利托那韦显示出最大的持久性。
