Jarrin Inma, Hernández-Novoa Beatriz, Alejos Belén, Riera Melchor, Navarro Gemma, Bernardino Jose Ignacio, Rivero Maria, del Amo Julia, Moreno Santiago
Instituto de Salud Carlos III, Madrid, Spain.
Antivir Ther. 2013;18(2):161-70. doi: 10.3851/IMP2287. Epub 2012 Sep 20.
The aim of this study was to estimate the persistence of the most commonly used first-line combined antiretroviral regimens (cART) in HIV-infected adults in the CoRIS cohort.
CoRIS is an open prospective multicentre cohort of HIV-infected adults naive to cART at entry. Patients enrolled between January 2008 and June 2010 were included. The main outcome was treatment persistence, defined as time from cART initiation to first treatment change (TC). Cox models taking into account competing risks to estimate sub-hazard ratios (sHR) were performed.
Of 1,512 patients, 919 (60.8%) initiated cART with the backbone tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) plus efavirenz (EFV), 252 (16.7%) plus lopinavir/ritonavir (LPV/r), 129 (8.5%) plus atazanavir/ritonavir (ATV/r), 110 (7.3%) plus darunavir/ritonavir (DRV/r) and 102 (6.7%) plus nevirapine (NVP). Among 414 patients who switched therapy, reason for switching was available for 393. The most frequent reasons were toxicity (40%), simplification (14%) and treatment failure/resistance (13%). In multivariate analyses, there were significant differences in the risk of TC according to initial cART regimen (P<0.001). Initiating TDF plus FTC with NVP (sHR 1.94, 95% CI 1.38, 2.72) or LPV/r (sHR 1.89, 95% CI 1.45, 2.47) was associated with higher risk of TC than initiating with TDF plus FTC plus EFV. No differences in TC were found between initiating EFV versus ATV/r (sHR 1.29, 95% CI 0.89, 1.86) or DRV/r (sHR 0.98, 95% CI 0.59, 1.65) with TDF plus FTC as backbone.
Switching from initial cART regimens is frequent, toxicity being the main reason for it. The significantly greater persistence of some combinations may be useful for making decisions when initiating cART.
本研究旨在评估CoRIS队列中感染HIV的成年患者最常用的一线联合抗逆转录病毒疗法（cART）的持续性。
CoRIS是一个开放性前瞻性多中心队列，纳入初治cART的HIV感染成年患者。纳入2008年1月至2010年6月期间入组的患者。主要结局是治疗持续性，定义为从开始cART到首次治疗变更（TC）的时间。采用考虑竞争风险的Cox模型来估计亚风险比（sHR）。
1512例患者中，919例（60.8%）开始使用富马酸替诺福韦二吡呋酯（TDF）加恩曲他滨（FTC）加依非韦伦（EFV）作为基础的cART，252例（16.7%）加用洛匹那韦/利托那韦（LPV/r），129例（8.5%）加用阿扎那韦/利托那韦（ATV/r），110例（7.3%）加用达芦那韦/利托那韦（DRV/r），102例（6.7%）加用奈韦拉平（NVP）。在414例更换治疗方案的患者中，393例有更换原因。最常见的原因是毒性（40%）、简化治疗方案（14%）和治疗失败/耐药（13%）。在多变量分析中，根据初始cART方案，TC风险存在显著差异（P<0.001）。与开始使用TDF加FTC加EFV相比，开始使用TDF加FTC加NVP（sHR 1.94，95%CI 1.38，2.72）或LPV/r（sHR 1.89，95%CI 1.45，——2.47）与更高的TC风险相关。以TDF加FTC为基础开始使用EFV与开始使用ATV/r（sHR 1.29，95%CI 0.89，1.86）或DRV/r（sHR 0.98，95%CI 0.59，1.65）之间在TC方面未发现差异。
从初始cART方案转换治疗很常见，毒性是主要原因。某些联合方案显著更高的持续性可能有助于在开始cART时做出决策。
