Department of Infectious Disease Epidemiology, Imperial College, Faculty of Medicine, London, United Kingdom.
PLoS One. 2013 Sep 30;8(9):e76071. doi: 10.1371/journal.pone.0076071. eCollection 2013.
Document progress in HIV-treatment in The Netherlands since 1996 by reviewing changing patterns of cART use and relating those to trends in patients' short-term clinical outcomes between 1996 and 2010.
1996-2010 data from 10,278 patients in the Dutch ATHENA national observational cohort were analysed. The annual number of patients starting a type of regimen was quantified. Trends in the following outcomes were described: i) recovery of 150 CD4 cells/mm(3) within 12 months of starting cART; ii) achieving viral load (VL) suppression ≤1,000 copies/ml within 12 months of starting cART; iii) switching from first-line to second-line regimen within three years of starting treatment; and iv) all-cause mortality rate per 100 person-years within three years of starting treatment.
Between 1996 and 2010, first-line regimens changed from lamivudine/zidovudine-based or lamivudine/stavudine-based regimens with unboosted-PIs to tenofovir with either emtricitabine or lamivudine with NNRTIs. Mortality rates did not change significantly over time. VL suppression and CD4 recovery improved over time, and the incidence of switching due to virological failure and toxicity more than halved between 1996 and 2010. These effects appear to be related to the use of new regimens rather than improvements in clinical care.
The use of first-line cART in the Netherlands closely follows changes in guidelines, to the benefit of patients. While there was no significant improvement in mortality, newer drugs with better tolerability and simpler dosing resulted in improved immunological and virological recovery and reduced incidences of switching due to toxicity and virological failure.
通过回顾自 1996 年以来荷兰 HIV 治疗中不断变化的 cART 使用模式，并将其与 1996 年至 2010 年间患者短期临床结局的趋势相关联，来记录 1996 年以来荷兰 HIV 治疗的进展。
分析了荷兰 ATHENA 全国观察性队列中 10278 名患者的 1996-2010 年数据。量化每年开始使用某种方案的患者数量。描述以下结局的趋势：i）开始 cART 后 12 个月内恢复 150 个 CD4 细胞/mm3；ii）开始 cART 后 12 个月内实现病毒载量（VL）≤1000 拷贝/ml；iii）开始治疗三年内从一线方案转换为二线方案；iv）开始治疗三年内每 100 人年的全因死亡率。
1996 年至 2010 年间，一线方案从无增强剂 PI 的拉米夫定/齐多夫定或拉米夫定/司他夫定方案转变为替诺福韦加恩曲他滨或拉米夫定加 NNRTI。死亡率随时间无显著变化。VL 抑制和 CD4 恢复随时间改善，由于病毒学失败和毒性而转换的发生率在 1996 年至 2010 年间减少了一半以上。这些效果似乎与新方案的使用有关，而不是临床护理的改善。
荷兰一线 cART 的使用密切遵循指南的变化，使患者受益。尽管死亡率没有显著改善，但新的药物具有更好的耐受性和更简单的剂量，导致免疫和病毒学恢复改善，由于毒性和病毒学失败而转换的发生率降低。
