*Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; †Department of Microbiology Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark; ‡Department of Infectious Diseases, Copenhagen University Hospital, Nordsjælland Hospital, Denmark; and §Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
J Acquir Immune Defic Syndr. 2014 Aug 1;66(4):407-13. doi: 10.1097/QAI.0000000000000199.
BACKGROUND: To assess the impact on virological outcomes of a switch from branded single-tablet regimen (STR) including tenofovir, efavirenz, and emtricitabine (STR-TEE) to generic triple-tablet regimen (TTR), including tenofovir, efavirenz, and lamivudine (TTR-TEL), which was implemented on April 1, 2011 to obtain economic savings. METHODS AND FINDINGS: From the Capital Region of Denmark (covering two-thirds of the Danish HIV patients), we included combination antiretroviral therapy (cART)-naive patients who administered STR-TEE from April 1, 2010 to March 31, 2011 (n = 111) or TTR-TEL from April 1, 2011 to March 31, 2012 (n = 56) and cART-experienced HIV patients who were on STR-TEE from April 1, 2010 (n = 356) or were switched from STR-TEE to TTR-TEL after April 1, 2011 (n = 512). We estimated the fraction with detectable HIV-RNA, development of the 184V/I resistance mutations, and time to switch of cART. Approximately 96.2% of cART-experienced patients on STR-TEE were shifted to TTR-TEL after April 1, 2011. For the naive STR-TEE and TTR-TEL patients, the fractions with detectable HIV-RNA at week 48 were 7.0% and 8.3% and for the cART experienced 4.0% and 4.4%, respectively. The 184V/I resistance mutation was detected in 1 cART-experienced patient on TTR-TEL with virological failure. The risk of switch to a new cART regimen was slightly increased in the cART-experienced population (difference in 1-year risk: 1.5%; 95% confidence interval: -2.4% to 5.4%). CONCLUSIONS: In settings comparable with the Danish health care system, the estimated economic savings from a switch from STR-TEE to TTR-TEL can be realized with negligible short-term risk of adverse outcomes.
背景:为了评估从包含替诺福韦、依非韦伦和恩曲他滨的品牌单一片剂方案(STR-TEE)转换为包含替诺福韦、依非韦伦和拉米夫定的通用三片剂方案(TTR-TEL)对病毒学结果的影响,于 2011 年 4 月 1 日实施了这一方案,以节省经济成本。
方法和发现:在丹麦首都大区(覆盖丹麦三分之二的艾滋病毒患者),我们纳入了从 2010 年 4 月 1 日至 2011 年 3 月 31 日接受 STR-TEE 治疗的初治患者(n=111)或从 2011 年 4 月 1 日至 2012 年 3 月 31 日接受 TTR-TEL 治疗的患者(n=56),以及从 2010 年 4 月 1 日开始接受 STR-TEE 治疗的接受过组合抗逆转录病毒治疗(cART)的经验性 HIV 患者(n=356)或在 2011 年 4 月 1 日后从 STR-TEE 转为 TTR-TEL 的患者(n=512)。我们估计了可检测到 HIV-RNA 的比例、184V/I 耐药突变的发展以及 cART 转换的时间。大约 96.2%的接受 STR-TEE 治疗的经验性 cART 患者在 2011 年 4 月 1 日后转为 TTR-TEL。对于初治的 STR-TEE 和 TTR-TEL 患者,第 48 周可检测到 HIV-RNA 的比例分别为 7.0%和 8.3%,而对于经验性 cART 患者,这一比例分别为 4.0%和 4.4%。1 例接受 TTR-TEL 治疗的经验性 cART 患者出现病毒学失败并检测到 184V/I 耐药突变。在经验性 cART 人群中,换用新的 cART 方案的风险略有增加(1 年风险差异:1.5%;95%置信区间:-2.4%至 5.4%)。
结论:在与丹麦医疗保健系统相当的环境中,从 STR-TEE 转换为 TTR-TEL 估计可以节省经济成本,并且不会带来明显的短期不良后果风险。
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