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因经济原因将每日一次单片方案转换为三联片剂方案的个体中抗逆转录病毒治疗的效果。

Effectiveness of antiretroviral therapy in individuals who for economic reasons were switched from a once-daily single-tablet regimen to a triple-tablet regimen.

机构信息

*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.

出版信息

J Acquir Immune Defic Syndr. 2014 Aug 1;66(4):407-13. doi: 10.1097/QAI.0000000000000199.


DOI:10.1097/QAI.0000000000000199
PMID:24984188
Abstract

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.

摘要

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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