Viciana Pompeyo, Ocampo Antonio, Hevia Henar, Palazuelos Marta, Ledesma Francisco
a Hospital Universitario Virgen del Rocío , Sevilla , Spain.
b Hospital Xeral Cíes , Vigo , Spain.
AIDS Care. 2016 Oct;28(10):1321-6. doi: 10.1080/09540121.2016.1173640. Epub 2016 May 3.
The Perfil-es study demonstrated that, while non-nucleoside reverse transcriptase inhibitor (NNRTI)-based initial antiretroviral therapy (ART) is more frequently used in human immunodeficiency virus (HIV)-infected naïve patients, ritonavir-boosted protease inhibitors (PI/r)-based regimens are the preferred option in patients with advanced infectious stages or high baseline viral load. The present analysis focused on the second phase of the Perfil-es study, where sociodemographic and clinical data were retrospectively collected from patients starting NNRTI- or PI/r-based regimens in order to identify factors that could influence the choice of initial ART. Patients' characteristics were compared by both bivariate and multivariate analyses. A total of 642 patients were evaluated. The main transmission group was men who have sex with men (MSM) (48%), and 24% of patients were coinfected with hepatitis B or C. Patients with cardiovascular risk accounted for 56%, and 15% had a neuropsychiatric history. Anxiolytics (29%), antidepressants (18%) and methadone (18%) were the most frequent concomitant medications. The use of PI/r-based regimens was more frequent in older patients, childbearing potential women patients coinfected with hepatitis B or C, and those with cardiovascular risk and a neuropsychiatric history. The presence of a neuropsychiatric disorder (OR: 1.912; CI 95%: 1.146-3.191; p < .05) and the use of concomitant medication (OR: 1.736; CI 95%: 1.204-2.502; p < .01) were identified as independent factors associated with the selection of PI/r-based regimens. MSM sexual conduct was the only independent factor related to the selection of NNRTI-based ART (OR: 0.699; CI 95%: 0.504-0.970; p < .05). Neither the physicians' characteristics nor the geographical area where HIV patients were attended influenced the choice of ART. In conclusion, patients' comorbidity, pregnancy potential and lifestyle seem to influence the choice of ART. Neuropsychiatric comorbidity and concomitant medication, mainly related to this condition, appear to be associated with the use of PI/r-based initial ART while MSM seem more likely to receive NNRTI-based regimens in Spain.
Perfil-es研究表明，虽然在初治的人类免疫缺陷病毒（HIV）感染患者中，更常使用基于非核苷类逆转录酶抑制剂（NNRTI）的初始抗逆转录病毒疗法（ART），但在处于感染晚期或基线病毒载量高的患者中，基于利托那韦增强蛋白酶抑制剂（PI/r）的方案是首选。本分析聚焦于Perfil-es研究的第二阶段，回顾性收集了开始基于NNRTI或PI/r方案治疗的患者的社会人口统计学和临床数据，以确定可能影响初始ART选择的因素。通过双变量和多变量分析对患者特征进行了比较。共评估了642例患者。主要传播群体是男男性行为者（MSM）（48%），24%的患者合并感染乙型或丙型肝炎。有心血管风险的患者占56%，15%有神经精神病史。最常使用的合并用药是抗焦虑药（29%）、抗抑郁药（18%）和美沙酮（18%）。在老年患者、合并感染乙型或丙型肝炎且有生育潜力的女性患者，以及有心血管风险和神经精神病史的患者中，更常使用基于PI/r的方案。神经精神障碍的存在（比值比：1.912；95%置信区间：1.146 - 3.191；p < 0.05）和合并用药的使用（比值比：1.736；95%置信区间：1.204 - 2.502；p < 0.01）被确定为与选择基于PI/r方案相关的独立因素。MSM性行为是与选择基于NNRTI的ART相关的唯一独立因素（比值比：0.699；95%置信区间：0.504 - 0.970；p < 0.05）。医生的特征以及HIV患者接受治疗的地理区域均未影响ART的选择。总之，患者的合并症、妊娠可能性和生活方式似乎会影响ART的选择。神经精神合并症和合并用药（主要与此情况相关）似乎与使用基于PI/r的初始ART有关，而在西班牙，MSM似乎更有可能接受基于NNRTI的方案。
