Davy-Mendez Thibaut, Eron Joseph J, Zakharova Oksana, Wohl David A, Napravnik Sonia
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Acquir Immune Defic Syndr. 2017 Oct 1;76(2):111-115. doi: 10.1097/QAI.0000000000001481.
Initiating antiretroviral therapy (ART) early improves clinical outcomes and prevents transmission. Guidelines for first-line therapy have changed with the availability of newer ART agents. In this study, we compared persistence and virologic responses with initial ART according to the class of anchor agent used.
An observational clinical cohort study in the Southeastern United States.
All HIV-infected patients participating in the UNC Center for AIDS Research Clinical Cohort (UCHCC) and initiating ART between 1996 and 2014 were included. Separate time-to-event analyses with regimen discontinuation and virologic failure as outcomes were used, including Kaplan-Meier survival curves and adjusted Cox proportional hazards models.
One thousand six hundred twenty-four patients were included (median age of 37 years at baseline, 28% women, 60% African American, and 28% white). Eleven percent initiated integrase strand transfer inhibitor (INSTI), 33% non-nucleoside reverse transcriptase inhibitor (NNRTI), 20% boosted protease inhibitor, 27% other, and 9% NRTI only regimens. Compared with NNRTI-containing regimens, INSTI-containing regimens had an adjusted hazard ratio of 0.49 (95% confidence interval, 0.35 to 0.69) for discontinuation and 0.70 (95% confidence interval, 0.46 to 1.06) for virologic failure. All other regimen types were associated with increased rates of discontinuation and failure compared with NNRTI.
Initiating ART with an INSTI-containing regimen was associated with lower rates of regimen discontinuation and virologic failure.
早期启动抗逆转录病毒疗法（ART）可改善临床结局并预防传播。随着新型ART药物的出现，一线治疗指南已发生变化。在本研究中，我们根据所使用的锚定药物类别比较了初始ART的持续性和病毒学反应。
美国东南部的一项观察性临床队列研究。
纳入所有参与北卡罗来纳大学艾滋病研究中心临床队列（UCHCC）并在1996年至2014年间开始接受ART的HIV感染患者。使用以治疗方案中断和病毒学失败为结局的单独的事件发生时间分析，包括Kaplan-Meier生存曲线和调整后的Cox比例风险模型。
共纳入1624例患者（基线时中位年龄为37岁，28%为女性，60%为非裔美国人，28%为白人）。11%的患者启动了整合酶链转移抑制剂（INSTI）方案，33%启动了非核苷类逆转录酶抑制剂（NNRTI）方案，20%启动了增强型蛋白酶抑制剂方案，27%启动了其他方案，9%仅启动了核苷类逆转录酶抑制剂（NRTI）方案。与含NNRTI的方案相比，含INSTI的方案中断治疗的调整后风险比为0.49（95%置信区间，0.35至0.69），病毒学失败的调整后风险比为0.70（95%置信区间，0.46至1.06）。与NNRTI相比，所有其他方案类型的中断治疗和失败率均增加。
启动含INSTI的ART方案与较低的治疗方案中断率和病毒学失败率相关。
