Fight Against AIDS Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain.
Royal Free and University College, London, UK.
HIV Med. 2018 May;19(5):324-338. doi: 10.1111/hiv.12581. Epub 2018 Feb 1.
The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens.
Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches.
The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART.
Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.
本研究旨在评估基于含阿扎那韦/利托那韦（ATZ/r）、达芦那韦/利托那韦（DRV/r）和洛匹那韦/利托那韦（LPV/r）方案的抗逆转录病毒治疗（ART）的长期应答。
分析了 2000 年 1 月 1 日至 2013 年 6 月 30 日期间开始接受 DRV/r、ATZ/r 或 LPV/r 方案治疗的 5678 名 EuroSIDA 登记患者的数据。分别对以下亚组患者进行了单独分析：（1）在开始使用利托那韦增强蛋白酶抑制剂（PI/r）时无 ART 治疗史的患者（8%）；（2）开始新的 PI/r 治疗且病毒载量（VL）≤500 HIV-1 RNA 拷贝/mL 的有 ART 治疗史的个体（44%）；（3）开始新的 PI/r 治疗且 VL>500 拷贝/mL 的有 ART 治疗史的患者（48%）。病毒学失败（VF）定义为在开始使用 PI/r 后≥24 周连续两次 VL 测量值>200 拷贝/mL。使用 Kaplan-Meier 和多变量 Cox 模型比较基于 PI/r 方案的治疗失败风险。主要分析采用意向治疗（ITT），不考虑治疗转换。
无论在何种分析中，与 LPV/r 相比，DRV/r 均优于 ATZ/r（对数秩检验；P<0.02）。然而，在控制了潜在混杂因素后，ART 治疗史患者的 VF 风险并无差异。在所有治疗史患者亚组中，DRV/r 的 VF 风险均低于 ATZ/r，而 ATZ/r 的 VF 风险又低于 LPV/r 方案。
尽管不能完全排除指标和日历时间的混杂作用，但在有 ART 治疗史的患者中，DRV/r 方案的长期有效性似乎优于 ATZ/r 和 LPV/r。
