Maladies infectieuses, hôpital l'Archet, 06000 Nice, France.
Maladies infectieuses et tropicales, hôpital Bichat, 75877 Paris, France; IAME, UMR 1137, Inserm, université Paris Diderot, 75877 Paris, France.
Med Mal Infect. 2019 Jun;49(4):264-269. doi: 10.1016/j.medmal.2018.10.005. Epub 2018 Nov 5.
To describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 and patients' characteristics related to the use of protease inhibitors in 2015.
We extracted all patients starting ART between 2005 and 2015 from a large prospective cohort. Regimens were classified as three nucleoside reverse transcriptase inhibitors (NRTI), or two NRTIs with a boosted protease inhibitor (bPI), with a non-nucleoside reverse transcriptase inhibitor (NNRTI), or with an INSTI. Patients' characteristics at the time of initiation were collected. A multinomial logit model was fitted to analyze characteristics related to the choice of regimen in 2015.
We analyzed data from 15,897 patients. The proportion of patients starting with (i) a bPI decreased from 60% before 2014 to 38.1% in 2015; (ii) an NNRTI decreased from 30% to 17.8% in 2015; (iii) an INSTI gradually increased to 39.4% in 2015. In 2015, patients with an initial viral load ˃5 log copies/mL were less likely to receive NNRTI (OR=0.08) or INSTI regimens (OR=0.69) than bPIs. Patients with initial CD4 T cell count ˂200/mm were less likely to receive an NNRTI (OR=0.28) or an INSTI regimen (OR=0.52) than a bPI. Women were less likely to receive an NNRTI (OR=0.79) or an INSTI regimen (OR=0.71) than a bPI; although this depended on age.
The use of bPI as first-line ART declined sharply in France from 2005 to 2015. bPI remained of preferential use in patients with high viral load, low CD4 T cell count, and in women.
描述 2005 年至 2015 年间法国一线抗逆转录病毒（ART）治疗方案的变化，以及 2015 年与使用蛋白酶抑制剂相关的患者特征。
我们从一个大型前瞻性队列中提取了所有在 2005 年至 2015 年期间开始接受 ART 的患者。方案分为三种核苷逆转录酶抑制剂（NRTI），或两种 NRTI 加增效蛋白酶抑制剂（bPI），加非核苷逆转录酶抑制剂（NNRTI），或整合酶抑制剂（INSTI）。收集患者开始治疗时的特征。使用多项逻辑回归模型分析 2015 年方案选择相关的特征。
我们分析了 15897 名患者的数据。（i）开始使用 bPI 的患者比例从 2014 年前的 60%下降到 2015 年的 38.1%；（ii）开始使用 NNRTI 的患者比例从 30%下降到 2015 年的 17.8%；（iii）开始使用 INSTI 的患者比例逐渐增加到 2015 年的 39.4%。2015 年，初始病毒载量>5 log 拷贝/ml 的患者接受 NNRTI（OR=0.08）或 INSTI 方案（OR=0.69）的可能性低于 bPI。初始 CD4 T 细胞计数<200/mm 的患者接受 NNRTI（OR=0.28）或 INSTI 方案（OR=0.52）的可能性低于 bPI。女性接受 NNRTI（OR=0.79）或 INSTI 方案（OR=0.71）的可能性低于 bPI，尽管这取决于年龄。
2005 年至 2015 年间，法国一线使用 bPI 的情况急剧下降。bPI 仍然是高病毒载量、低 CD4 T 细胞计数和女性患者的首选治疗方法。
