中国西南地区 HIV 患者初始差异化抗逆转录病毒治疗方案的治疗结局：一项观察性队列研究的比较。
Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study.
机构信息
State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS) , Chinese Center for Disease Control and Prevention (China CDC) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
Guangxi Center for Disease Control and Prevention, Nanning, China.
出版信息
BMJ Open. 2019 Mar 30;9(3):e025666. doi: 10.1136/bmjopen-2018-025666.
OBJECTIVES
China has continued to expand antiretroviral therapy (ART) services and optimise ART guidelines in an effort to significantly reduce and prevent mortality and transmission rates among HIV patients. However, no study to date has compared treatment outcomes of initial differential antiretroviral regimens among HIV patients in a real-world setting in China. This study aimed to compare the effects of different ART regimens on treatment outcomes among adults.
DESIGN
Observational retrospective cohort study.
SETTING
Data from 2011 to 2013 in Guangxi, China.
PARTICIPANTS
Patients aged ≥18 years (n=25 732) were selected.
RESULTS
A total of 25 732 patients were included in this study. The average mortality and attrition rate were 2.64 and 4.98, respectively, per 100 person-years. Using Cox proportional hazard models, zidovudine-based (AZT-based) regimen versus stavudine-based (D4T-based) regimen had an adjusted HR (AHR) for death of 0.65 (95% CI 0.58 to 0.73); the AHR of tenofovir-based (TDF-based) versus D4T-based regimens was 0.81 (95% CI 0.71 to 0.92), and of lopinavir-ritonavir-based (LPV/r-based) versus D4T-based regimens, 1.19 (95% CI 1.04 to 1.37). AZT-based versus D4T-based regimens had an AHR for dropout of 0.89 (95% CI 0.81 to 0.97); this ratio for TDF-based versus D4T-based regimens was 0.88 (95% CI 0.80 to 0.98), and for LPV/r-based versus D4T-based regimens, 1.42 (95% CI 1.27 to 1.58). AZT-based and TDF-based regimens had a lower risk compared with D4T-based regimens, while LPV/r-based regimens had a higher risk. High gastrointestinal reactions and poor adherence were observed among HIV patients whose initial ART regimen was LPV/r-based.
CONCLUSIONS
Our study found that the treatment outcomes of initial ART regimens that were AZT-based or TDF-based were significantly better than D4T-based or LPV/r-based regimens. This finding could be related to the higher rates of gastrointestinal reactions and poorer adherence associated with the LPV/r-based regimens compared with other initial ART regimens.
目的
中国一直在扩大抗逆转录病毒治疗（ART）服务，并优化 ART 指南，以大幅降低和预防艾滋病毒感染者的死亡率和传播率。然而，迄今为止，尚无研究比较中国真实环境中 HIV 患者初始差异化抗逆转录病毒方案的治疗效果。本研究旨在比较不同 ART 方案对成年人治疗效果的影响。
设计
观察性回顾性队列研究。
地点
中国广西 2011 年至 2013 年的数据。
参与者
选择年龄≥18 岁的患者（n=25732）。
结果
本研究共纳入 25732 例患者。每 100 人年的平均死亡率和失访率分别为 2.64 和 4.98。使用 Cox 比例风险模型，齐多夫定（AZT）为基础的方案与司他夫定（D4T）为基础的方案相比，死亡的调整后风险比（AHR）为 0.65（95%CI 0.58 至 0.73）；替诺福韦（TDF）为基础的方案与 D4T 为基础的方案相比的 AHR 为 0.81（95%CI 0.71 至 0.92），洛匹那韦/利托那韦（LPV/r）为基础的方案与 D4T 为基础的方案相比的 AHR 为 1.19（95%CI 1.04 至 1.37）。AZT 为基础的方案与 D4T 为基础的方案相比，脱落的 AHR 为 0.89（95%CI 0.81 至 0.97）；TDF 为基础的方案与 D4T 为基础的方案相比的 AHR 为 0.88（95%CI 0.80 至 0.98），LPV/r 为基础的方案与 D4T 为基础的方案相比的 AHR 为 1.42（95%CI 1.27 至 1.58）。与 D4T 为基础的方案相比，AZT 为基础和 TDF 为基础的方案风险较低，而 LPV/r 为基础的方案风险较高。初始 ART 方案为 LPV/r 为基础的 HIV 患者观察到胃肠道反应较高和药物依从性较差。
结论
我们的研究发现，AZT 为基础或 TDF 为基础的初始 ART 方案的治疗效果明显优于 D4T 为基础或 LPV/r 为基础的方案。这一发现可能与 LPV/r 为基础的方案比其他初始 ART 方案更高的胃肠道反应率和较差的药物依从性有关。
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