Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France.
Virology Department, Lille University Hospital, Lille, France.
BMC Infect Dis. 2019 May 24;19(1):467. doi: 10.1186/s12879-019-4047-7.
The circumstances of prescription of tropism tests clinically relevant in treatment-experienced patients are unclear.
We performed a monocentric retrospective analysis of all tropism tests performed between 2006 and 2015 in HIV-infected patients on antiretroviral therapy (ART) without MVC. The motivation of tropism determination was collected. Factors associated with MVC prescription were determined using logistic regression analysis.
Five hundred sixty-three tests were performed in experienced patients not receiving MVC. Reasons for tropism performance were: virological failure (44%), side effects or drug-interactions (37%), simplification or sparing strategies (11%), immunological failure (5%), and improvement of neurological diffusion (3%). MVC was prescribed in 110 cases (20%), though 366 tests (65%) revealed a tropism CCR5. MVC was more often prescribed before 2011 (OR 3.65, 95% CI 2.17-6.13) and in patients with multiple previous ART regimens (less than 4 ART regimens compare to more than 10 ART regimens (OR 0.34, 95% CI 0.15-0.74)).
In experienced patients not receiving MVC, tropism test prescription should be restricted to patients with virological failure and limited therapeutic options such as patients already treated with a wide range of ART regimens.
在有治疗经验的患者中，临床上与处方趋化性检测相关的情况尚不清楚。
我们对 2006 年至 2015 年间在接受抗逆转录病毒治疗（ART）但未接受 MVC 的 HIV 感染患者中进行的所有趋化性检测进行了单中心回顾性分析。收集了趋化性检测的动机。使用逻辑回归分析确定与 MVC 处方相关的因素。
在未接受 MVC 的有经验的患者中进行了 563 次检测。进行趋化性检测的原因是：病毒学失败（44%）、副作用或药物相互作用（37%）、简化或节省策略（11%）、免疫失败（5%）和改善神经扩散（3%）。尽管 366 次检测（65%）显示趋化性 CCR5，但仍有 110 例（20%）患者处方了 MVC。MVC 更常被开在 2011 年之前（OR 3.65，95%CI 2.17-6.13）和之前有多种 ART 方案的患者中（少于 4 种 ART 方案比多于 10 种 ART 方案（OR 0.34，95%CI 0.15-0.74））。
在未接受 MVC 的有经验的患者中，趋化性检测的处方应仅限于病毒学失败且治疗选择有限的患者，例如已经接受了广泛的 ART 方案治疗的患者。
