在泰国的 HIV 感染者中，改用多替拉韦的耐受性良好。
Switch to dolutegravir is well tolerated in Thais with HIV infection.
机构信息
SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
J Int AIDS Soc. 2019 Jul;22(7):e25324. doi: 10.1002/jia2.25324.
INTRODUCTION
Dolutegravir (DTG) is recommended as part of first-line antiretroviral therapy (ART) for people living with HIV(PLHIV). We sought to determine the rate of adverse events (AEs) and discontinuations among Thais treated during acute HIV infection (AHI) and switched to DTG-based regimens.
METHODS
Thai participants in the SEARCH010/RV254 cohort who initiated ART during AHI and switched to DTG for at least 48 weeks were prospectively observed and included in the analysis. Rates and characteristics of DTG-related AEs and discontinuations were described.
RESULTS
A total of 313 Thai participants were included in the analysis. The median age was 29 years, 96% were male, 64% had a Bachelor's degree or higher and 16% had a body mass index (BMI) <18.5 kg/m . Participants were on ART for a median of 124 weeks before switching to DTG. The median (IQR) body weight increased from 63 (56 to 70) kg before to 65 (58 to 73) kg (p < 0.0001) after 48 weeks of DTG. Forty-nine (16%) developed DTG-related AEs, corresponding to an incidence of 16.6 per 100 person-years. Neuropsychiatric symptoms were most frequently encountered (n = 25, 8%), followed by laboratory abnormalities (n = 16, 5%). Six (2%) discontinued DTG, corresponding to an incidence of 2.4 per 100 person-years. All discontinuations were due to increased liver enzymes in the presence of hepatitis C virus coinfection. In the multivariate analysis, incident hepatitis C virus infection was the only risk factor for discontinuing DTG (hazard ratio 59.4, 95% CI 8.5 to 297.9, p < 0.0001). Neither low BMI nor concurrent abacavir therapy was associated with discontinuation.
CONCLUSIONS
DTG was well tolerated with few discontinuations in this cohort of young men. Incident hepatitis C virus infection was a driver of liver-related AEs leading to discontinuations. In populations at risk, regular testing for hepatitis C virus during ART is recommended to anticipate possible AEs, guide management and improve safety.
简介
多替拉韦（DTG）被推荐作为人类免疫缺陷病毒（HIV）感染者（PLHIV）一线抗逆转录病毒治疗（ART）的一部分。我们旨在确定在急性 HIV 感染（AHI）期间接受治疗并转为 DTG 为基础方案的泰国人发生不良事件（AE）和停药的比率。
方法
前瞻性观察了 SEARCH010/RV254 队列中在 AHI 期间开始接受 ART 并转为 DTG 治疗至少 48 周的泰国参与者，并将其纳入分析。描述了 DTG 相关 AE 和停药的发生率和特征。
结果
共纳入 313 例泰国参与者。中位年龄 29 岁，96%为男性，64%具有学士学位或更高学历，16%的体重指数（BMI）<18.5kg/m 。参与者在转为 DTG 前的中位（IQR）ART 时间为 124 周。48 周 DTG 治疗后体重中位数（IQR）从 63（56 至 70）kg 增加至 65（58 至 73）kg（p<0.0001）。49 例（16%）发生 DTG 相关 AE，发生率为 16.6/100 人年。神经精神症状最常见（n=25，8%），其次是实验室异常（n=16，5%）。6 例（2%）停用 DTG，发生率为 2.4/100 人年。所有停药均因丙型肝炎病毒合并感染时肝酶升高所致。多变量分析显示，丙型肝炎病毒感染是停用 DTG 的唯一危险因素（风险比 59.4，95%CI 8.5 至 297.9，p<0.0001）。低 BMI 或同时使用阿巴卡韦与停药无关。
结论
在该年轻男性队列中，DTG 耐受性良好，停药病例较少。丙型肝炎病毒感染是导致肝相关 AE 进而导致停药的驱动因素。在高危人群中，ART 期间应定期检测丙型肝炎病毒，以预测可能的 AE，指导管理并提高安全性。
Zotero 插件