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TDF 方案治疗病毒学抑制的 HIV 感染者从换用 TAF 方案中显著获益:一项随机对照试验的荟萃分析。

Virologically suppressed HIV-infected patients on TDF-containing regimens significantly benefit from switching to TAF-containing regimens: A meta-analysis of randomized controlled trials.

机构信息

National Key Laboratory for Infectious Diseases Prevention and Treatment with Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing 400036, China.

Department of Infection Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China.

出版信息

Int J Infect Dis. 2019 Oct;87:43-53. doi: 10.1016/j.ijid.2019.07.011. Epub 2019 Jul 19.

Abstract

BACKGROUND

To investigate whether TDF-containing regimens significantly benefited efficacy, safety, and tolerability in TAF-containing regimens in virologically suppressed HIV-infected patients.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Trial Registry were systematically searched for eligible studies. We extracted and evaluated the pooled data from available randomized controlled trials (RCTs).

RESULTS

Eight eligible RCTs were included. In the intention-to-treat (ITT) analysis, patients who switched to TAF-containing regimens had significantly better viral suppression than those continuing TDF-containing regimens at weeks 48 and 96 (RR, 1.02; 95CI, 1.00-1.03; p<0.05), but no significant difference in the per-protocol (PP) analysis (RR, 1.00; 95CI, 0.99-1.01; p>0.05). Compared with those receiving the TDF-containing regimens, virologically suppressed HIV-infected patients on the TAF-containing regimens had significant increases in CD4 cell counts (SMD, 0.12; 95CI, 0.08 to 0.17; p<0.05), renal and bone parameters at the hip (RR, 2.86; 95CI, 2.24-3.64; p<0.05) and the spine (RR, 2.43; 95 CI, 2.03-2.90; p<0.05) between weeks 48 and 96.

CONCLUSIONS

Virologically suppressed HIV-infected patients on TDF-containing regimens significantly benefit from switching to TAF-containing regimens, resulting in better viral suppression, better immune reconstruction, and less bone and renal problems.

摘要

背景

研究 TDF 为基础的方案转换为 TAF 为基础的方案对已抑制病毒的 HIV 感染者的疗效、安全性和耐受性是否有显著获益。

方法

系统检索 PubMed、Embase、Web of Science 和 Cochrane 临床试验注册库中关于 TAF 为基础方案的研究。提取并评价纳入的随机对照试验(RCT)的数据。

结果

共纳入 8 项 RCT。意向性治疗(ITT)分析显示,在第 48 周和第 96 周,转换为 TAF 为基础方案的患者病毒抑制情况明显优于继续使用 TDF 为基础方案的患者(RR,1.02;95%CI,1.00-1.03;p<0.05),而在符合方案(PP)分析中差异无统计学意义(RR,1.00;95%CI,0.99-1.01;p>0.05)。与使用 TDF 为基础方案的患者相比,转换为 TAF 为基础方案的患者病毒抑制的 HIV 感染者 CD4 细胞计数(SMD,0.12;95%CI,0.08-0.17;p<0.05)、髋关节(RR,2.86;95%CI,2.24-3.64;p<0.05)和脊柱(RR,2.43;95%CI,2.03-2.90;p<0.05)的肾和骨参数在第 48 周和第 96 周时有显著增加。

结论

转换为 TAF 为基础方案可使继续使用 TDF 为基础方案的已抑制病毒的 HIV 感染者病毒抑制效果更好,免疫重建更好,骨和肾问题更少。

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