Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofia, Madrid, Spain.
PLoS One. 2019 Aug 26;14(8):e0221598. doi: 10.1371/journal.pone.0221598. eCollection 2019.
We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen.
We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen.
Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//μL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location.
The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location.
我们旨在描述近年来西班牙艾滋病毒/艾滋病研究网络（CoRIS）队列中 HIV 阳性患者中最常开的初始抗逆转录病毒治疗（ART）方案，并研究与每种方案选择相关的因素。
我们分析了 2014 年至 2017 年期间参与 CoRIS 的成年人开的初始 ART 方案。仅考虑了在>5%的患者中开的方案。我们使用多变量多项回归来估计社会人口统计学和临床特征与初始方案选择之间的相对风险比（RRR）。
在 2874 名参与者中，阿巴卡韦（ABC）/拉米夫定（3TC）/度鲁特韦（DTG）是最常开的方案（32.1%），其次是富马酸替诺福韦二吡呋酯（TDF）/恩曲他滨（FTC）/艾维雷韦（EVG）/考比司他（COBI）（14.9%）、TDF/FTC/利匹韦林（RPV）（14.0%）、替诺福韦艾拉酚胺（TAF）/FTC/EVG/COBI（13.7%）、TDF/FTC+DTG（10.0%）、TDF/FTC+达芦那韦/利托那韦或达芦那韦/考比司他（bDRV）（9.8%）和 TDF/FTC+拉替拉韦（RAL）（5.6%）。与 ABC/3TC/DTG 相比，CD4<200 个细胞/μL 和 HIV-RNA>100.000 拷贝/mL 的患者起始 TDF/FTC/RPV 的可能性较低。CD4<200 个细胞/μL 和 HIV-RNA>100.000 拷贝/mL 的患者更常开 TDF/FTC+DTG。CD4<200 个细胞/μL 和传播类别非男男性接触者的患者也更常开 TDF/FTC+RAL 和 TDF/FTC+bDRV。与 ABC/3TC/DTG 相比，除 TDF/FTC+DTG 外，其他初始 ART 方案的处方量从 2014-2015 年到 2016-2017 年减少。初始 ART 方案选择的差异与医院的位置有关。
初始 ART 方案的选择符合西班牙指南的建议，但也明显受到医生根据患者的临床和社会人口统计学变量以及处方医院位置的看法的影响。
