Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
Imperial College, London, UK.
HIV Med. 2020 Oct;21(9):613-615. doi: 10.1111/hiv.12900. Epub 2020 Sep 1.
Rapid antiretroviral therapy (ART) initiation is recommended in early HIV infection (EHI), even in the absence of baseline viral resistance test result. We analysed time to viral suppression according to ART regimen started in a cohort of patients diagnosed with EHI.
Clinical records of individuals consecutively diagnosed with EHI between July 2016-June 2018 were reviewed. The distribution of clinical, virological and immunological factors was compared in treatment groups using the Mann-Whitney U-test.
262 individuals (97% MSM) were diagnosed with EHI. 58% of patients agreed to start ART within 14 days of diagnosis. Tenofovir-based combinations were prescribed to all patients. DRV/b was the most commonly prescribed third agent (78%), when genotypic resistance testing was not available at time of ART choice. Switching to INSTI was encouraged once VRT became available and 27% switched from DRV/b to INSTI (mainly RAL) within 28 days from ART start. Those receiving INSTI were more likely to have a baseline viral load exceeding 1 million HIV-1 RNA copies/mL compared with those starting with DRV/b. Rapid start with INSTI regimens resulted in quicker viral suppression than when DRV/b was chosen in EHI, even when that was subsequently switched to INSTI. Retention in care following rapid ART start was achieved by all patients at 24 weeks.
Starting an INSTI-based ART combination was associated with quicker viral suppression than when a protease inhibitor-based combination was chosen. No differences in the achievement of viral suppression or in retention in care were observed.
在 HIV 早期感染（EHI）中，即使没有基线病毒耐药性检测结果，也推荐快速启动抗逆转录病毒治疗（ART）。我们分析了在一组诊断为 EHI 的患者中，根据开始的 ART 方案，病毒抑制的时间。
回顾了 2016 年 7 月至 2018 年 6 月期间连续诊断为 EHI 的个体的临床记录。使用 Mann-Whitney U 检验比较了治疗组中临床、病毒学和免疫学因素的分布。
262 例（97%为男男性接触者）被诊断为 EHI。58%的患者同意在诊断后 14 天内开始 ART。所有患者均开具了以替诺福韦为基础的联合方案。当选择 ART 时，无法进行基因型耐药检测时，最常开的第三种药物是 DRV/b（78%）。一旦 VRT 可用，就鼓励更换为 INSTI，并且在开始 ART 后 28 天内，27%的患者从 DRV/b 转换为 INSTI（主要是 RAL）。与开始使用 DRV/b 的患者相比，接受 INSTI 的患者基线病毒载量超过 100 万 HIV-1 RNA 拷贝/mL 的可能性更大。在 EHI 中，与选择 DRV/b 相比，快速开始 INSTI 方案可更快地抑制病毒，即使随后转换为 INSTI。所有患者在 24 周时均保留在接受快速 ART 治疗中。
与选择基于蛋白酶抑制剂的联合方案相比，开始基于 INSTI 的 ART 联合方案与更快的病毒抑制相关。在达到病毒抑制或保留在护理方面，没有差异。
