在病毒载量≤50 拷贝/毫升的 HIV 感染者中，从富马酸替诺福韦二吡呋酯转换为替诺福韦艾拉酚胺或基于双重治疗的方案：估算肾小球滤过率重要吗？

Switching from tenofovir disoproxil fumarate to tenofovir alafenamide or dual therapy-based regimens in HIV-infected individuals with viral load ≤50 copies/mL: does estimated glomerular filtration rate matter?

机构信息

HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', Institute of Hospitalization and Scientific Care (IRCCS), Via Portuense 292, 00149 Rome, Italy.

出版信息

Int J Antimicrob Agents. 2020 Dec;56(6):106154. doi: 10.1016/j.ijantimicag.2020.106154. Epub 2020 Sep 10.

DOI:10.1016/j.ijantimicag.2020.106154

PMID:32919008

Abstract

Our aim was to evaluate the association between recent eGFR values and risk of switching from TDF to TAF or dual therapy (DT) in real life. HIV-positive patients achieving HIV-RNA ≤50 copies/mL for the first time after starting a TDF-based regimen were included. Kaplan-Meier (KM) curves and Cox regression models were used to estimate the time from TDF to switch to TAF or DT. 1486 participants were included: median (IQR) age 36 (30-42) years; baseline CKD-EPI eGFR 99.92 (86.47-111.4) mL/min/1.73m. We observed a consistently higher proportion of people with HIV-RNA ≤50 copies/mL who switched from TDF to TAF rather than to DT. By competing risk analysis, at 2 years from baseline, the probability of switching was 3.5% (95% CI 2.6-4.7%) to DT and 46.7% (42.8-48.5%) to TAF. A significantly higher probability of switching to TAF was found for patients receiving INSTI at baseline versus NNRTIs and PI/b [KM, 65.6% (61.7-69.4%) vs. 4.0% (1.8-6.1%) and 59.9% (52.7-67.2%), respectively; P < 0.0001]. eGFR <60 mL/min/1.73m both as time-fixed covariate at baseline or as current value was associated with a higher risk of switching to DT [aHR 6.68 (2.69-16.60) and 8.18 (3.54-18.90); P < 0.001] but not to TAF-based cART [aHR 0.94 (0.39-2.31), P = 0.897; and 1.19 (0.60-2.38), P = 0.617]. Counter to our original hypothesis, current eGFR is used by clinicians to guide switches to DT but does not appear to be a key determinant for switching to TAF.

摘要

我们的目的是评估在真实环境中，最近的 eGFR 值与从 TDF 转换为 TAF 或双重治疗（DT）的风险之间的关联。纳入了首次开始 TDF 为基础的方案后 HIV-RNA ≤50 拷贝/mL 的 HIV 阳性患者。使用 Kaplan-Meier（KM）曲线和 Cox 回归模型来估计从 TDF 转换为 TAF 或 DT 的时间。纳入了 1486 名参与者：中位（IQR）年龄 36（30-42）岁；基线 CKD-EPI eGFR 99.92（86.47-111.4）mL/min/1.73m。我们观察到，HIV-RNA ≤50 拷贝/mL 的患者中，转换为 TAF 的比例始终高于转换为 DT 的比例。通过竞争风险分析，从基线开始 2 年时，转换为 DT 的概率为 3.5%（95%CI 2.6-4.7%），转换为 TAF 的概率为 46.7%（42.8-48.5%）。与基线时接受 NNRTIs 和 PI/b 的患者相比，接受 INSTI 的患者转换为 TAF 的可能性明显更高[KM，65.6%（61.7-69.4%）比 4.0%（1.8-6.1%）和 59.9%（52.7-67.2%）；P<0.0001]。基线时将 eGFR <60 mL/min/1.73m 作为时间固定协变量或当前值与转换为 DT 的风险较高相关[aHR 6.68（2.69-16.60）和 8.18（3.54-18.90）；P<0.001]，但与 TAF 为基础的 cART 无关[aHR 0.94（0.39-2.31），P=0.897；和 1.19（0.60-2.38），P=0.617]。与我们的原始假设相反，临床医生使用当前的 eGFR 来指导转换为 DT，但似乎不是转换为 TAF 的关键决定因素。