抗逆转录病毒药物类别治疗高病毒载量 HIV 感染者的疗效比较：一项多中心回顾性队列研究。

Comparative effectiveness of antiretroviral drug classes for the treatment of HIV infection in patients with high viral loads: a multicentre retrospective cohort study.

机构信息

Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA.

Division of Infectious Diseases, Cooper University Hospital, Camden, NJ, USA.

出版信息

HIV Med. 2021 Jan;22(1):28-36. doi: 10.1111/hiv.12959. Epub 2020 Sep 23.

DOI:10.1111/hiv.12959

PMID:32964664

Abstract

OBJECTIVES

We aimed to compare the effectiveness of antiretroviral therapy (ART) classes for achieving HIV RNA suppression to < 50 HIV-1 RNA copies/mL within 6 months of initiation with high viral loads (VLs). Secondary objectives were to compare viral suppression (VS) at 12 weeks and 12 months, partial HIV RNA suppression to < 200 copies/mL, time to VS, time to rebound, and change in CD4 cell count.

METHODS

This was a multicentre, retrospective, observational study. Adult patients were included if they initiated ART between January 2005 and December 2016 with a VL ≥ 100 000 copies/mL.

RESULTS

There were 220 patients included in the study. The median VL was 252 919 [interquartile range (IQR) 149 472-500 000] copies/mL. Nonnucleoside reverse transcriptase inhibitor (NNRTI) recipients were more likely to achieve VS by 6 months compared to those initiating ART containing protease inhibitors (PIs) [75.4% vs. 44.1%, respectively; odds ratio (OR) 3.34; 95% confidence interval (CI) 1.62-6.90] or integrase strand transfer inhibitors (INSTIs) (75.4% vs. 55.8%, respectively; OR 2.40; 95% CI 1.03-5.58). VS at 12 weeks was more frequent with INSTI-containing regimens than with PIs (28.9% vs. 9.0%, respectively; OR 4.10; 95% CI 1.69-9.92). VS at 12 months did not significantly differ between treatment regimens. Median time to complete VS for INSTI, PI and NNRTI recipients was 22.3 (95% CI 13.4-33), 30.1 (95% CI 25-36) and 19.9 (95% CI 16-22.3) weeks, respectively. There were no significant differences in time to viral rebound or change in CD4 cell counts.

CONCLUSIONS

Patients with high VLs initiated on NNRTIs were more likely to achieve VS by 6 months on ART compared to INSTI and PI recipients.

摘要

目的

我们旨在比较在高病毒载量（VL）时开始抗逆转录病毒治疗（ART）后 6 个月内达到 HIV RNA 抑制至 <50 HIV-1 RNA 拷贝/ml 的效果，比较不同 ART 类别的疗效。次要目标是比较 12 周和 12 个月时的病毒抑制（VS）、部分 HIV RNA 抑制至 <200 拷贝/ml、达到 VS 的时间、病毒反弹时间以及 CD4 细胞计数的变化。

方法

这是一项多中心、回顾性、观察性研究。如果患者在 2005 年 1 月至 2016 年 12 月期间开始 ART，VL≥100000 拷贝/ml，则纳入本研究。

结果

本研究共纳入 220 例患者。中位 VL 为 252919 [四分位距（IQR）149472-500000] 拷贝/ml。与接受包含蛋白酶抑制剂（PIs）的 ART 治疗的患者（分别为 44.1%；优势比（OR）3.34；95%置信区间（CI）1.62-6.90）或整合酶链转移抑制剂（INSTIs）（分别为 55.8%；OR 2.40；95% CI 1.03-5.58）相比，接受非核苷类逆转录酶抑制剂（NNRTI）的患者在 6 个月时更有可能实现 VS。在 12 周时，接受 INSTI 治疗的患者 VS 发生率高于接受 PI 治疗的患者（分别为 28.9%和 9.0%；OR 4.10；95% CI 1.69-9.92）。治疗方案之间在 12 个月时 VS 无显著差异。INSTI、PI 和 NNRTI 治疗患者完全 VS 的中位时间分别为 22.3（95% CI 13.4-33）、30.1（95% CI 25-36）和 19.9（95% CI 16-22.3）周。病毒反弹时间和 CD4 细胞计数变化无显著差异。