ViiV Healthcare, Brentford, United Kingdom.
Infectious Diseases Unit, Hospital Virgen de la Victoria, Málaga, Spain.
J Acquir Immune Defic Syndr. 2021 Jun 1;87(2):794-800. doi: 10.1097/QAI.0000000000002655.
In TANGO, switching to dolutegravir/lamivudine was noninferior at 48 weeks to continuing 3-/4-drug tenofovir alafenamide-based regimens in virologically suppressed individuals with HIV-1. Antiretroviral agents have been associated with weight gain and metabolic complications.
One hundred thirty-four centers; 10 countries.
We assessed weight; fasting lipids, glucose, and insulin; and prevalence of insulin resistance and metabolic syndrome at baseline and week 48 in TANGO participant subgroups by boosting agent use in baseline regimens (boosted and unboosted).
In each treatment group, 74% of participants used boosted regimens at baseline. In boosted and unboosted subgroups, weight and fasting glucose changes at week 48 were small and similar between treatment groups. Overall and in the boosted subgroup, greater decreases from baseline were observed with dolutegravir/lamivudine in fasting total cholesterol (P < 0.001), low-density lipoprotein cholesterol (P < 0.001), triglycerides (P < 0.001), total cholesterol/high-density lipoprotein cholesterol ratio (overall, P = 0.017; boosted, P = 0.007), and insulin (boosted, P = 0.005). Prevalence of HOMA-IR ≥2 was significantly lower at week 48 with dolutegravir/lamivudine overall [adjusted odds ratio (aOR), 0.59; 95% confidence interval (CI), 0.40 to 0.87; P = 0.008] and in the boosted subgroup [aOR, 0.56; 95% CI, 0.36 to 0.88; P = 0.012] but not in the unboosted subgroup [aOR, 0.70; 95% CI, 0.31 to 1.58; P = 0.396]. Prevalence of metabolic syndrome at week 48 was low and consistent between treatment groups overall, with differences trending to favor dolutegravir/lamivudine in the unboosted subgroup [aOR, 0.41; 95% CI, 0.15 to 1.09; P = 0.075].
Generally, switching from 3-/4-drug tenofovir alafenamide-based regimens to dolutegravir/lamivudine improved metabolic parameters, particularly when switching from boosted regimens. Because of smaller sample size in the unboosted subgroup, results warrant further investigation.
在 TANGO 研究中，与继续使用基于替诺福韦艾拉酚胺的 3 药或 4 药方案相比，在病毒学抑制的 HIV-1 感染者中，换用多替拉韦/拉米夫定在 48 周时非劣效。抗逆转录病毒药物与体重增加和代谢并发症相关。
134 个中心；10 个国家。
我们根据基线方案中增效剂的使用情况（增效和未增效），评估了 TANGO 参与者亚组在基线和 48 周时的体重、空腹血脂、血糖和胰岛素，以及胰岛素抵抗和代谢综合征的患病率。
在每个治疗组中，74%的参与者在基线时使用了增效方案。在增效和未增效亚组中，治疗组间 48 周时体重和空腹血糖的变化较小且相似。总体而言，与多替拉韦/拉米夫定相比，在增效亚组中，空腹总胆固醇（P < 0.001）、低密度脂蛋白胆固醇（P < 0.001）、甘油三酯（P < 0.001）、总胆固醇/高密度脂蛋白胆固醇比值（总体，P = 0.017；增效，P = 0.007）和胰岛素（增效，P = 0.005）的降幅更大。总体而言，与多替拉韦/拉米夫定相比，48 周时 HOMA-IR≥2 的患病率显著降低[调整后的优势比（aOR），0.59；95%置信区间（CI），0.40 至 0.87；P = 0.008]，在增效亚组中[aOR，0.56；95%CI，0.36 至 0.88；P = 0.012]，但在未增效亚组中[aOR，0.70；95%CI，0.31 至 1.58；P = 0.396]。48 周时代谢综合征的患病率较低，且在各组之间保持一致，在未增效亚组中，与多替拉韦/拉米夫定相比，结果有倾向于获益的趋势[aOR，0.41；95%CI，0.15 至 1.09；P = 0.075]。
一般来说，从基于替诺福韦艾拉酚胺的 3 药或 4 药方案转换为多替拉韦/拉米夫定可改善代谢参数，特别是在从增效方案转换时。由于未增效亚组的样本量较小，结果需要进一步研究。
