Department of Pharmacy, 6915Mayo Clinic, Rochester, MN, USA.
Department of Pharmacy, Virginia Commonwealth University Health System, Richmond, VA, USA.
Int J STD AIDS. 2021 Sep;32(10):963-967. doi: 10.1177/09564624211011902. Epub 2021 May 8.
Antiretroviral (ARV) therapy in people living with HIV (PLWH) and end-stage renal disease (ESRD) on hemodialysis (HD) is complicated, requiring renally adjusted nucleoside reverse transcriptase inhibitors (NRTIs) and daily administration of non-renally eliminated agents. Recent data in PLWH with ESRD on HD demonstrate maintenance of viral suppression (82% with viral loads (VLs) <50 copies/mL) and favorable safety/tolerability profiles after ARV simplification with a fixed dose combination single tablet [elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF)]. Extrapolation of these data to all F/TAF formulations would allow ARV simplification to most PLWH with ESRD receiving HD. The objective of this retrospective study was to identify if ARV-experienced PLWH with ESRD on HD receiving renally adjusted NRTIs may be simplified to once daily ARV formulations without adverse effects while maintaining viral suppression. This single-center retrospective analysis assessed virologic control (3-12 months) and ARV tolerability post-regimen simplification (primarily NRTI once-daily dose adjustment) in PLWH with ESRD on thrice weekly HD receiving human immunodeficiency virus (HIV) care in an ambulatory clinic. Seventeen PLWH with ESRD on HD were included after documented ARV simplification. At 12 months, 12 patients (71%) remained undetectable (HIV VL <50 copies/mL) with two additional maintaining viral suppression (<200 copies/mL). One patient remained undetectable at month eight but became non-adherent with viral rebound. Two patients did not complete the 6- and 12-month evaluation after documented nonadherence ( = 1) and an adverse effect (pruritus) ( = 1). At 12 months, virologic suppression and tolerability resulted after a simplified ARV regimen including once daily F/TAF was initiated in PLWH with ESRD on thrice weekly HD with a reduction in pill burden.
抗逆转录病毒 (ARV) 疗法在接受血液透析 (HD) 的人类免疫缺陷病毒 (HIV) 感染者 (PLWH) 和终末期肾病 (ESRD) 患者中较为复杂，需要对肾脏进行调整的核苷逆转录酶抑制剂 (NRTIs)，并且需要每日给予非肾脏消除的药物。最近在接受 HD 的 ESRD 的 PLWH 中获得的数据表明，在简化 ARV 治疗方案后，通过固定剂量组合单片剂（依维替拉韦/考比司他/恩曲他滨/替诺福韦艾拉酚胺 [E/C/F/TAF]），可以维持病毒抑制（82%的病毒载量 (VL) <50 拷贝/mL），且具有良好的安全性/耐受性。将这些数据外推到所有 F/TAF 制剂，将允许大多数接受 HD 的 ESRD 的 PLWH 简化 ARV 治疗方案。本回顾性研究的目的是确定接受肾脏调整的 NRTIs 的接受 HD 的 ESRD 的 PLWH 是否可以简化为每日一次的 ARV 制剂，而不会产生不良影响，同时保持病毒抑制。这项单中心回顾性分析评估了在接受门诊诊所 HIV 护理的每周三次 HD 的 ESRD 的 PLWH 中，简化方案后病毒学控制（3-12 个月）和 ARV 耐受性（主要是 NRTI 每日一次剂量调整）。在接受证实的 ARV 简化治疗后，17 名接受 HD 的 ESRD 的 PLWH 被纳入研究。在 12 个月时，12 名患者（71%）保持不可检测（HIV VL <50 拷贝/mL），另外两名患者保持病毒抑制（<200 拷贝/mL）。一名患者在第八个月仍未检测到病毒，但因不依从而出现病毒反弹。两名患者在记录到不依从（=1）和不良反应（瘙痒）（=1）后，未能完成 6 个月和 12 个月的评估。在每周三次 HD 的 ESRD 的 PLWH 中，简化 ARV 方案包括每日一次 F/TAF，在降低药物负担的情况下，在 12 个月时可实现病毒学抑制和耐受性。
