The Hebrew University Hadassah Medical School, Jerusalem, Israel.
Institute of Allergy, Immunology and AIDS Rambam Medical Center, Haifa, Israel.
PLoS One. 2021 Oct 29;16(10):e0259271. doi: 10.1371/journal.pone.0259271. eCollection 2021.
Combined antiretroviral treatment (cART) traditionally consists of three antiretroviral medications, while two-drug regimens (2DR), historically used infrequently, recently been suggested to be non-inferior to three-drug regimens, is emerging as a potential treatment option and is currently a recommended option for treatment initiation in many guidelines.
Characterize the indications and clinical efficacy of 2DR use at a real-life setting in a nation-wide survey.
A cross-sectional survey of Israeli patients treated by 2DR until July 2019, included demographic, immunologic, virologic, genotypic and biochemical/metabolic parameters at diagnosis, ART initiation, 2DR initiation and following 24, 48, 96 and 144 weeks of 2DR treatment.
176 patients were included in the study. In contrast to historical data implicating ART resistance and adverse effects as the major reasons leading to 2DR switching, treatment simplification was the main reason leading to 2DR treatment in 2019. 2DR that included INSTI and PI were more commonly used in cases of drug resistance, while a combination of INSTI and NNRTI was used in all other 2DR indications. A switch to 2DR induced a mean CD4 T cell increase from 599 cells/μl at treatment initiation to 680 cells/μl at 96 weeks of treatment p<0.001 and viral suppression improvement from 73.9% at initiation to 87.0% at 48 weeks of treatment (p = 0.004). PI and INSTI 2DR was inferior in suppressing viral levels compared to other 2DRs but used for subset of more complex patients.
2DR in a large-scale real-life nation-wide survey proved to be safe and effective. Most 2DRs, other than PI and INSTI, were similarly effective in suppressing HIV viremia and in elevating CD4 T cell counts.
在全国范围内的调查中，以真实环境为背景，描述二联抗病毒治疗（2DR）的应用指征和临床疗效。
对 2019 年 7 月前接受 2DR 治疗的以色列患者进行横断面调查，包括诊断、开始接受 ART 治疗、开始 2DR 治疗以及 24、48、96 和 144 周时的人口统计学、免疫、病毒学、基因型和生化/代谢参数。
共纳入 176 例患者。与历史数据表明的 ART 耐药和不良反应是导致 2DR 转换的主要原因不同，治疗简化是 2019 年导致 2DR 治疗的主要原因。包含 INSTI 和 PI 的 2DR 更常用于耐药病例，而 INSTI 和 NNRTI 的组合则用于所有其他 2DR 适应证。转换为 2DR 治疗可使 CD4+T 细胞计数从治疗开始时的 599 个/μl 平均增加到 96 周时的 680 个/μl（p<0.001），病毒载量抑制率从治疗开始时的 73.9%提高到治疗 48 周时的 87.0%（p = 0.004）。与其他 2DR 相比，PI 和 INSTI 2DR 在抑制病毒水平方面效果较差，但用于更复杂患者亚组。
在大规模全国范围内的真实环境调查中，2DR 被证明是安全有效的。除了 PI 和 INSTI 之外，大多数 2DR 在抑制 HIV 病毒血症和提高 CD4+T 细胞计数方面同样有效。
