Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
J Glob Antimicrob Resist. 2022 Jun;29:7-16. doi: 10.1016/j.jgar.2022.02.007. Epub 2022 Feb 13.
We aimed to investigate the incidence of low-level viremia (LLV) and its impact on virologic failure (VF) in people living with HIV (PLWH) on stable antiretroviral therapy (ART) who switched to co-formulated elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide (EVG/c/FTC/TAF).
PLWH aged 18 years or older who had received ART with plasma HIV RNA load (PVL) <50 copies/mL for 6 months or longer and switched to EVG/c/FTC/TAF between March and October 2018 were retrospectively included. The incidence of LLV (defined as PVL of 50-999 copies/mL) and VF (PVL ≥1000 copies/mL) was calculated and represented by Kaplan-Meier plots. The generalised estimating equation model was constructed to identify factors associated with LLV and VF. Resistance-associated mutations were determined using population sequencing.
A total of 1078 PLWH were included. The incidence rates of LLV and VF after the switch to EVG/c/FTC/TAF were 3.5 and 0.8 events per 100 person-years of follow-up, respectively, whereas the respective cumulative incidence of LLV and VF reached 11.7% and 2.9% within 3 years of follow-up. LLV was associated with any LLV episode before or after the switch and prior exposure to integrase strand transfer inhibitor-based ART. VF was associated with any LLV before or after the switch and prior exposure to raltegravir, but not the level or frequency of LLV.
The risks of LLV and VF were low in PLWH who had achieved virologic suppression and switched to EVG/c/FTC/TAF, and the presence of LLV and prior exposure to raltegravir increased the risk of VF.
我们旨在研究在接受稳定抗逆转录病毒治疗（ART）且病毒载量（VL）＜50 拷贝/ml 达 6 个月或更长时间的 HIV 感染者（PLWH）中，转换为依维莫司、考比司他、恩曲他滨和替诺福韦艾拉酚胺（EVG/c/FTC/TAF）时低水平病毒血症（LLV）的发生率及其对病毒学失败（VF）的影响。
回顾性纳入 2018 年 3 月至 10 月期间接受过 ART 治疗且 VL＜50 拷贝/ml 达 6 个月或更长时间并转换为 EVG/c/FTC/TAF 的年龄≥18 岁的 PLWH。通过 Kaplan-Meier 图计算并表示 LLV（定义为 VL 为 50-999 拷贝/ml）和 VF（VL≥1000 拷贝/ml）的发生率。构建广义估计方程模型以确定与 LLV 和 VF 相关的因素。使用群体测序确定耐药相关突变。
共纳入 1078 例 PLWH。转换为 EVG/c/FTC/TAF 后 LLV 和 VF 的发生率分别为每 100 人年 3.5 和 0.8 例，而 LLV 和 VF 的累积发生率在 3 年内分别达到 11.7%和 2.9%。LLV 与转换前后任何 LLV 发作以及先前接触整合酶抑制剂的 ART 相关。VF 与转换前后任何 LLV 发作以及先前接触拉替拉韦有关，但与 LLV 的水平或频率无关。
在实现病毒学抑制并转换为 EVG/c/FTC/TAF 的 PLWH 中，LLV 和 VF 的风险较低，LLV 的存在和先前接触拉替拉韦增加了 VF 的风险。
