De Vito Andrea, Botta Annarita, Berruti Marco, Castelli Valeria, Lai Vincenzo, Cassol Chiara, Lanari Alessandro, Stella Giulia, Shallvari Adrian, Bezenchek Antonia, Di Biagio Antonio
Unit of Infectious Diseases, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, 07100 Sassari, Italy.
Infectious and Tropical Disease Unit, Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, 50134 Florence, Italy.
J Pers Med. 2022 Jan 31;12(2):188. doi: 10.3390/jpm12020188.
Long-acting (LA) formulations have been designed to improve the quality of life of people with HIV (PWH) by maintaining virologic suppression. However, clinical trials have shown that patient selection is crucial. In fact, the HIV-1 resistance genotype test and the Body Mass Index of individual patients assume a predominant role in guiding the choice. Our work aimed to estimate the patients eligible for the new LA therapy with cabotegravir (CAB) + rilpivirine (RPV). We selected, from the Antiviral Response Cohort Analysis (ARCA) database, all PWH who had at least one follow-up in the last 24 months. We excluded patients with HBsAg positivity, evidence of non-nucleoside reverse transcriptase inhibitor (except K103N) and integrase inhibitor mutations, and with a detectable HIV-RNA (>50 copies/mL). Overall, 4103 patients are currently on follow-up in the ARCA, but the eligible patients totaled 1641 (39.9%). Among them, 1163 (70.9%) were males and 1399 were Caucasian (85.3%), of which 1291 (92%) were Italian born. The median length of HIV infection was 10.2 years (IQR 6.3-16.3) with a median nadir of CD4 cells/count of 238 (106-366) cells/mm and a median last available CD4 cells/count of 706 (509-944) cells/mm. The majority of PWH were treated with a three-drug regimen ( = 1116, 68%). Among the 525 (30.3%) patients treated with two-drug regimens, 325 (18.1%) were treated with lamivudine (3TC) and dolutegravir (DTG) and only 84 (5.1%) with RPV and DTG. In conclusion, according to our snapshot, roughly 39.9% of virologically suppressed patients may be suitable candidates for long-acting CAB+RPV therapy. Therefore, based on our findings, many different variables should be taken into consideration to tailor the antiretroviral treatment according to different individual characteristics.
长效（LA）制剂的设计目的是通过维持病毒学抑制来改善艾滋病毒感染者（PWH）的生活质量。然而，临床试验表明患者选择至关重要。事实上，HIV-1耐药基因型检测和个体患者的体重指数在指导选择方面起着主要作用。我们的工作旨在评估符合使用卡博特韦（CAB）+利匹韦林（RPV）进行新的长效治疗条件的患者。我们从抗病毒反应队列分析（ARCA）数据库中筛选出在过去24个月内至少有一次随访的所有PWH。我们排除了乙肝表面抗原阳性、有非核苷类逆转录酶抑制剂（K103N除外）和整合酶抑制剂突变证据以及可检测到HIV-RNA（>50拷贝/mL）的患者。总体而言，目前有4103名患者在ARCA队列中接受随访，但符合条件的患者共有1641名（39.9%）。其中，1163名（70.9%）为男性，1399名（85.3%）为白种人，其中1291名（92%）出生于意大利。HIV感染的中位时长为10.2年（四分位间距6.3 - 16.3），CD4细胞计数的中位最低点为238（106 - 366）个/mm³，最后一次可获得的CD4细胞计数的中位值为706（509 - 944）个/mm³。大多数PWH接受的是三联疗法（n = 1116，68%）。在接受二联疗法的525名（30.3%）患者中，325名（18.1%）接受的是拉米夫定（3TC）和多替拉韦（DTG）治疗，只有84名（5.1%）接受的是RPV和DTG治疗。总之，根据我们的简要分析，大约39.9%的病毒学抑制患者可能是长效CAB + RPV治疗的合适候选者。因此，基于我们的研究结果，应考虑许多不同变量，以便根据不同个体特征量身定制抗逆转录病毒治疗方案。
