Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
The Kirby Institute, UNSW Sydney, Sydney, Australia.
PLoS One. 2022 Mar 30;17(3):e0264157. doi: 10.1371/journal.pone.0264157. eCollection 2022.
The use of holding regimens for people living with HIV (PLWH) without effective antiretroviral options can have effects on outcomes and future treatment options. We aimed to investigate the use of holding regimens for PLWH in Asian countries. Data from adults enrolled in routine HIV care in IeDEA Asia-Pacific cohorts were included. Individuals were considered to be on holding regimen if they had been on combination antiretroviral therapy for at least 6 months, had two confirmed viral loads (VL) ≥1000 copies/mL, and had remained on the same medications for at least 6 months. Survival time was analyzed using Fine and Gray's competing risk regression. Factors associated with CD4 changes and VL <1000 copies/mL were analyzed using linear regression and logistic regression, respectively. A total of 425 PLWH (72.9% male; 45.2% high-income and 54.8% low-to-middle-income country) met criteria for being on a holding regimen. From high-income countries, 63.0% were on protease inhibitors (PIs); from low-to-middle-income countries, 58.4% were on non-nucleoside reverse transcriptase inhibitors (NNRTIs); overall, 4.5% were on integrase inhibitors. The combination of lamivudine, zidovudine, and efavirenz was the most commonly used single regimen (n = 46, 10.8%), followed by lamivudine, zidovudine, and nevirapine (n = 37, 8.7%). Forty-one PLWH (9.7%) died during follow-up (mortality rate 2.0 per 100 person-years). Age >50 years compared to age 31-40 years (sub-hazard ratio [SHR] 3.29, 95% CI 1.45-7.43, p = 0.004), and VL ≥1000 copies/ml compared to VL <1000 copies/mL (SHR, 2.14, 95% CI 1.08-4.25, p = 0.029) were associated with increased mortality, while higher CD4 counts were protective. In our Asia regional cohort, there was a diversity of holding regimens, and the patterns of PI vs. NNRTI use differed by country income levels. Considering the high mortality rate of PLWH with holding regimen, efforts to extend accessibility to additional antiretroviral options are needed in our region.
对于没有有效抗逆转录病毒选择的艾滋病毒感染者（PLWH），使用维持治疗方案可能会对结果和未来的治疗选择产生影响。我们旨在调查亚洲国家使用维持治疗方案的情况。本研究纳入了 IeDEA 亚太队列中接受常规 HIV 护理的成年人的数据。如果患者接受联合抗逆转录病毒治疗至少 6 个月，两次确认的病毒载量（VL）≥1000 拷贝/ml，且至少 6 个月内使用相同药物，则被认为正在接受维持治疗方案。使用 Fine 和 Gray 的竞争风险回归分析生存时间。使用线性回归和逻辑回归分别分析与 CD4 变化和 VL<1000 拷贝/ml 相关的因素。共有 425 名 PLWH（72.9%为男性；45.2%来自高收入国家，54.8%来自中低收入国家）符合接受维持治疗方案的标准。来自高收入国家的患者中有 63.0%接受蛋白酶抑制剂（PIs）治疗；来自中低收入国家的患者中有 58.4%接受非核苷类逆转录酶抑制剂（NNRTIs）治疗；总体而言，有 4.5%接受整合酶抑制剂治疗。拉米夫定、齐多夫定和依非韦伦联合方案是最常用的单一方案（n=46，10.8%），其次是拉米夫定、齐多夫定和奈韦拉平（n=37，8.7%）。在随访期间，有 41 名 PLWH（9.7%）死亡（死亡率为每 100 人年 2.0 人）。与 31-40 岁年龄组相比，年龄>50 岁（亚危险比 [SHR] 3.29，95%CI 1.45-7.43，p=0.004）和 VL≥1000 拷贝/ml 与 VL<1000 拷贝/ml 相比（SHR，2.14，95%CI 1.08-4.25，p=0.029）与死亡率增加相关，而较高的 CD4 计数具有保护作用。在我们的亚洲队列中，维持治疗方案的种类繁多，PI 与 NNRTI 的使用模式因国家收入水平而异。考虑到接受维持治疗方案的 PLWH 死亡率较高，我们地区需要努力扩大获得更多抗逆转录病毒选择的机会。
