Lumu Ivan, Musaazi Joseph, Castelnuovo Barbara
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
School of Medicine, University of Liverpool, Liverpool, England.
AIDS. 2022 Nov 1;36(13):1791-1800. doi: 10.1097/QAD.0000000000003340. Epub 2022 Jul 25.
The study investigated the durability of switched therapy and factors associated with the viral rebound among patients on second-line antiretroviral therapy (ART) in Uganda.
A retrospective dynamic cohort of adults initiated on second-line ART after virological failure to first-line ART.
Patients on second-line treatment for at least 6 months between 2007 and 2017 were included. Patients were followed, until they experienced a viral rebound (viral load ≥200 copies/ml). Cumulative probability of viral rebounds and factors associated with viral rebound were determined using Kaplan-Meier methods and Cox proportional hazard models.
One thousand, one hundred and one participants were enrolled of which 64% were women, the median age was 37 years [interquartile range (IQR) 31-43]. The preswitch median CD4 + cell count and viral load were 128 cells/μl (IQR 58-244) and 45 978 copies/ml (IQR 13 827-139 583), respectively. During the 4190.37 person-years, the incidence rate of viral rebound was 83.29 [95% confidence interval (CI) 74.99-92.49] per 1000 person-years. The probability of viral rebound at 5 and 10 years was 0.29 (95% CI 0.26-0.32) and 0.62 (95% CI 0.55-0.69), respectively. The median rebound-free survival was 8.7 years. Young adults (18-24 years) [adjusted hazard ratio (aHR) 2.49, 95% CI 1.32-4.67], preswitch viral load at least 100 000 copies/ml (aHR 1.53, 95% CI 1.22-1.92), and atazanavir/ritonavir (ATV/r)-based second-line (aHR 1.73, 95% CI 1.29-2.32) were associated with an increased risk of viral rebound.
Switched therapies are durable for 8 years after failure of recommended regimens. A high preswitch viral load, ATV/r-based regimens, and young adulthood are risk factors for viral rebound, which underscores the need for more durable regimens and differentiated care services.
本研究调查了乌干达接受二线抗逆转录病毒治疗（ART）患者的转换治疗的持久性以及与病毒反弹相关的因素。
一项回顾性动态队列研究，纳入一线ART病毒学失败后开始二线ART的成年人。
纳入2007年至2017年间接受二线治疗至少6个月的患者。对患者进行随访，直至出现病毒反弹（病毒载量≥200拷贝/毫升）。使用Kaplan-Meier方法和Cox比例风险模型确定病毒反弹的累积概率以及与病毒反弹相关的因素。
共纳入1101名参与者，其中64%为女性，中位年龄为37岁[四分位间距（IQR）31 - 43]。转换治疗前的中位CD4 +细胞计数和病毒载量分别为128个细胞/微升（IQR 58 - 244）和45978拷贝/毫升（IQR 13827 - 139583）。在4190.37人年期间，病毒反弹的发生率为每1000人年83.29[95%置信区间（CI）74.99 - 92.49]。5年和10年时病毒反弹的概率分别为0.29（95% CI 0.26 - 0.32）和0.62（95% CI 0.55 - 0.69）。无反弹生存的中位时间为8.7年。年轻成年人（18 - 24岁）[调整后风险比（aHR）2.49，95% CI 1.32 - 4.67]、转换治疗前病毒载量至少100000拷贝/毫升（aHR 1.53，95% CI 1.22 - 1.92）以及基于阿扎那韦/利托那韦（ATV/r）的二线治疗（aHR 1.73，95% CI 1.29 - 2.32）与病毒反弹风险增加相关。
在推荐方案失败后，转换治疗可持续8年。转换治疗前病毒载量高、基于ATV/r的方案以及年轻成年是病毒反弹的危险因素，这突出了需要更持久方案和差异化护理服务的必要性。
