Philadelphia FIGHT, Philadelphia, Pennsylvania, USA.
Epividian, Raleigh, North Carolina, USA.
HIV Med. 2023 Jun;24(6):716-726. doi: 10.1111/hiv.13467. Epub 2023 Feb 15.
Our objective was to compare the immunological responses to commonly used antiretroviral therapy (ART) regimens among people with advanced HIV in the USA and to assess virological outcomes and regimen persistence.
This study included ART-naïve adults with advanced HIV infection (CD4 cell count <200 cells/μL) initiating ART with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), boosted darunavir (bDRV), dolutegravir (DTG), or elvitegravir (EVG/c)-containing regimens between 1 January 2018 and 31 December 2020 in the Observational Pharmaco-Epidemiology Research and Analysis (OPERA) cohort. Cox proportional hazards models and linear mixed models with random intercept were fit with inverse probability of treatment weighting.
Overall, 1349 people with advanced HIV (816 B/F/TAF, 253 DTG, 146 EVG/c, 134 bDRV) were followed for a median of 22 months. Compared with B/F/TAF, a lower likelihood of achieving a CD4 cell count ≥200 cells/μL was observed with bDRV (hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.60-0.96), DTG (HR 0.82; 95% CI 0.69-0.98), and EVG/c (HR 0.73; 95% CI 0.57-0.93). All groups had a similar pattern of CD4:CD8 ratio changes: a rapid increase in the first 6 months (ranging from +0.15 to +0.16 units), followed by a slower increase thereafter. Only 40 individuals (4%) achieved CD4:CD8 ratio normalization (≥1). B/F/TAF was associated with a faster time to virological suppression (viral load <200 copies/mL) and a slower time to discontinuation compared with other regimens.
Among people with advanced HIV infection, B/F/TAF initiation was associated with faster CD4 cell count recovery and favourable virological outcomes compared with bDRV-, DTG-, and EVG/c-based regimens, although no difference was observed in CD4:CD8 ratio changes over time across regimens.
本研究旨在比较美国晚期 HIV 感染者中常用抗逆转录病毒治疗（ART）方案的免疫反应，并评估病毒学结局和方案的持续情况。
这项研究纳入了 2018 年 1 月 1 日至 2020 年 12 月 31 日期间在 Observational Pharmaco-Epidemiology Research and Analysis（OPERA）队列中接受比克替拉韦/恩曲他滨/丙酚替诺福韦（B/F/TAF）、增效达芦那韦（bDRV）、多替拉韦（DTG）或艾维雷韦/考比司他（EVG/c）为基础的方案治疗的初治晚期 HIV 感染（CD4 细胞计数＜200 个/μL）的成人患者。采用逆概率治疗加权法，拟合 Cox 比例风险模型和具有随机截距的线性混合模型。
总体而言，1349 例晚期 HIV 感染者（816 例接受 B/F/TAF、253 例接受 DTG、146 例接受 EVG/c、134 例接受 bDRV）中位随访 22 个月。与 B/F/TAF 相比，bDRV（风险比 [HR]0.76；95%置信区间 [CI]0.60-0.96）、DTG（HR0.82；95%CI0.69-0.98）和 EVG/c（HR0.73；95%CI0.57-0.93）的 CD4 细胞计数≥200 个/μL 的可能性较低。所有组的 CD4:CD8 比值变化模式相似：在前 6 个月快速增加（范围从+0.15 到+0.16 个单位），此后增加速度较慢。仅有 40 例（4%）患者实现 CD4:CD8 比值正常化（≥1）。与其他方案相比，B/F/TAF 更快达到病毒学抑制（病毒载量＜200 拷贝/mL），但停药时间较慢。
在晚期 HIV 感染患者中，与 bDRV、DTG 和 EVG/c 为基础的方案相比，B/F/TAF 方案的 CD4 细胞计数恢复更快，病毒学结局更好，尽管各方案在 CD4:CD8 比值随时间的变化上没有差异。
