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接受比克替拉韦、恩曲他滨和丙酚替诺福韦二吡呋酯复方制剂治疗的病毒抑制 HIV 感染者的患者报告结局。

Patient-reported outcomes among virally suppressed people living with HIV after switching to Co-formulated bictegravir, emtricitabine and tenofovir alafenamide.

机构信息

Centre of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

出版信息

J Microbiol Immunol Infect. 2023 Jun;56(3):575-585. doi: 10.1016/j.jmii.2023.01.015. Epub 2023 Feb 9.

Abstract

BACKGROUND

While some evidence has suggested the benefits of co-formulated bictegravir, emtricitabine and tenofovir alafenamide (B/F/TAF) in improving the quality of life of people living with HIV (PLWH), patient-reported outcome studies that focus on Asian population remain scarce. We aimed to determine the changes in HIV-related symptom burden in virally-suppressed PLWH switching to B/F/TAF in a real-world setting.

METHODS

PLWH on stable antiretroviral therapy (ART) for ≥6 months with plasma HIV RNA <200 copies/mL who decided to switch to B/F/TAF were eligible for the study. Participants' experience with 20 symptoms were assessed using HIV Symptom Index at baseline and weeks 24 and 48. Responses were dichotomized in two ways: 1) present vs. not present; and 2) bothersome vs. not bothersome, and compared across time points.

RESULTS

Six hundred and thirty participants (prior regimen, 94.4% integrase inhibitor-based) who completed week 48 visit were included in the analysis. Forty-eight weeks after switching to B/F/TAF, six symptoms were significantly less prevalent, and seven symptoms were significantly less bothersome. Improvement was more pronounced in participants whose prior regimen was elvitegravir-based versus dolutegravir-based. Logistic regression results showed that prior dolutegravir-based ART and pre-existing diabetes independently predicted improvement in diarrhea/loose bowels and muscle aches/joint pain, respectively. Despite the overall improvement, some symptoms persisted in a substantial proportion of participants.

CONCLUSIONS

Virally-suppressed PLWH might benefit from a regimen switch to B/F/TAF to reduce the prevalence and level of bother of HIV-related symptoms. Nevertheless, additional multidisciplinary interventions are warranted to further alleviate the symptom burden of PLWH.

摘要

背景

虽然有证据表明双药复方比克替拉韦、恩曲他滨和丙酚替诺福韦(B/F/TAF)可改善艾滋病毒感染者(PLWH)的生活质量,但关注亚洲人群的患者报告结局研究仍然很少。我们旨在确定在真实环境中,病毒抑制的 PLWH 换用 B/F/TAF 后,HIV 相关症状负担的变化。

方法

符合条件的参与者为接受稳定抗逆转录病毒治疗(ART)≥6 个月、血浆 HIV RNA<200 拷贝/mL 且决定换用 B/F/TAF 的 PLWH。在基线和第 24 周和第 48 周使用 HIV 症状指数评估参与者的 20 种症状体验。采用两种方式将应答分为存在和不存在,以及令人烦恼和不令人烦恼,并在各时间点进行比较。

结果

630 名完成第 48 周访视的参与者(既往方案 94.4%为基于整合酶抑制剂)被纳入分析。换用 B/F/TAF 48 周后,有 6 种症状的发生率显著降低,7 种症状的令人烦恼程度显著降低。与换用基于艾维雷韦的方案相比,换用基于多拉韦林的方案者改善更为明显。Logistic 回归结果显示,既往基于多拉韦林的 ART 和预先存在的糖尿病分别独立预测腹泻/稀便和肌肉疼痛/关节痛的改善。尽管总体上有所改善,但仍有相当一部分参与者存在一些症状。

结论

病毒抑制的 PLWH 换用 B/F/TAF 可能有助于降低 HIV 相关症状的发生率和严重程度。然而,仍需要采取多学科综合干预措施来进一步减轻 PLWH 的症状负担。

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