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