Antinori Andrea
Clinical Department of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
Infez Med. 2023 Sep 1;31(3):277-282. doi: 10.53854/liim-3103-2. eCollection 2023.
Advanced HIV naive represents an unfavorable prognostic condition due to a persistent high risk of death, increased probability of virological failure, immunologic impairment, clinical progression, and immune reconstitution inflammatory syndrome (IRIS), cumulative adverse drug events, drug-drug interactions and increased healthcare costs. Currently, all international guidelines recommend the rapid initiation of ART, especially in late-stage naive patients. Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), due to its efficacy high genetic barrier, good safety profile, and low DDI potential, is one of the regimens recommended for overall rapid initiation by international guidelines. B/F/TAF has been tested in observational or uncontrolled pilot studies (OPERA, RAINBOW), while a large randomized controlled trial is currently ongoing (LAPTOP). In conclusion, B/F/TAF is an ideal combination for the initiation of antiretroviral therapy, particularly in the HIV late presenter or advanced HIV disease patient, even in the context of rapid start or same-day treatment regimens, where the initiation of treatment usually occurs in the absence of information on viral load, CD4 count, biochemical profile and HIV transmitted resistance.
初治晚期艾滋病患者预后不佳,存在持续的高死亡风险、病毒学失败概率增加、免疫功能损害、临床进展以及免疫重建炎症综合征(IRIS),还会出现累积不良药物事件、药物相互作用以及医疗成本增加等情况。目前,所有国际指南均建议迅速启动抗逆转录病毒治疗(ART),尤其是针对晚期初治患者。比克替拉韦/恩曲他滨/替诺福韦艾拉酚胺(B/F/TAF)因其高效、高基因屏障、良好的安全性以及较低的药物相互作用可能性,是国际指南推荐用于全面快速启动治疗的方案之一。B/F/TAF已在观察性或非对照试验性研究(OPERA、RAINBOW)中进行了测试,目前一项大型随机对照试验正在进行(LAPTOP)。总之,B/F/TAF是启动抗逆转录病毒治疗的理想组合,尤其适用于晚期艾滋病患者或艾滋病晚期患者,即使在快速启动或当日治疗方案的情况下,通常在缺乏病毒载量、CD4细胞计数、生化指标以及HIV传播耐药性信息时开始治疗。