Ikegaya Kenichi, Muramatsu Takashi, Sekiya Ryoko, Sekine Yusuke, Harada Yuko, Miyashita Ryui, Yamaguchi Tomoko, Ichiki Akito, Chikasawa Yushi, Bingo Masato, Yotsumoto Mihoko, Hagiwara Takeshi, Amano Kagehiro, Takeuchi Hironori, Kinai Ei
Departments of Pharmacy, Tokyo Medical University Hospital, Tokyo, Japan.
Laboratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan.
J Infect Chemother. 2025 Feb;31(2):102544. doi: 10.1016/j.jiac.2024.10.012. Epub 2024 Oct 22.
The two-drug regimen of dolutegravir/lamivudine (DTG/3TC) is currently an optional antiretroviral therapy (ART). Despite its reported advantages on body weight and lipid profile, the same effects have not yet been reported for Asian population.
We conducted a single-center retrospective study involving Japanese people living with HIV (PLWH). They were divided into four groups: those who had received abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) and continued the same (ABC-ON group) or switched to DTG/3TC (ABC-OFF group), those who had received tenofovir alafenamide fumarate/emtricitabine/dolutegravir (TAF/FTC/DTG) and continued the same (TAF-ON group) or switched to DTG/3TC (TAF-OFF group). We compared changes in viral load, CD4⁺ cell count, CD4⁺/CD8⁺ ratio, body weight, BMI, lipid profiles, estimated glomerular filtration rate (eGFR), and fibrosis index based on four factors (FIB4-index) between the pre-switch and post-switch period.
Of the 541 PLWH on DTG-based ART, 165, 94, 264 and 18 constituted the ABC-ON, ABC-OFF, TAF-ON, and TAF-OFF groups, respectively. Neither viral rebound nor CD4decline was observed in the post-switch period in all groups. Multivariate analysis showed significant reduction in total cholesterol, LDL-C and HDL-C in the ABC-OFF group (-6.280, -6.957 and -2.268, p = 0.040, 0.012 and 0.022, respectively), but not in the TAF-OFF group (-3.000, 6.708 and 0.046, p = 0.607, 0.276 and 0.983, respectively). No significant changes were observed in body weight, eGFR, or FIB4-index at 72 weeks after the discontinuation of ABC or TAF.
Switching from ABC/3TC/DTG to DTG/3TC lowered lipids significantly, but not with TAF/FTC/DTG. Neither switch affected body weight or other markers.
多替拉韦/拉米夫定（DTG/3TC）两药方案目前是一种可选的抗逆转录病毒疗法（ART）。尽管有报道称其对体重和血脂谱有优势，但亚洲人群尚未有同样的效果报道。
我们进行了一项单中心回顾性研究，纳入了日本HIV感染者（PLWH）。他们被分为四组：接受阿巴卡韦/拉米夫定/多替拉韦（ABC/3TC/DTG）并继续使用该方案的（ABC-ON组）或换用DTG/3TC的（ABC-OFF组），接受替诺福韦艾拉酚胺富马酸盐/恩曲他滨/多替拉韦（TAF/FTC/DTG）并继续使用该方案的（TAF-ON组）或换用DTG/3TC的（TAF-OFF组）。我们比较了换药前和换药后病毒载量、CD4⁺细胞计数、CD4⁺/CD8⁺比值、体重、BMI、血脂谱、估计肾小球滤过率（eGFR）以及基于四个因素的纤维化指数（FIB4指数）的变化。
在541例接受基于DTG的ART的PLWH中，ABC-ON组、ABC-OFF组、TAF-ON组和TAF-OFF组分别有165例、94例、264例和18例。所有组在换药后均未观察到病毒反弹或CD4下降。多变量分析显示，ABC-OFF组总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇显著降低（分别为-6.280、-6.957和-2.268，p = 0.040、0.012和0.022），而TAF-OFF组未出现显著降低（分别为-3.000、6.708和0.046，p = 0.607、0.276和0.983）。停用ABC或TAF 72周后，体重、eGFR或FIB4指数未观察到显著变化。
从ABC/3TC/DTG换用DTG/3TC可显著降低血脂，但从TAF/FTC/DTG换用则不然。两种换药方式均未影响体重或其他指标。
