Vergori Alessandra, Gianotti Nicola, Tavelli Alessandro, Tincati Camilla, Giacomelli Andrea, Matteini Elena, Lapadula Giuseppe, Taramasso Lucia, Sarmati Loredana, D'Arminio Monforte Antonella, Antinori Andrea, Cozzi-Lepri Alessandro
Viral Immunodeficiency Unit, National Institute for Infectious Diseases L. Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00143 Roma, Italy.
Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, 20133 Milano, Italy.
Viruses. 2024 Nov 23;16(12):1822. doi: 10.3390/v16121822.
: This study examined the impact of the COVID-19 lockdown on antiretroviral therapy (ART) prescriptions among persons living with HIV (PWH) in Italy. : Data from the ICONA cohort included ART-naïve individuals who started ART between January 2019 and December 2022, and ART-experienced individuals who started new ART with HIV RNA ≤50 cps/mL from January 2016 to December 2022. The analysis focused on the proportion of PWH starting or switching to dual (2DR) versus triple (3DR) ART regimens. Comparisons were made using Chi-square and Kruskal-Wallis tests, with logistic regression (LR) to assess associations, adjusting for sex and age. : Among 2481 ART-naïve PWH, 17% were female, with a median age of 40. Using 2020 as the comparator (the lockdown year), the odds ratio (OR) from fitting a LR showed a reduced probability of prescribing 2DR both before and after 2020. The proportion of PWH starting 2DR was 9% in 2019, 18% in 2020, 13% in 2021, and 10% in 2022. Among 12,335 ART-experienced PWH, 20% were female, with a median age of 47. The proportion switching to 2DR rose from 24% in 2016 to 38% in 2020, 62% in 2021, and 65% in 2022, showing a >3-fold higher probability to be switched to 2DR instead of 3DR in recent years (2021-2022). : For ART-naive PWH, 2DR initiation did not decrease during the 2020 lockdown but changed in the following years, possibly indicating shifts in clinical practice or resuming HIV services. For ART-experienced PWH, 2DR prescriptions increased significantly over time, especially for INSTI-based regimens.
本研究调查了意大利新冠疫情封锁措施对艾滋病毒感染者（PWH）抗逆转录病毒疗法（ART）处方的影响。ICONA队列的数据包括2019年1月至2022年12月开始接受ART治疗的初治个体，以及2016年1月至2022年12月开始接受新ART治疗且HIV RNA≤50拷贝/毫升的经治个体。分析重点关注开始或转换为双药（2DR）与三药（3DR）ART方案的PWH比例。使用卡方检验和克鲁斯卡尔-沃利斯检验进行比较，并采用逻辑回归（LR）评估关联，对性别和年龄进行调整。在2481名初治PWH中，17%为女性，中位年龄为40岁。以2020年（封锁年份）作为对照，拟合LR得到的优势比（OR）显示，2020年前后开具2DR的概率均降低。2019年开始接受2DR治疗的PWH比例为9%，2020年为18%，2021年为13%，2022年为10%。在12335名经治PWH中，20%为女性，中位年龄为47岁。转换为2DR的比例从2016年的24%上升至2020年的38%、2021年的62%和2022年的65%，表明近年来（2021 - 2022年）转换为2DR而非3DR的概率高出3倍以上。对于初治PWH，2020年封锁期间2DR的起始率并未下降，但在随后几年有所变化，这可能表明临床实践发生了转变或艾滋病毒服务得以恢复。对于经治PWH，2DR处方随时间显著增加，尤其是基于整合酶链转移抑制剂（INSTI）的方案。
