Calza Leonardo, Giglia Maddalena, Zuppiroli Alberto, Cretella Silvia, Vitale Salvatore, Appolloni Lucia, Viale Pierluigi
Department of Medical and Surgical Sciences, Unit of Infectious Diseases.
Department of Medical and Surgical Sciences, Hospital Pharmacy, S. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
New Microbiol. 2025 May;48(1):70-77.
Clinical trials of triple regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) demonstrated potent efficacy and favorable safety in both antiretroviral therapy-naïve and -experienced people living with HIV (PLWH), in association with a low risk of drug-drug interactions (DDIs), but data about older people are still lacking. This retrospective cohort study evaluated records from suppressed PLWH aged ≥60 years and who switched to BIC/FTC/TAF. One hundred and nine patients were included: median age was 67.2 years (range, 60-81) and 82% were men. The most common reasons for switch were DDIs (in 66% of cases), followed by simplification (51.3%), and toxicity (26.6%). Overall, 139 potential DDIs between antiretroviral drugs and other concomitant agents were registered in 72 individuals. The most common DDIs included statins in 45 cases (33%), antidepressants in 27 (19%), cardiologic drugs in 23 (17%), proton pump inhibitors in 15 (11%), and benzodiazepines in 12 (9%). After the switch to BIC/FTC/TAF, the number of potential DDIs decreased significantly (from 139 to 18, -87%; p<0.001). The median DDI score also decreased significantly after the switch (from 0.64 to 0.14, -78%; p<0.001). After 12 months, 101 patients (92.7%) had HIV RNA <20 copies/mL. Eight patients discontinued BIC/FTC/TAF: three for virological failure, two for adverse events, and three for missing data. In this real-world cohort, switching to BIC/FTC/TAF in virologically suppressed PLWH aged over 60 years led to a remarkable reduction in potential DDIs, in association with high virological efficacy and good tolerability profile.
比克替拉韦/恩曲他滨/丙酚替诺福韦（BIC/FTC/TAF）三联疗法的临床试验表明，在初治和经治的HIV感染者（PLWH）中，该疗法疗效显著且安全性良好，药物相互作用（DDIs）风险较低，但关于老年人的数据仍然缺乏。这项回顾性队列研究评估了年龄≥60岁且转换为BIC/FTC/TAF治疗的病毒得到抑制的PLWH的记录。共纳入109例患者：中位年龄为67.2岁（范围60 - 81岁），82%为男性。转换治疗的最常见原因是药物相互作用（66%的病例），其次是简化治疗方案（51.3%）和毒性反应（26.6%）。总体而言，72例患者共记录到139例抗逆转录病毒药物与其他伴随用药之间的潜在药物相互作用。最常见的药物相互作用包括他汀类药物45例（33%）、抗抑郁药27例（19%）、心脏病药物23例（17%）、质子泵抑制剂15例（11%）和苯二氮䓬类药物12例（9%）。转换为BIC/FTC/TAF治疗后，潜在药物相互作用的数量显著减少（从139例降至18例，-87%；p<0.001）。转换治疗后，药物相互作用评分中位数也显著降低（从0.64降至0.14，-78%；p<0.001）。12个月后，101例患者（92.7%）的HIV RNA<20拷贝/mL。8例患者停用BIC/FTC/TAF：3例因病毒学失败，2例因不良事件，3例因数据缺失。在这个真实世界队列中，60岁以上病毒得到抑制的PLWH转换为BIC/FTC/TAF治疗后，潜在药物相互作用显著减少，同时具有高病毒学疗效和良好的耐受性。
