Cozzi-Lepri Alessandro, Tavelli Alessandro, Taramasso Lucia, Lapadula Giuseppe, Bobbio Nicoletta, Piconi Stefania, Guaraldi Giovanni, Di Biagio Antonio, Castagna Antonella, Mazzotta Valentina, d'Arminio Monforte Antonella
CREME Centre, IGH University College London, London, UK.
Icona Foundation, Milano, Italy.
J Antimicrob Chemother. 2025 Jul 1;80(7):1849-1859. doi: 10.1093/jac/dkaf137.
To estimate the incidence of comorbidities in persons with HIV (PWH) with a stable viral load (VL) of ≤50 copies/mL and evaluate the likelihood of treatment switch (TS) according to the new development of dyslipidaemia (DP), kidney disease and a weight change that determined overweight.
We carried out six case-control studies nested within the Icona Foundation Study cohort with the outcome of TS of the current regimen (due to intolerance/toxicity or simplification) and investigated the incident comorbidities. Conditional logistic regression models were employed.
Overall, the median age of study participants was 45 years (IQR: 36-52), 19% were female, 48% were MSM and 17% were migrants. DP was confirmed to be the most frequent incident comorbidity [138 events; incidence rate (IR) = 28.4%; 95% CI: 22.7%-34%], followed by estimated glomerular filtration rate (eGFR) deterioration and BMI elevation. None of the studied factors was associated with the risk of TS because of simplification. TS because of toxicity was predicted by incident DP [adjusted OR (aOR) = 2.49, 95% CI: 1.19-5.19, P = 0.02] and by a decline in eGFR of >10 mL/min/1.73 m2 (aOR = 1.51, 95% CI: 0.98-2.32, P = 0.06). The association with DP was stronger in participants who were receiving a boosted PI-based regimen at baseline (aOR = 3.38, 95% CI: 1.11-10.30, P = 0.03). Therapy discontinuation because of toxicity/simplification has remained common in PWH with VL of ≤50 copies/mL in recent years.
The onset of DP and a decline in eGFR was associated with discontinuations due to toxicity. Interventions aiming to mitigate the risk of developing lipid abnormalities in PWH are likely to also reduce the number of ART changes, which can potentially affect future drug options.
评估病毒载量（VL）稳定在≤50拷贝/mL的HIV感染者（PWH）中合并症的发生率，并根据血脂异常（DP）、肾脏疾病的新进展以及导致超重的体重变化来评估治疗转换（TS）的可能性。
我们在伊科纳基金会研究队列中开展了六项病例对照研究，以当前治疗方案的TS为结果（由于不耐受/毒性或简化），并调查新发合并症。采用条件逻辑回归模型。
总体而言，研究参与者的中位年龄为45岁（四分位间距：36 - 52岁），19%为女性，48%为男男性行为者，17%为移民。DP被确认为最常见的新发合并症[138例事件；发病率（IR）=28.4%；95%置信区间：22.7% - 34%]，其次是估计肾小球滤过率（eGFR）恶化和体重指数（BMI）升高。所研究的因素均与因简化导致的TS风险无关。因毒性导致的TS可由新发DP预测[调整后比值比（aOR）=2.49，95%置信区间：1.19 - 5.19，P = 0.02]以及eGFR下降>10 mL/min/1.73 m²预测（aOR = 1.51，95%置信区间：0.98 - 2.32，P = 0.06）。在基线时接受基于蛋白酶抑制剂（PI）强化方案的参与者中，与DP的关联更强（aOR = 3.38，95%置信区间：1.11 - 10.30，P = 0.03）。近年来，因毒性/简化导致的治疗中断在VL≤50拷贝/mL的PWH中仍然很常见。
DP的发生和eGFR下降与因毒性导致的治疗中断有关。旨在降低PWH发生脂质异常风险的干预措施可能也会减少抗逆转录病毒治疗（ART）的更改次数，而这可能会影响未来的药物选择。
