Di Perri Giovanni, Bonora Stefano
Dept of Medical Sciences, University of Torino Medical School, Torino, Italy.
Infez Med. 2025 Sep 1;33(3):268-278. doi: 10.53854/liim-3303-3. eCollection 2025.
Our confidence on the efficacy of antiretroviral therapy has steadily increased in the last decade thanks to the continuous improvement of drugs, strategies and the ability to cope with the increase in life expectancy of people with HIV (PWH). Nevertheless antiretroviral therapy keeps on being a lifelong commitment and the current clinical research on anti-HIV treatment also points on the possibility to mitigate a series of remaining difficulties like patients' adherence, stigma and the logistic burden associated to periodical monitoring and drug refills. The newly developed long-acting injectables drugs made it possible to reduce the frequency of administration and improved adherence, but at present the recipients of these new solutions are asked to join the outpatient HIV services at least every two months to receive their injections and undergo immunovirological monitoring. This also because these newly developed options consist of two (2DR) instead of three drugs and such close monitoring might be necessary due to the lesser genetic barrier and forgiveness. The patients who instead are under stable oral antiretroviral therapy with persistent virologic suppression may benefit from extension of the time between consecutive controls. This particularly applies when 2 generation integrase inhibitors (INSTIs)-based three-drug regimens (3DR) are considered. Properties like intrinsic potency, genetic barrier, forgiveness, tolerability and safety make such regimens well suitable for less frequent immunovirological monitoring. The case of the single-tablet regimen consisting of Bictegravir/Emtricitabine/Tenofovir alafenamide (BIC/FTC/TAF) is unique, as in a single pill with a total net weight of 275 mg we actually find all the necessary ingredients to ensure the success of such initiative. Such powerful option looks as the most promising treatment to successfully increase the time between consultations and monitoring up to 9 or 12 months and thus providing the resulting advantages.
在过去十年中，由于药物、治疗策略的不断改进以及应对艾滋病毒感染者（PWH）预期寿命增加的能力提升，我们对抗逆转录病毒疗法疗效的信心稳步增强。然而，抗逆转录病毒疗法仍然需要终身坚持，目前关于抗艾滋病毒治疗的临床研究也指出，有可能缓解一系列遗留难题，如患者的依从性、耻辱感以及与定期监测和药物补充相关的后勤负担。新开发的长效注射药物降低了给药频率并提高了依从性，但目前这些新疗法的接受者至少每两个月需要前往门诊艾滋病毒服务机构接受注射并进行免疫病毒学监测。这也是因为这些新开发的疗法由两种（2DR）而非三种药物组成，由于遗传屏障较低以及容错性较差，可能需要进行如此密切的监测。而对于接受稳定口服抗逆转录病毒疗法且病毒持续被抑制的患者，可能会受益于延长连续两次检查之间的时间间隔。当考虑基于第二代整合酶抑制剂（INSTIs）的三联药物疗法（3DR）时尤其如此。诸如内在效力、遗传屏障、容错性、耐受性和安全性等特性使得此类疗法非常适合进行不那么频繁的免疫病毒学监测。由比克替拉韦/恩曲他滨/替诺福韦艾拉酚胺（BIC/FTC/TAF）组成的单片复方制剂的情况很独特，因为在一片总净重为275毫克的药丸中，我们实际上找到了确保该方案成功所需的所有成分。这种强大的疗法似乎是最有希望成功将咨询和监测间隔时间延长至9或12个月并带来相应益处的治疗方法。
