在同一天对人类免疫缺陷病毒感染者进行艾滋病毒/艾滋病抗逆转录病毒治疗:疗效和治疗方案比较研究。

IF 7.5 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Jing Yuan, Changgang Deng, Qisui Li, Yanyu Sun, Wei Huang, Wei Zhang, Min Liu
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引用次数: 0

摘要

背景:指南推荐快速启动抗逆转录病毒疗法(ART),但在中国当天启动抗逆转录病毒疗法的实际研究有限,最佳治疗方案尚未确定。本研究旨在为快速启动抗逆转录病毒疗法提供现实参考:我们回顾性分析了重庆市公共卫生医疗中心2021年1月1日至2022年12月31日期间确诊并开具ART当日起始治疗处方的PWH临床数据。这些患者自愿选择抗逆转录病毒疗法,并将其分为两组:国家免费抗逆转录病毒治疗项目(NFATP)推荐方案组(2种核苷类逆转录酶抑制剂+非核苷类逆转录酶抑制剂/保护酶抑制剂)和比特拉韦/恩曲他滨/替诺福韦-阿拉非酰胺(BIC/FTC/TAF)组。主要终点是两组患者在 24 周和 48 周时当天开始抗逆转录病毒疗法的病毒学结果。次要终点包括 CD4 细胞计数的变化、48 周时原有抗逆转录病毒疗法的维持情况以及 48 周时的血脂水平和肾功能:共有255名PWH参与了研究,其中NFATP组131人(51.4%),BIC/FTC/TAF组124人(48.6%)。24 周和 48 周的总体病毒学抑制率分别为 78.2%(165/211)和 95.4%(207/217)。在 24 周时,NFATP 组的病毒学抑制率低于 BIC/FTC/TAF 组(65.3% [66/101] vs. 90.0% [99/110],P 结论:在确诊当天开始抗逆转录病毒疗法是有效、安全和可行的,而且病毒学抑制率、48 周初始抗逆转录病毒疗法保留率和治疗保留率均令人满意。在我们的研究中,BIC/FTC/TAF 方案的早期病毒抑制率、CD4 细胞计数和治疗保持率明显优于 NFATP 方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
HIV/AIDS antiretroviral therapy initiated on the same day in treatment-naïve people with human immunodeficiency virus: A comparative study of efficacy and regimen.

Background: Rapid initiation of antiretroviral therapy (ART) is recommended by guidelines, however, real-world studies of same-day initiation of ART in China are limited, and an optimal treatment regimen has yet to be identified. The study aims to provide a realistic reference for rapid initiation of ART.

Methods: We retrospectively analyzed the clinical data of treatment-naïve PWHs who were diagnosed and prescribed same-day ART initiation from January 1, 2021 to December 31, 2022 at Chongqing Public Health Medical Center. PWHs voluntarily chose an ART regimen that divided them into two groups: National Free Antiretroviral Treatment Program (NFATP)-recommended regimens group (2 nucleoside reverse transcriptase inhibitors + non-nucleoside reverse transcriptase inhibitors/protease inhibitors) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) group. The primary endpoint was the virological outcome of the two groups for same-day ART initiation at 24 weeks and 48 weeks. The secondary endpoints included changes in CD4 counts, maintenance of the original ART regimen at 48 weeks, and lipid levels and renal function at 48 weeks.

Results: A total of 255 PWHs were included in the study, including 131 (51.4%) in the NFATP group and 124 (48.6%) in the BIC/FTC/TAF group. The overall virological suppression rates at 24 weeks and 48 weeks were 78.2% (165/211) and 95.4% (207/217), respectively. At 24 weeks, the virologic suppression rate in the NFATP group was lower than that in the BIC/FTC/TAF group (65.3% [66/101] vs. 90.0% [99/110], P <0.001). The median increase in the CD4 count was 198.0 (126.0-300.0) cells/μL at 24 weeks, with 182.0 (108.0-245.0) cells/μL in the NFATP group and 219 (132.0-316.0) cells/μL in the BIC/FTC/TAF group (P = 0.035). At 48 weeks, there was no significant difference in the virological suppression rate or CD4 count between the groups. The 48-week initial ART regimen retention rates and treatment retention rates were significantly higher in the BIC/FTC/TAF group than in the NFATP group (91.1% (113/124) vs. 71.8% (94/131), 99.2% (118/119) vs. 93.0% (120/129), respectively). In terms of safety, there were no significant changes from baseline in levels of creatinine, estimated glomerular filtration rate (eGFR), or lipids in either group at 48 weeks.

Conclusions: ART initiation on the day of diagnosis is effective, safe, and feasible, with satisfactory rates of virologic suppression, 48-week initial ART regimen retention rates, and treatment retention rates in treatment-naïve PWHs. In our study, the early virologic suppression rate, CD4 cell counts, and treatment retention of the BIC/FTC/TAF regimens were significantly better than those of the NFATP regimens.

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来源期刊
Chinese Medical Journal
Chinese Medical Journal 医学-医学:内科
CiteScore
9.80
自引率
4.90%
发文量
19245
审稿时长
6 months
期刊介绍: The Chinese Medical Journal (CMJ) is published semimonthly in English by the Chinese Medical Association, and is a peer reviewed general medical journal for all doctors, researchers, and health workers regardless of their medical specialty or type of employment. Established in 1887, it is the oldest medical periodical in China and is distributed worldwide. The journal functions as a window into China’s medical sciences and reflects the advances and progress in China’s medical sciences and technology. It serves the objective of international academic exchange. The journal includes Original Articles, Editorial, Review Articles, Medical Progress, Brief Reports, Case Reports, Viewpoint, Clinical Exchange, Letter,and News,etc. CMJ is abstracted or indexed in many databases including Biological Abstracts, Chemical Abstracts, Index Medicus/Medline, Science Citation Index (SCI), Current Contents, Cancerlit, Health Plan & Administration, Embase, Social Scisearch, Aidsline, Toxline, Biocommercial Abstracts, Arts and Humanities Search, Nuclear Science Abstracts, Water Resources Abstracts, Cab Abstracts, Occupation Safety & Health, etc. In 2007, the impact factor of the journal by SCI is 0.636, and the total citation is 2315.
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