一项综合前瞻性和回顾性比较研究评估了病毒学抑制的泰国HIV患者从TDF + FTC + EFV转换为TDF/3TC/DTG (TLD)与DTG + 3TC后的肾脏结局。

IF 1.7 4区 医学 Q3 INFECTIOUS DISEASES
HIV Research & Clinical Practice Pub Date : 2025-12-01 Epub Date: 2025-05-24 DOI:10.1080/25787489.2025.2509379
Samadhi Patamatamkul, Phattarapon Burimat, Sathaporn Kanogtorn, Opass Putcharoen
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引用次数: 0

摘要

背景:根据世卫组织2019年和泰国艾滋病毒指南,TDF/3TC/DTG (TLD)已被采纳为所有艾滋病毒感染者的一线治疗方法。因此,泰国接受TDF/FTC/EFV治疗的艾滋病毒感染者被转到TLD治疗。然而,越来越多的数据表明,与基于tdf的联合ART (cART)作为一种转换治疗相比,DTG + 3TC的tdf保留双重治疗的有效性和肾脏安全性。目前还没有对接受tdf治疗的HIV患者转换为TLD与DTG + 3TC治疗的肾小球滤过率(eGFR)进行直接比较。方法:我们招募了病毒学抑制的年龄≥18岁的HIV感染者,目前使用TDF + FTC + EFV,在两家三级医院改用TLD或DTG + 3TC。转换方案的选择由医生自行决定。主要终点是24周时eGFR的变化,通过肌酐计算。次要结局包括24周时LDL、体重和BMI的变化。结果:在招募的53名参与者中,TLD组和DTG + 3TC组分别有28名和15名完成了第二次随访。TLD组的平均年龄高于DTG + 3TC组(表1)。从艾滋病毒诊断到转换的中位时间为8.5年。TLD组eGFR降低显著高于DTG + 3TC组:-17.24±9.24 vs -8.4±9.03 mL/min/1.73 m2 (p = 0.004)。两组患者均获得病毒学抑制。两组间CD4计数无明显变化。切换到DTG + 3TC后,eGFR下降明显较小(平均差异:6.216 mL/min/1.73 m2;95% ci 0.169-12.263;p = 0.044)。结论:与改用DTG + 3TC的HIV患者相比,改用TLD的HIV患者eGFR显著降低。两组之间LDL和BMI的变化具有可比性。对于有肾脏安全顾虑的个体,DTG + 3TC的双重治疗可能是TLD的首选切换选择。进一步的随机前瞻性试验需要更长时间的随访来证实这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A combined prospective and retrospective comparative study evaluating renal outcomes after switching from TDF + FTC + EFV to TDF/3TC/DTG (TLD) vs. DTG + 3TC in virologically suppressed Thai people with HIV.

Background: TDF/3TC/DTG (TLD) has been adopted as the first-line therapy for all people with HIV according to the WHO 2019 and Thai HIV guidelines. As a result, people with HIV in Thailand on TDF/FTC/EFV are switched to TLD. However, increasing data demonstrate the efficacy and renal safety of the TDF-sparing dual therapy with DTG + 3TC compared with TDF-based combination ART (cART) as a switching therapy. A direct comparison of estimated glomerular filtration rates (eGFR) among people with HIV treated with TDF-based regimens who switch to TLD vs. DTG + 3TC is yet to be made.

Methods: We enrolled virologically suppressed people with HIV aged ≥18 years currently on TDF + FTC + EFV to either switch to TLD or DTG + 3TC at two tertiary care hospitals. The switching regimen was chosen at the physicians' discretion. The primary outcome was the change in eGFR, calculated by creatinine at 24 weeks. Secondary outcomes included changes in LDL, body weight, and BMI at 24 weeks.

Results: Among 53 recruited participants, 28 and 15 completed the second follow-up in the TLD and DTG + 3TC groups, respectively. The mean age was higher in the TLD group compared to the DTG + 3TC group (Table 1). The median time from HIV diagnosis to switching was 8.5 years. The eGFR reduction was significantly greater in the TLD group than in the DTG + 3TC group: -17.24 ± 9.24 vs. -8.4 ± 9.03 mL/min/1.73 m2 (p = 0.004). All participants in both groups achieved virological suppression. There was no significant change in CD4 counts between the two groups. Switching to DTG + 3TC was associated with a significantly smaller decline in eGFR post-switch (mean difference: 6.216 mL/min/1.73 m2; 95% CI 0.169-12.263; p = 0.044) compared to those who switched to TLD.

Conclusions: There was a significant reduction in eGFR among people with HIV who switched to TLD compared to those switched to DTG + 3TC. Changes in LDL and BMI were comparable between groups. Dual therapy with DTG + 3TC may be a preferred switching option over TLD for individuals with renal safety concerns. Further randomized prospective trials with longer follow-up are warranted to confirm these findings.

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