{"title":"一项随机对照试验评估病毒学抑制的泰国PWH患者从TDF+FTC或3TC+EFV切换到TDF/3TC/DTG （TLD）与DTG+3TC的病毒学和肾脏预后-一项初步研究","authors":"Sathaporn Kanogtorn, Opass Putcharoen, Samadhi Patamatamkul","doi":"10.2174/011570162X384022250910065252","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Tenofovir disoproxil fumarate (TDF)/lamivudine (3TC)/dolutegravir (DTG) (TLD) is the preferred first-line therapy for all people living with HIV (PWH) per WHO 2019 and Thai HIV guidelines. This has prompted switches from TDF + FTC or 3TC + EFV to TLD in Thailand.</p><p><strong>Methods: </strong>We conducted a randomized trial among virologically suppressed PWH aged ≥18 years on TDF + FTC or 3TC + EFV who were switched to either TLD or DTG + 3TC. The primary outcome was the change in estimated glomerular filtration rate (eGFR) calculated by cystatin C at 24 weeks.</p><p><strong>Results: </strong>Sixteen participants (eight per group), 69% male with a mean age of 41 years and a median duration of HIV diagnosis of 7.1 years, were enrolled. A greater, though not statistically significant, decline in eGFR was observed in the TLD group. The mean differences were 5.15 mL/ min/1.73 m² (95% CI: -12.06 to 22.35; p = 0.532) for cystatin C and 4.01 mL/min/1.73 m² (95% CI: -3.58 to 11.59; p = 0.277) for creatinine. All participants maintained virological suppression. No significant differences were observed in BMI, LDL, or CD4 counts.</p><p><strong>Discussion: </strong>Although not statistically significant, TLD was associated with a trend toward greater eGFR decline. This finding warrants attention, particularly in patients at risk for renal dysfunction.</p><p><strong>Conclusion: </strong>Dual therapy with DTG + 3TC may be a preferable switch option over TLD for virologically suppressed PWH with renal safety concerns.</p>","PeriodicalId":10911,"journal":{"name":"Current HIV Research","volume":" ","pages":""},"PeriodicalIF":1.0000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Randomized Controlled Trial Evaluating Virologic and Renal Outcomes After Switching from TDF+FTC or 3TC+EFV to TDF/3TC/DTG (TLD) Versus DTG+3TC in Virologically Suppressed Thai PWH - A Pilot Study.\",\"authors\":\"Sathaporn Kanogtorn, Opass Putcharoen, Samadhi Patamatamkul\",\"doi\":\"10.2174/011570162X384022250910065252\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Tenofovir disoproxil fumarate (TDF)/lamivudine (3TC)/dolutegravir (DTG) (TLD) is the preferred first-line therapy for all people living with HIV (PWH) per WHO 2019 and Thai HIV guidelines. This has prompted switches from TDF + FTC or 3TC + EFV to TLD in Thailand.</p><p><strong>Methods: </strong>We conducted a randomized trial among virologically suppressed PWH aged ≥18 years on TDF + FTC or 3TC + EFV who were switched to either TLD or DTG + 3TC. The primary outcome was the change in estimated glomerular filtration rate (eGFR) calculated by cystatin C at 24 weeks.</p><p><strong>Results: </strong>Sixteen participants (eight per group), 69% male with a mean age of 41 years and a median duration of HIV diagnosis of 7.1 years, were enrolled. A greater, though not statistically significant, decline in eGFR was observed in the TLD group. The mean differences were 5.15 mL/ min/1.73 m² (95% CI: -12.06 to 22.35; p = 0.532) for cystatin C and 4.01 mL/min/1.73 m² (95% CI: -3.58 to 11.59; p = 0.277) for creatinine. All participants maintained virological suppression. No significant differences were observed in BMI, LDL, or CD4 counts.</p><p><strong>Discussion: </strong>Although not statistically significant, TLD was associated with a trend toward greater eGFR decline. This finding warrants attention, particularly in patients at risk for renal dysfunction.</p><p><strong>Conclusion: </strong>Dual therapy with DTG + 3TC may be a preferable switch option over TLD for virologically suppressed PWH with renal safety concerns.</p>\",\"PeriodicalId\":10911,\"journal\":{\"name\":\"Current HIV Research\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2025-09-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Current HIV Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2174/011570162X384022250910065252\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current HIV Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2174/011570162X384022250910065252","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
A Randomized Controlled Trial Evaluating Virologic and Renal Outcomes After Switching from TDF+FTC or 3TC+EFV to TDF/3TC/DTG (TLD) Versus DTG+3TC in Virologically Suppressed Thai PWH - A Pilot Study.
Introduction: Tenofovir disoproxil fumarate (TDF)/lamivudine (3TC)/dolutegravir (DTG) (TLD) is the preferred first-line therapy for all people living with HIV (PWH) per WHO 2019 and Thai HIV guidelines. This has prompted switches from TDF + FTC or 3TC + EFV to TLD in Thailand.
Methods: We conducted a randomized trial among virologically suppressed PWH aged ≥18 years on TDF + FTC or 3TC + EFV who were switched to either TLD or DTG + 3TC. The primary outcome was the change in estimated glomerular filtration rate (eGFR) calculated by cystatin C at 24 weeks.
Results: Sixteen participants (eight per group), 69% male with a mean age of 41 years and a median duration of HIV diagnosis of 7.1 years, were enrolled. A greater, though not statistically significant, decline in eGFR was observed in the TLD group. The mean differences were 5.15 mL/ min/1.73 m² (95% CI: -12.06 to 22.35; p = 0.532) for cystatin C and 4.01 mL/min/1.73 m² (95% CI: -3.58 to 11.59; p = 0.277) for creatinine. All participants maintained virological suppression. No significant differences were observed in BMI, LDL, or CD4 counts.
Discussion: Although not statistically significant, TLD was associated with a trend toward greater eGFR decline. This finding warrants attention, particularly in patients at risk for renal dysfunction.
Conclusion: Dual therapy with DTG + 3TC may be a preferable switch option over TLD for virologically suppressed PWH with renal safety concerns.
期刊介绍：
Current HIV Research covers all the latest and outstanding developments of HIV research by publishing original research, review articles and guest edited thematic issues. The novel pioneering work in the basic and clinical fields on all areas of HIV research covers: virus replication and gene expression, HIV assembly, virus-cell interaction, viral pathogenesis, epidemiology and transmission, anti-retroviral therapy and adherence, drug discovery, the latest developments in HIV/AIDS vaccines and animal models, mechanisms and interactions with AIDS related diseases, social and public health issues related to HIV disease, and prevention of viral infection. Periodically, the journal invites guest editors to devote an issue on a particular area of HIV research of great interest that increases our understanding of the virus and its complex interaction with the host.
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