Comparative Clinical Outcomes With Scale-up of Dolutegravir as First-Line Antiretroviral Therapy in Ukraine.
Comparative Clinical Outcomes With Scale-up of Dolutegravir as First-Line Antiretroviral Therapy in Ukraine.
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DOI：
10.1097/qai.0000000000003038
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发表时间：
2022-10-01
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要实现联合国艾滋病规划署的95-95-95目标，就必须采用易于使用、耐受性好、成本效益高的抗逆转录病毒疗法。以多洛替格雷(DTG)为基础的方案比其他常见的一线方案有效且成本更低。这项研究评估了DTG方案在治疗乌克兰幼稚的艾滋病毒携带者方面的实际效果。我们从国家医疗信息系统中提取了2017年10月至2018年6月在乌克兰12个地区的23家大型诊所使用DTG、洛比那韦/利托那韦(LPV/r)或EFV(EFV)启动抗逆转录病毒治疗的所有成年患者的数据。治疗开始后12±3个月的病毒抑制和12个月的病毒滞留是令人感兴趣的结果。在1057例患者中，721例患者在感兴趣的窗口内进行了病毒载量试验，652例(90%)的病毒载量为200cp/ml。与DTG组相比，EFV组的抑制比例较低(AOR=0.4[95%CI 0.2-0.8])，而LPV组的AOR=1.6[0.5-4.9]。诊断和治疗之间间隔24个月或更长时间与较低的抑制几率相关(AOR=0.4[0.2-0.8])。治疗保留率为90%(957/1057)，不同方案组间差异无统计学意义。注射吸毒史与保留率降低有关(AOR=0.5[0.3-0.8])。在乌克兰的一个多部位队列中，基于DTG的方案与LPV相似，在ART幼稚患者中实现病毒抑制方面比EFV更有效。在所有三组中，治疗保留率都同样高。来自乌克兰的证据支持ART优化计划作为一种战略，在不对患者临床结果产生负面影响的情况下提高ART计划的效率。
Achievement of the UNAIDS 95-95-95 targets requires ARV regimens that are easy to use, well-tolerated, and cost-effective. Dolutegravir (DTG)-based regimens are efficacious and less costly than other common first-line regimens. This study assessed real-world effectiveness of DTG regimens in treatment-naïve people living with HIV in Ukraine. We extracted data from the national Medical Information System on all adult patients who initiated ART with DTG, lopinavir/ritonavir (LPV/r), or efavirenz (EFV) between 10/2017 and 06/2018, at 23 large clinics in 12 regions of Ukraine. Viral suppression at 12±3 months and retention at 12 months after treatment initiation were the outcomes of interest. Of total 1057 patients, 721 had a viral load test within the window of interest, and 652 (90%) had viral load of <=200cp/ml. The proportion with suppression was lower in the EFV group (aOR=0.4 [95%CI 0.2-0.8]) and not different in the LPV group (aOR=1.6 [0.5-4.9]) compared to the DTG group. A 24-month or longer gap between diagnosis and treatment was associated with lower odds of suppression (aOR=0.4 [0.2-0.8]). Treatment retention was 90% (957/1057), with no significant difference by regimen group. History of injecting drug use was associated with decreased retention (aOR=0.5 [0.3-0.8]). DTG-based regimens were comparable to LPV and more effective than EFV in achieving viral suppression among ART-naïve patients in a multi-site cohort in Ukraine. Treatment retention was equally high in all three groups. This evidence from Ukraine supports the ART Optimization Initiative as a strategy to improve efficiency of the ART program without negatively affecting patient clinical outcomes.
影响因子：
3.7
作者：
Rich SN;Cook RL;Yaghjyan L;Francois K;Puttkammer N;Robin E;Bae J;Joseph N;Pessoa-Brandão L;Delcher C
通讯作者：
Delcher C