Optimizing treatment switch for virologic failure during first-line antiretroviral therapy in resource-limited settings.
Optimizing treatment switch for virologic failure during first-line antiretroviral therapy in resource-limited settings.
复制标题
在资源有限的环境中，在一线抗逆转录病毒疗法期间的病毒学衰竭优化治疗转换。
DOI：
10.1177/1545109712463733
复制
发表时间：
2013-07
影响因子：
--
通讯作者：
Murphy R
中科院分区：
文献类型：
--
作者：
Adetunji AA;Achenbach C;Feinglass J;Darin KM;Scarsi KK;Ekong E;Taiwo BO;Adewole IF;Murphy R
我们评估了在一线抗逆转录病毒治疗期间因病毒学失败（确认HIV-1 RNA病毒载量>1000拷贝/mL）而转为蛋白酶抑制剂（PI/r）为基础的二线治疗方案的尼日利亚成人抗逆转录病毒患者。描述了病毒载量（VL）>400拷贝/mL的患者比例以及二线治疗期间与非抑制相关的特征。大约15%的患者（34/225）在治疗转换为基于PI/r的方案后1年时VL >400拷贝/mL。在校正分析中，治疗转换时VL ≥5 log 10拷贝/mL（OR 2.90 [CI 1.21-6.93]）;病毒学失败后一线治疗持续时间>180天（OR 2.56 [CI 1.0-6.54]）和PI/r方案依从性<90%（OR 3.27 [CI 1.39-7.68]）与二线治疗1年时VL >400拷贝/mL相关。因此，我们建议，当患者在资源有限的情况下发生一线抗逆转录病毒治疗失败时，从怀疑病毒学失败到完成抗逆转录病毒治疗转换的最长允许时间不应超过6个月。
We evaluated adult Nigerian patients with antiretroviral switch to second-line treatment with protease inhibitor (PI/r)-based regimens due to virologic failure (confirmed HIV-1 RNA viral load >1000 copies/mL) during first-line antiretroviral therapy. Proportion of patients with viral load (VL) >400 copies/mL and characteristics associated with non-suppression during second-line treatment are described. Approximately 15% of patients (34/225) had VL >400 copies/mL at 1-year after treatment switch to PI/r-based regimens. In adjusted analyses, VL ≥5 log10 copies/mL at treatment switch (OR 2.90 [CI 1.21–6.93]); duration of first-line treatment after virologic failure >180 days (OR 2.56 [CI 1.0–6.54]); and PI/r regimen adherence <90% (OR 3.27 [CI 1.39–7.68]) were associated with VL >400 copies/mL at 1-year of second-line treatment. We therefore recommend that the maximum permissible time between suspicion of virologic failure and completion of antiretroviral treatment switch should not exceed 6-months when patients develop first-line antiretroviral failure in resource-limited settings.