Choice of Initial Combination Antiretroviral Therapy in Individuals With HIV Infection Determinants and Outcomes
Choice of Initial Combination Antiretroviral Therapy in Individuals With HIV Infection Determinants and Outcomes
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DOI：
10.1001/archinternmed.2012.3216
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发表时间：
2012-09-24
影响因子：
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通讯作者：
Battegay, Manuel
中科院分区：
文献类型：
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作者：
Elzi, Luigia;Erb, Stefan;Battegay, Manuel
背景：目前的指南给出了首选联合抗逆转录病毒治疗（cART）的建议。我们调查的影响因素，在临床practice.Methods的初始cART的选择：我们分析了治疗初治成人与人类免疫缺陷病毒（HIV）感染参与瑞士艾滋病毒队列研究，并开始cART从2005年1月1日至2009年12月31日。主要终点是初始抗逆转录病毒治疗方案的选择。次要终点是病毒学抑制，CD 4细胞计数从基线增加，并在开始治疗后12个月内进行治疗调整。替诺福韦-恩曲他滨（TDF-FTC）-依法韦仑是最常处方的cART（29.9%），其次是TDF-FTC-洛匹那韦/r（16.9%）、TDF-FTC-阿扎那韦/r（12.9%）、齐多夫定-拉米夫定（ZDV-3 TC）-洛匹那韦/r（12.8%）和阿巴卡韦/拉米夫定（ABC-3 TC）-依法韦仑（5.7%）。不同的瑞士艾滋病队列研究中心之间的处方差异（P <0.001）。在多变量分析中，与TDF-FTC-依法韦仑相比，开始TDF-FTC-洛匹那韦/r治疗与既往AIDS相关（相对风险比，2.78; 95% CI，1.78-4.35），HIV-RNA大于100 000拷贝/mL（1.53; 1.07-2.18），CD 4> 350个/μ L（1.67; 1.04-2.70）; TDF-FTC-阿扎那韦/r伴抑郁症（1.77; 1.04-3.01），HIV-RNA大于100 000拷贝/mL（1.54; 1.05-2.25）和阿片替代方案（2.76; 1.09-7.00）;和ZDV-3 TC-洛匹那韦/r，雌性（3.89; 2.39-6.31）和CD 4细胞计数大于350个细胞/μ L（4.50; 2.58-7.86）。在12个月时，1715例患者（87.6%）达到病毒载量低于50拷贝/mL，CD 4细胞计数增加的中位数（四分位数间距）为173（89-269）个细胞/μ L。TDF-FTC-依法韦仑更可能抑制病毒学，ZDV-3 TC-洛匹那韦/r的CD 4升高更高。结果没有差异，观察瑞士艾滋病毒队列Studys.Conclusions：处方，但没有在结果之间的研究站点观察到很大的差异。注意到个体化cART的趋势，表明初始cART受医生偏好和患者特征的显著影响。我们的研究强调需要循证数据来确定不同艾滋病毒感染者的最佳初始方案。
Background: Current guidelines give recommendations for preferred combination antiretroviral therapy (cART). We investigated factors influencing the choice of initial cART in clinical practice and its outcome.Methods: We analyzed treatment-naive adults with human immunodeficiency virus (HIV) infection participating in the Swiss HIV Cohort Study and starting cART from January 1, 2005, through December 31, 2009. The primary end point was the choice of the initial antiretroviral regimen. Secondary end points were virologic suppression, the increase in CD4 cell counts from baseline, and treatment modification within 12 months after starting treatment.Results: A total of 1957 patients were analyzed. Tenofovir-emtricitabine (TDF-FTC)-efavirenz was the most frequently prescribed cART (29.9%), followed by TDF-FTC-lopinavir/r (16.9%), TDF-FTC-atazanavir/r (12.9%), zidovudine-lamivudine (ZDV-3TC)-lopinavir/r (12.8%), and abacavir/lamivudine (ABC-3TC)-efavirenz (5.7%). Differences in prescription were noted among different Swiss HIV Cohort Study sites (P < .001). In multivariate analysis, compared with TDF-FTC-efavirenz, starting TDF-FTC-lopinavir/r was associated with prior AIDS (relative risk ratio, 2.78; 95% CI, 1.78-4.35), HIV-RNA greater than 100 000 copies/mL (1.53; 1.07-2.18), and CD4greater than 350 cells/mu L (1.67; 1.04-2.70); TDF-FTC-atazanavir/r with a depressive disorder (1.77; 1.04-3.01), HIV-RNA greater than 100 000 copies/mL (1.54; 1.05-2.25), and an opiate substitution program (2.76; 1.09-7.00); and ZDV-3TC-lopinavir/r with female sex (3.89; 2.39-6.31) and CD4 cell counts greater than 350 cells/mu L (4.50; 2.58-7.86). At 12 months, 1715 patients (87.6%) achieved viral load less than 50 copies/mL and CD4 cell counts increased by a median (interquartile range) of 173 (89-269) cells/mu L. Virologic suppression was more likely with TDF-FTC-efavirenz, and CD4 increase was higher with ZDV-3TC-lopinavir/r. No differences in outcome were observed among Swiss HIV Cohort Study sites.Conclusions: Large differences in prescription but not in outcome were observed among study sites. A trend toward individualized cART was noted suggesting that initial cART is significantly influenced by physician's preference and patient characteristics. Our study highlights the need for evidence-based data for determining the best initial regimen for different HIV-infected persons.