Stability of antiretroviral regimens in patients with viral suppression
Stability of antiretroviral regimens in patients with viral suppression
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DOI：
10.1097/qad.0b013e3282fec415
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发表时间：
2008-05-31
期刊：
影响因子：
3.8
通讯作者：
Phillips, Andrew N.
中科院分区：
文献类型：
--
作者：
Lodwick, Rebecca K.;Smith, Colette J.;Phillips, Andrew N.
目的：研究开始抗逆转录病毒治疗后 6 个月内实现病毒抑制且从未经历过病毒学失败的患者因毒性而导致的治疗变化率。方法：纳入在伦敦皇家自由医院就诊、2000-2005 年开始抗逆转录病毒治疗并在 6 个月内实现病毒抑制的患者。纳入的随访（在病毒学失败时进行审查）采用拉米夫定或恩曲他滨联合第二种核苷/核苷酸逆转录酶抑制剂以及蛋白酶抑制剂或非核苷逆转录酶抑制剂的治疗方案。结果：在 912 人年中，由于毒性而发生了 140 次治疗改变（比率 = 每 100 人年 15.4 次，置信区间 = 12.8-17.9）。在多变量分析中，与因毒性而导致治疗改变率较高相关的因素包括年龄增加（每增加10年：发生率比=1.28，置信区间=1.04-1.57）、司他夫定与齐多夫定相比（发生率比=2.04，置信区间=1.28-3.26）以及洛匹那韦与依非韦伦相比（发生率） 比率=1.55，置信区间=1.04-2.31），而与较低发生率相关的因素是与齐多夫定相比，服用替诺福韦（发生率比=0.46，置信区间=0.29-0.73），以及与依非韦伦相比，使用阿扎那韦（发生率比=0.23，置信区间=0.06-0.91）。 结论： 从未经历过病毒学失败，由于毒性而改变治疗的比率很低，并且某些治疗方案的改变率甚至更低。如果避免病毒学失败，到目前为止，一些治疗方案已被证明足够稳定，表明长期使用可能是可行的。 (C) 2008 年 Wolters Kluwer Health 垂直条 Lippincott Williams & Wilkins。
Objective: To study the rate of treatment change due to toxicities in patients who achieved viral suppression within 6 months of starting antiretroviral therapy and who have never experienced virological failure.Methods: Included patients attended the Royal Free Hospital in London, started antiretroviral therapy in 2000-2005, and achieved viral suppression within 6 months. Included follow-up (censored at virological failure) was spent on a regimen of lamivudine or emtricitabine, with a second nucleoside/nucleotide reverse transcriptase inhibitor, and either a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor.Results: In 912 person-years, there were 140 treatment changes due to toxicities (rate = 15.4 per 100 person-years, confidence interval = 12.8-17.9). In the multivariable analysis, factors associated with a higher rate of treatment change due to toxicities included increased age (for every 10 years increase: incidence rate ratio=1.28, confidence interval=1.04-1.57), being on stavudine compared with zidovudine (incidence rate ratio = 2.04, confidence interval=1.28-3.26), and being on lopinavir compared with efavirenz (incidence rate ratio=1.55, confidence interval=1.04-2.31), whereas factors associated with a lower rate were being on tenofovir compared with zidovudine (incidence rate ratio=0.46, confidence interval =0.29-0.73), and being on atazanavir compared with efavirenz (incidence rate ratio=0.23, confidence interval = 0.06-0.91).Conclusions: In patients who have never experienced virological failure, the rate of treatment change due to toxicities is low, and certain regimens are associated with an even lower rate of change. If virological failure is avoided, some regimens are so far proving to be sufficiently stable to suggest that very long-term use is potentially feasible. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.