Pre-existent NRTI and NNRTI resistance impacts on maintenance of virological suppression in HIV-1-infected patients who switch to a tenofovir/emtricitabine/rilpivirine single-tablet regimen
Pre-existent NRTI and NNRTI resistance impacts on maintenance of virological suppression in HIV-1-infected patients who switch to a tenofovir/emtricitabine/rilpivirine single-tablet regimen
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DOI：
10.1093/jac/dkw512
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发表时间：
2017-03-01
影响因子：
5.2
通讯作者：
Santoro, M. M.
中科院分区：
文献类型：
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作者：
Armenia, D.;Di Carlo, D.;Santoro, M. M.
目的：通过考虑预先存在的耐药（pRes），评估抗逆转录病毒治疗的HIV-1抑制患者转为替诺福韦/恩曲他滨/利匹韦林（TDF/FTC/RPV）单片剂方案后病毒学抑制（VS）的维持情况。病毒反弹（VR）的概率和预测因素进行了evaluated.Results：309例患者进行了分析，其中5.8%的耐药NRTIs和NNRTIs，而12.6%的耐药，只有这些药物类之一。到72周时，VR的概率为11.3%。在以下组中发现VR的概率更高：（i）与携带NRTI或NNRTI pRes的患者和没有逆转录酶抑制剂pRes的患者相比，NRTI+NNRTI pRes患者（39.2% vs. 11.5% vs. 9.4%，P < 0.0001）;（ii）与具有对替诺福韦/恩曲他滨和利匹韦林两者具有完全/中等抗性的病毒的患者相比，具有对替诺福韦/恩曲他滨和利匹韦林两者具有完全/中等抗性的病毒的患者，对替诺福韦/恩曲他滨或利匹韦林中度耐药，以及对TDF/FTC/RPV完全敏感的病毒（36.4%对17.8%对9.7%，P < 0.001）;（iii）治疗前病毒血症> 500 000拷贝/mL的患者与病毒血症水平较低的患者相比（> 500 000：16.0%; 100 000-500 000：9.3%; < 100 000拷贝/mL：4.8%，P = 0.009）。多变量考克斯回归分析显示，pRes和治疗前病毒血症> 500 000拷贝/mL是VR的独立预测因子。结论：TDF/FTC/RPV作为一种治疗简化策略，显示了非常高的VS维持率。存在NRTI和NNRTI的pRes以及治疗前病毒血症> 500 000拷贝/mL与VR风险增加相关，强调在简化之前需要准确选择患者。
Objectives: To evaluate the maintenance of virological suppression (VS) in antiretroviral-treated HIV-1-suppressed patients switching to a tenofovir/emtricitabine/rilpivirine (TDF/FTC/RPV) single-tablet regimen, by considering pre-existent resistance (pRes).Methods: pRes was evaluated according to resistance on all previous plasma genotypic resistance tests. Probability and predictors of virological rebound (VR) were evaluated.Results: Three hundred and nine patients were analysed; 5.8% of them showed resistance to both NRTIs and NNRTIs, while 12.6% showed resistance to only one of these drug classes. By 72 weeks, the probability of VR was 11.3%. A higher probability of VR was found in the following groups: (i) patients with NRTI+NNRTI pRes compared with those harbouring NRTI or NNRTI pRes and with those without reverse transcriptase inhibitor pRes (39.2% versus 11.5% versus 9.4%, P < 0.0001); (ii) patients with a virus with full/intermediate resistance to both tenofovir/emtricitabine and rilpivirine compared with those having a virus with full/intermediate resistance to tenofovir/emtricitabine or rilpivirine and those having a virus fully susceptible to TDF/FTC/RPV (36.4% versus 17.8% versus 9.7%, P < 0.001); and (iii) patients with pre-therapy viraemia > 500 000 copies/mL compared with those with lower viraemia levels (> 500 000: 16.0%; 100 000-500 000: 9.3%; < 100 000 copies/mL: 4.8%, P = 0.009). pRes and pre-therapy viraemia > 500 000 copies/mL were independent predictors of VR by multivariable Cox regression.Conclusions: TDF/FTC/RPV as a treatment simplification strategy shows a very high rate of VS maintenance. The presence of pRes to both NRTIs and NNRTIs and a pre-therapy viraemia > 500 000 copies/mL are associated with an increased risk of VR, highlighting the need for an accurate selection of patients before simplification.