Virologic suppression and CD4+ cell count recovery after initiation of raltegravir or efavirenz-containing HIV treatment regimens.
Virologic suppression and CD4+ cell count recovery after initiation of raltegravir or efavirenz-containing HIV treatment regimens.
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DOI：
10.1097/qad.0000000000001668
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发表时间：
2018-01-14
期刊：
影响因子：
--
通讯作者：
CNICS investigators
中科院分区：
文献类型：
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作者：
Edwards JK;Cole SR;Hall HI;Mathews WC;Moore RD;Mugavero MJ;Eron JJ;CNICS investigators
探讨基于拉替拉韦的抗逆转录病毒疗法 (ART) 对寻求常规临床护理的未接受 ART 治疗的患者的治疗反应的有效性。对美国参加艾滋病毒护理的成年人进行的队列研究。我们使用美国临床队列的观察数据，比较了开始包含拉替拉韦或依非韦伦的 ART 治疗方案后 2.5 年内的病毒学抑制和 CD4 细胞计数恢复情况，该数据适用于美国确诊 HIV 的人群。我们使用逆概率权重考虑了非随机治疗分配、信息审查和美国目标人群的非随机选择。在该研究纳入的 2843 名患者中，2476 名患者开始接受含依非韦伦的治疗方案，367 名患者开始接受含拉替拉韦的治疗方案。在加权意向治疗分析中，在 2.5 年的研究期间，使用拉替拉韦方案的患者平均多存活 74 天 (95% CI: 41, 106)，且病毒载量受到抑制。拉替拉韦治疗方案下 CD4 细胞计数恢复也较好。接受拉替拉韦治疗的患者比接受依非韦伦治疗的患者存活和抑制的时间更长，但治疗后 2.5 年病毒抑制的概率在组间相似。优化病毒抑制状态的时间对于提高艾滋病毒感染者的生存率和减少进一步传播非常重要。
To explore the effectiveness of raltegravir-based antiretroviral therapy (ART) on treatment response among ART-naive patients seeking routine clinical care. Cohort study of adults enrolled in HIV care in the United States. We compared virologic suppression and CD4 cell count recovery over a 2.5 year period after initiation of an ART regimen containing raltegravir or efavirenz using observational data from a US clinical cohort, generalized to the US population of people with diagnosed HIV. We accounted for nonrandom treatment assignment, informative censoring, and nonrandom selection from the US target population using inverse probability weights. Of the 2843 patients included in the study, 2476 initiated the efavirenz-containing regimen and 367 initiated the raltegravir-containing regimen. In the weighted intent-to-treat analysis, patients spent an average of 74 (95% CI: 41, 106) additional days alive with a suppressed viral load on the raltegravir regimen than on the efavirenz regimen over the 2.5-year study period. CD4 cell count recovery was also superior under the raltegravir regimen. Patients receiving raltegravir spent more time alive and suppressed than patients receiving efavirenz, but the probability of viral suppression by 2.5 years after treatment was similar between groups. Optimizing the amount of time spent in a state of viral suppression is important to improve survival among people living with HIV and to reduce onward transmission.