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集成酶链转移抑制剂在西班牙的有效性和安全性:一个前性的现实研究
José Ramón Santos1, Maria Casadellà2, Marc Noguera-Julian2
1Fight Infections Foundation, Service of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Frontiers in cellular and infection microbiology
|July 12, 2023
概括
第一代整合酶链转移抑制剂 (INSTIs),如埃尔维特格拉维尔/科比西斯塔特和拉尔特格拉维尔,在杜洛特格拉维尔无法获得时提供有效的艾滋病毒治疗. 这些INSTI显示出可比的病毒学和免疫学结果,即使在具有挑战性的患者群体.
科学领域:
- 传染性疾病 传染性疾病
- 病毒学 病毒学
- 药理学 药理学是指药理学的学科.
背景情况:
- 第二代整合酶链转移抑制剂 (INSTIs),特别是多卢特格拉维尔 (DTG),是全球首选的HIV治疗方法.
- 在资源有限的环境中,DTG的可用性可能受到限制.
- 关于INSTI的现实数据对于在偏好的选择无法获得时指导治疗决策至关重要.
研究的目的:
- 评估杜洛特格拉维尔 (DTG),埃尔维特格拉维尔/科比西斯塔特 (EVG/c) 和拉尔特格拉维尔 (RAL) 在西班牙一大群艾滋病毒-1感染患者中的实际有效性和安全性.
- 在不同患者群体 (ART-naïve,ART-switching,ART-salvage) 中,在这些INSTIs中比较病毒学失败 (VF) 和治疗中止率.
主要方法:
- 一项现实研究涉及艾滋病毒感染的成年人启动DTG,EVG/c或基于RAL的治疗方案.
- 主要终点:治疗中断的中位时间.
- 二次终点:病毒感染患者的比例和病毒感染的时间,以特定的病毒载荷值来定义.
主要成果:
- 在一线和救援治疗中,EVG/c和RAL显示出与DTG相似的病毒学有效性.
- 与DTG相比,EVG/c和RAL治疗中断的频率更高.
- 具有较低基线CD4+计数 (<100细胞/μL) 开始RAL或EVG/c的患者有更高的VF发病率.
- 在这三种药物之间没有观察到VF或INSTI停止时间的显著差异.
- 所有组的免疫学参数均有所改善,安全性概况符合预期.
结论:
- 第一代INSTIs (EVG/c,RAL) 为艾滋病毒治疗提供了显著的病毒学和免疫学益处,与DTG相美.
- 当DTG无法使用时,这些药物仍然是有价值的治疗选择,特别是在资源有限的环境中.
- 在启动RAL或EVG/c时,可能需要仔细考虑患者的特征,例如基线CD4+计数.
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