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从以埃法维伦兹为基础的疗法直接切换为肌肉内长效卡博特格拉维尔加里尔皮维林:一个病例报告

Elizabeth Senkoro^1,2, Margherita Bracchi¹, Joseph Heskin¹

¹HIV Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.

International journal of STD & AIDS

|November 24, 2023

概括

从efavirenz (EFV) 直接切换到注射性cabotegravir (CAB) + rilpivirine (RPV) 可能会降低药物水平,但保持病毒抑制. 本案例研究探讨了在重症监护机构中的这种转换.

科学领域:

药理学和病毒学.
艾滋病毒/艾滋病治疗

背景情况:

肌内注射 (IM) 卡博特格拉维尔 (CAB) + 里尔皮维林 (RPV) 是口服抗逆转录病毒疗法 (ART) 的替代品.
指南建议不要直接从基于efavirenz (EFV) 的ART转换为IM CAB + RPV,因为EFV具有诱导酶的特性.
EFV可以延长UGT1A1和CYP3A4酶的诱导,可能会影响CAB和RPV代谢,导致药物度和耐药性低于最佳水平.

研究的目的:

在重症监护场景中,描述一个切换从以法维伦兹 (EFV) 为基础的ART到长效注射卡博特格拉维尔 (CAB) + 里尔皮维林 (RPV) 的现实情况.
评估直接切换的可行性和影响,当口服摄入是不可能的.

主要方法:

由于无法服用口服药物,一名患者正在服用emtricitabine/tenofovir-DF (FTC/TDF) + EFV,因此被直接切换到IM CAB + RPV.
切换是在重症监护环境中进行的,绕过了标准的口服引入阶段.

主要成果:

之前的研究 (ATLAS,ATLAS 2M) 和药理学建模表明,在从EFV切换到口服或IM CAB + RPV时,RPV度可能会降低,但病毒抑制会维持.
这个案例提供了有限的现实数据,关于从EFV直接切换到IM CAB + RPV,特别是在具有挑战性的临床情况下.

结论:

在特定的临床情况中,可以考虑直接从基于EFV的ART转换为IM CAB + RPV,例如重症监护,尽管有指导方针建议.
需要进一步的现实世界数据才能充分了解从EFV直接切换到长效注射抗逆转录病毒药物的安全性和有效性.

关键词:

治疗方法 (抗逆转录病毒疗法)

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