Frontiers in Pharmacology：LPV/r一线治疗HIV感染研究结果发表

2020-01-11 关爱汇关爱汇

含LPV/r的方案主要用于HIV感染者二线治疗，作为初始治疗的研究数据有限。近期一项对含LPV/r方案用于一线治疗的真实世界研究发表在Frontiers in Pharmacology（2018年影响因子3.845）上。研究结果显示，在前6个月的治疗中含LPV/r方案的病毒抑制率显著高于含EFV的治疗方案（93.80% vs 87.80%，P＜0.05），CD4细胞计数的均值随治疗时间改善，也显著

含LPV/r的方案主要用于HIV感染者二线治疗，作为初始治疗的研究数据有限。近期一项对含LPV/r方案用于一线治疗的真实世界研究发表在Frontiers in Pharmacology上。研究结果显示，在前6个月的治疗中含LPV/r方案的病毒抑制率显著高于含EFV的治疗方案（93.80% vs 87.80%，P＜0.05），CD4细胞计数的均值随治疗时间改善，也显著优于含EFV的方案，详细见：Frontier in Pharmacology：HIV感染者使用LPV/r二线治疗的长期、大规模、多中心、真实世界研究结果发布。

洛匹那韦/利托那韦（LPV/r）是我国抗反转录病毒治疗中的主要二线用药，在某些特定情况下，例如CD4细胞计数较低、治疗前耐药（pretreatment drug resistance）、孕产妇、某些特殊情况无法使用依非韦伦（EFV）或奈韦拉平（NVP）时，LPV/r可用于一线治疗。
目前我国初治患者中使用基于LPV/r方案进行一线治疗的研究数据较为缺乏。佑安医院最近发表的真实世界研究评估了含LPV/r方案或含EFV方案用于一线抗反转录病毒治疗的疗效和安全性，对于资源有限地区一线治疗的选择有所启示。对2012—2017年期间在北京佑安医院就诊随访的HIV感染者数据进行分析。根据基线数据对接受LPV/r和EFV治疗的患者进行病例匹配，评估初治患者使用含LPV/r或EFV方案的疗效和安全性。HIV阳性、大于18岁，初始治疗使用含LPV/r或EFV方案。主要研究终点是第6、12、18和24个月时，HIV RNA＜40copies/ml的受试者比例。次要终点包括与基线相比，第6、12、18和24个月时，CD4细胞计数的变化比例。

表1　受试者的基线人口学和临床特征

治疗24个月后，病毒抑制率可达98.5%

基于LPV/r的方案在治疗开始后的前6个月，病毒抑制率显著高于含EFV的方案（93.80% vs 87.80%，P＜0.05）。两种方案的病毒抑制率在12个月内持续增加，且在之后的12个月中持续稳定至＞98%（图1）。

图1　HIV RNA＜40copies/ml的患者比例

LPV/r和EFV组的患者中，24个月内CD4细胞计数平均值分别增加至579.21/μl和531.88/μl。多层分析显示，接受LPV/r治疗的患者，其CD4细胞计数随治疗时间改善，优于接受EFV治疗的患者（P＜0.001）（图2）。

图2　患者CD4细胞计数平均值的变化

耐受性良好，严重不良反应少

无患者因不良事件而停药。LPV/r治疗组中有19例患者（5.91%）发生3级或4级实验室不良事件，EFV治疗组有3例（1.20%）。患者接受LPV/r治疗24个月后LDL-C水平未显著增加，提示该方案对患者心血管风险影响微不足道。

表2　第6、12、18和24个月时实验室检查异常的患者数量

含LPV/r初治方案可高效抑制病毒，持续改善免疫情况，并具有良好的安全性，是较好的临床选择。

原始出处：

SU B, WANG Y, ZHOU R F, et al. Efficacy and Tolerability of Lopinavir/Ritonavir- and Efavirenz-Based Initial Antiretroviral Therapy in HIV-1-Infected Patients in a Tertiary Care Hospital in Beijing, China[J\OL]. Frontiers in Pharmacology, 2019, (2019-12-12)[2020-01-09]. DOI: 10.3389/fphar.2019.01472.

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2020-04-16 yb6560

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2020-10-08 jj000001

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2020-09-21 anminleiryan

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2020-11-28 Eleven11

#pharmacology#

60 0
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2020-10-08 1249894fm84暂无昵称

#研究结果#

40 0
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2020-04-10 dingxiaobo

#Pharmacol#

32 0
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2020-03-26 chentianping

#pharma#

0 0

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