NEJM:HIV感染二线治疗选择——度鲁特韦方案vs达芦那韦方案

2021-07-25 MedSci原创 MedSci原创

对于先前核苷类药物一线治疗失败的HIV感染者,度鲁特韦联合核苷类药物二线方案可有效抑制病毒复制,其效果与达芦那韦联合核苷类药物方案相当。在核苷药物选择方面,替诺福韦与齐多夫定方案的效果相当

抗逆转录病毒药物是HIV治疗的重要组成,整合酶抑制剂度鲁特韦,联合替诺福韦和拉米夫定,成为WHO推荐的一线治疗方案,对于接受过不含度鲁特韦的其他抗病毒药物治疗失败的患者,含度鲁特韦治疗方案被推荐作为二线治疗手段,但由于核苷类药物的交叉耐药性,度鲁特韦二线方案的疗效可能会受到一定程度的影响。达芦那韦,是第二代HIV蛋白酶抑制剂,可作为二线治疗手段,用于核苷类药物耐药性HIV患者的治疗。近日研究人员开展非劣性研究,比较了达芦那韦 vs 度鲁特韦二线治疗HIV感染的效果差异。

HIV一线治疗方案失败的患者参与研究,患者病毒载量为每毫升血液HIV-RNA拷贝数超过1000,患者均接受拉米夫定治疗,随机接受度鲁特韦或达芦那韦(含利托那韦增效剂)+替诺福韦或齐多夫定。研究的主要终点为48周后,病毒载量每毫升血液HIV-RNA拷贝数小于400 的患者比例,非劣性边界为12%。

研究在撒哈拉以南非洲的7个中心开展,总计招募464名患者。48周治疗后,度鲁特韦组主要终点达标率为90.2%(212/235例),达芦那韦组为91.7%(210/229例),主要终点达标率差异为-1.5%,达到非劣性终点。替诺福韦组患者主要终点达标率为92.3%(215/233),而齐多夫定组为89.6%(207/231),达到非劣性终点。组间不良事件率差异不显著。

研究认为,对于先前核苷类药物一线治疗失败的HIV感染者,度鲁特韦联合核苷类药物二线方案可有效抑制病毒复制,其效果与达芦那韦联合核苷类药物方案相当。在核苷药物选择方面,替诺福韦与齐多夫定方案的效果相当

原始出处:

Nicholas I. Paton et al. Dolutegravir or Darunavir in Combination with Zidovudine or Tenofovir to Treat HIV. N Engl J Med,July 22,2021.

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    2021-07-25 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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    2021-07-25 ms3000001999514966

    理学物理方按

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