Tolerability of four-drug antiretroviral combination therapy in primary HIV-1 infection

被引:2
作者
Burns, J. E. [1 ]
Stohr, W. [2 ]
Kinloch-De Loes, S. [3 ,4 ]
Fox, J. [5 ,6 ]
Clarke, A. [7 ,8 ,9 ]
Nelson, M. [10 ]
Thornhill, J. [11 ,12 ]
Babiker, A. [2 ]
Frater, J. [13 ,14 ]
Pett, S. L. [1 ,2 ]
Fidler, S. [11 ,12 ]
机构
[1] UCL, Inst Global Hlth, Ctr Clin Res Infect & Sexual Hlth, London, England
[2] UCL, Inst Clin Trials & Methodol, Med Res Council Clin Trials Unit, London, England
[3] Royal Free Hosp, Dept Infect & Immun, London, England
[4] UCL, Inst Immun & Transplantat, London, England
[5] Guys & St Thomas NHS Trust, Dept Genitourinary Med & Infect Dis, London, England
[6] Kings Coll London, NIHR Biomed Res Ctr, Dept Genitourinary Med & Infect Dis, London, England
[7] Elton John Ctr, Brighton, E Sussex, England
[8] Sussex Univ Hosp, Dept HIV & Sexual Hlth, Brighton, E Sussex, England
[9] Univ Sussex, Brighton & Sussex Med Sch, Brighton, E Sussex, England
[10] Imperial Coll London, Dept HIV Med, Chelsea & Westminster Hosp, London, England
[11] Imperial Coll London, Dept Infect Dis, London, England
[12] NIHR Imperial Biomed Res Ctr, London, England
[13] Univ Oxford, Nuffield Dept Med, Oxford, England
[14] Oxford NIHR Biomed Res Ctr, Nuffield Dept Med, Oxford, England
基金
英国医学研究理事会;
关键词
adherence; antiretroviral therapy; primary HIV‐ 1; infection; tolerability; VIRAL LOAD; OPEN-LABEL; SURVEILLANCE; SUPPRESSION; RESERVOIR;
D O I
10.1111/hiv.13118
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives Rapid initiation of antiretroviral therapy (ART) is important for individuals with high baseline viral loads, such as in primary HIV-1 infection (PHI). Four-drug regimens are sometimes considered; however, data are lacking on tolerability. We aimed to evaluate the tolerability of four-drug regimens used in the Research in Viral Eradication of HIV-1 Reservoirs (RIVER) study. Methods At enrolment, ART-naive adult participants or those newly commenced on ART were initiated or intensified to four-drug regimens within 4 weeks of PHI. Rapid start was defined as pre-confirmation or <= 7 days of confirmed diagnosis. Primary and secondary outcomes were patient-reported adherence measured by 7-day recall and regimen switches between enrolment and randomization, respectively. Results Overall, 54 men were included: 72.2% were of white ethnicity, with a median age of 32 years old, 42.6% had a viral load of >= 100 000 HIV-1 RNA copies/mL, and in 92.6% sex with men was the mode of acquisition of HIV-1. Twenty (37%) started a four-drug regimen and 34 (63%) were intensified. Rapid ART initiation occurred in 28%, 100% started in <= 4 weeks. By weeks 4, 12, and 24, 37.0%, 69.0%, and 94.0% were undetectable (viral load < 50 copies/mL), respectively. Adherence rates of 100% at weeks 4, 12, 22 and 24 were reported in 88.9%, 87.0%, 82.4% and 94.1% of participants, respectively. Five individuals switched to three drugs, four changed their regimen constituents, and two switched post-randomization. Conclusions Overall, four-drug regimens were well tolerated and had high levels of adherence. Whilst their benefit over three-drug regimens is lacking, our findings should provide reassurance if a temporarily intensified regimen is clinically indicated to help facilitate treatment.
引用
收藏
页码:770 / 774
页数:5
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