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首页> 外文期刊>JAIDS: Journal of acquired immune deficiency syndromes >The nucleoside backbone affects durability of efavirenz- or nevirapine-based highly active antiretroviral therapy in antiretroviral-naive individuals.
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The nucleoside backbone affects durability of efavirenz- or nevirapine-based highly active antiretroviral therapy in antiretroviral-naive individuals.

机译：核苷主链影响未接受抗逆转录病毒治疗的个体中基于依非韦伦或奈韦拉平的高活性抗逆转录病毒治疗的持久性。

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OBJECTIVES: We wished to determine the efficacy of nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens in antiretroviral-naive patients commencing highly active antiretroviral therapy (HAART) and to evaluate the effect of calendar year, nucleoside analogue reverse transcriptase inhibitor (NRTI) backbone, sex, and ethnicity on treatment outcome. METHODS: Antiretroviral-naive individuals commencing efavirenz or nevirapine with dual-nucleoside analogue backbones were identified from a prospective database. Virological success was defined as HIV viral load <500 copies per milliliter. Treatment failure was defined as a switch or discontinuation of NNRTI or documented virological failure (2 measurements with viral load >500 copies/mL). RESULTS: From a cohort of 994 individuals, 73% commenced efavirenz- and 27% nevirapine-containing regimens. We found no differences between the 2 treatment groups for the time to virological success (proportion with virological success: efavirenz 71%, nevirapine 72%, P = 0.77) or treatment failure (proportion failing treatment: efavirenz 23%, nevirapine 26%, P = 0.58). There was a significant difference in the calendar year for commencing HAART for the time to virological success and treatment failure (P < 0.001). In the multivariable model, the likelihood of virological success for stavudine/lamivudine was 52% [relative hazard (RH) 1.52, 95% confidence interval (CI) 1.17 to 1.97, P = 0.002]. The nonthymidine analogue backbones as a group seemed to be least likely associated with virological success (RH 0.62, 95% CI 0.48 to 0.80, P < 0.001). This was however largely driven by tenofovir/didanosine being significantly associated with treatment failure (RH 6.48, 95% CI 3.81 to 11.0, P < 0.001). Sex and ethnicity were not associated with treatment outcome. CONCLUSIONS: We found no significant differences between nevirapine and efavirenz for the time to virological success or treatment failure. Calendar year of commencing HAART and NRTI backbones were significant predictors of virological success and treatment failure, explaining differences in data to the 2NN study. The weaker the NNRTI (or the weaker the protease inhibitor) the more important the NRTI backbone becomes.
机译：目的：我们希望确定基于非核苷逆转录酶抑制剂（NNRTI）的方案在开始高活性抗逆转录病毒治疗（HAART）的抗逆转录病毒初治患者中的疗效，并评估日历年核苷类似物逆转录酶抑制剂（NRTI）骨架的疗效，性别和种族对治疗效果的影响。方法：从前瞻性数据库中识别出初次使用依非韦伦或奈韦拉平并具有双核苷类似物骨架的抗逆转录病毒个体。病毒学成功定义为HIV病毒载量＜每毫升500份。治疗失败的定义为NNRTI的转换或停用或已记录的病毒学失败（2项病毒载量> 500拷贝/ mL的测量）。结果：从994名患者中，73％开始使用依非韦伦治疗，27％开始使用奈韦拉平治疗。我们发现两个治疗组在病毒学成功时间（病毒学成功率：依非韦伦71％，奈韦拉平72％，P = 0.77）或治疗失败（失败依比例治疗：依非韦伦23％，奈韦拉平26％，P之间没有差异= 0.58）。从HAART开始到病毒学成功和治疗失败的时间，日历年之间存在显着差异（P <0.001）。在多变量模型中，司他夫定/拉米夫定在病毒学上成功的可能性为52％[相对危险度（RH）1.52，95％置信区间（CI）1.17至1.97，P = 0.002]。一组非胸苷类似物骨架似乎最不可能与病毒学成功相关（RH 0.62，95％CI 0.48至0.80，P <0.001）。然而，这在很大程度上是由替诺福韦/地丹诺辛与治疗失败显着相关所致（RH 6.48，95％CI 3.81至11.0，P <0.001）。性别和种族与治疗结果无关。结论：我们发现奈韦拉平和依非韦伦在病毒学成功或治疗失败的时间上无显着差异。 HAART和NRTI骨架开始使用的日历年是病毒学成功和治疗失败的重要预测指标，为2NN研究解释了数据差异。 NNRTI越弱（或蛋白酶抑制剂越弱），NRTI主链变得越重要。

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