Analysis Of The Reasons For Replacement Of Initial Antiviral Therapy For AIDS

Objective By observing the change of initial antiviral therapy for HIV/AIDS patients,the reasons for the change were analyzed,and the change risks of different treatment schemes were compared.Looking for treatment schemes with low side effects?strong long-term tolerance and persistent viral inhibition,patients'medication compliance should be improved,the risk of treatment failure should be reduced,and clinical individualized treatment should be optimized.Methods Using retrospective survey and analysis methods,the HIV/AIDS naive patients from a People's Hospital were collected from the national“AIDS Integrated Prevention and Treatment Information System First Antiviral Treatment Management”database.The time of collection is from August 1,2016 to July 31,2017.Case data,including baseline information before treatment and follow-up information for subsequent treatment,were followed from August 2016 to October26,2018.Establish a treatment cohort of 182 patients with AZT/3TC+EFV,56patients with AZT/3TC+LPV/r,600 patients with TDF+3TC+EFV,and 38 patients with TDF+3TC+LPV/r with initial treatment plan.Replacement as an observation outcome,loss of follow-up?withdrawal?referral?death or termination of observation time is censored.Survival analysis statistical method,Kaplan-Meier cumulative curve method was used to evaluate the risk of drug change of each factor,and Cox proportional hazard regression model was used to analyze the factors of treatment replacement.Results A total of 876 patients were enrolled in the study.The median follow-up period was 17.7 months(IQR,8.5-22.2 months).196 patients(22.37%)underwent treatment regimen replacement.The reasons for modification of the first combined antiretroviral therapy can be divided into four aspects:adverse drug reactions?treatment failure?drug interactions and others.Adverse drug reactions(ADRs)were the main causes of drug change,accounting for 76.02%.The common ADRs were bone marrow suppression?renal dysfunction?liver dysfunction?rash?central nervous system reaction?gastrointestinal reaction and body shape change.Another important reason is treatment failure,accounting for 7.65%,mainly virological failure,only found in the TDF+3TC+EFV program group.Nine patients with non-objective factors were changed,and the remaining867 patients were tested by Kaplan-Meier cumulative curve test.The risk of dressing change of TDF+3TC+EFV was significantly lower than that of AZT/3TC+EFV;the risk of heterosexual transmission of infection was higher than that of homosexual transmission;age?30 years old?CD4<200 cells/mm~3?platelets<50×10~9/L?serum creatinine?133?mol/l?eGFR<90 ml/(min×1.73m~2)and T.BIL>20?mol/l patients have a higher risk of dressing change than the patients whose age<29 years old?CD4?200 cells/mm~3?platelets>100×10~9/L?serum creatinine<133?mol/l?eGFR?90 ml/(min×1.73m~2)?T.BIL?20?mol/l.After multi-factor adjustment by Cox regression,the TDF+3TC+EFV regimen had the lowest risk of dressing change,followed by AZT+3TC+LPV/r,TDF+3TC+LPV/r,and AZT+3TC+EFV had the highest risk of dressing change;The risk of dressing change in patients whose age?40 year old is higher than that in patients whose age<29 years old,and the older the patient,the higher the risk of dressing change;patients with CD4<200 cells/mm~3 and T.BIL>20?mol/L have a higher risk of dressing change than Patients with CD4?200 cells/mm~3 and T.BIL?20?mol/L.Conclusions Adverse drug reactions are the main reasons for the change of initial treatment regimen,and treatment failure is another important reason.TDF+3TC+EFV has the lowest risk of dressing change.If there is no contraindication,TDF+3TC+EFV can be the first choice for initial treatment.In order to avoid higher risk of dressing change,it is not recommended that EFV and AZT be combined if there is no special case.When HAART containing LPV/r is initiated as an initial treatment regimen,clinical evaluation should be carefully carried out.LPV/r is not recommended to initiate antiviral therapy if it is not necessary.Age>40 years old,CD4<200 cells/mm~3 and T.BIL>20?mol/L were independent risk factors for dressing change.