Rapid viral suppression using integrase inhibitors during acute HIV-1 infection.

IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Journal of Antimicrobial Chemotherapy Pub Date : 2024-11-06 DOI:10.1093/jac/dkae391
Mehri S McKellar, Jessica R Keys, Lindsey M Filiatreau, Kara S McGee, Joann D Kuruc, Guido Ferrari, David M Margolis, Joseph J Eron, Charles B Hicks, Cynthia L Gay
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Abstract

Background: Antiretroviral therapy (ART) is recommended for all individuals with HIV infection, including those with acute HIV-1 infection (AHI). While recommendations are similar to those for chronic infection, efficacy data regarding treatment of acute HIV is limited.

Methods: This was a single arm, 96-week study of a once-daily integrase inhibitor (INSTI)-based regimen using elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF) in AHI. Primary endpoint was proportion of participants with HIV-1 RNA <200 copies/mL and <50 copies/mL by treatment weeks 24 and 48, respectively. We also examined time to viral suppression and weight gain after treatment initiation. Outcomes and characteristics were compared with a historical AHI cohort using a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen with efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF).

Results: Thirty-three participants with AHI were enrolled with 31 available for analyses. Most were African American (61%) and men who have sex with men (73%). Median age was 26 (IQR 22-42). Demographics were similar between the two AHI cohorts. By Week 24, 100% in the INSTI and 99% in the NNRTI cohort were <200 copies/mL; by Week 48, 100% in both cohorts were <50 copies/mL. Time to viral suppression was shorter in the INSTI cohort (median 54 versus 99 days). Mean weight change was similar with a 3.6 kg increase in the INSTI cohort and 2.4 kg in the NNRTI cohort at 96 weeks.

Conclusions: INSTI-based ART during AHI resulted in rapid and sustained viral suppression. Over 96 weeks, weight increased in the INSTI-based cohort but was similar to weight increase in a historical NNRTI-based AHI cohort.

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在 HIV-1 急性感染期间使用整合酶抑制剂快速抑制病毒。
背景:抗逆转录病毒疗法(ART)被推荐用于所有 HIV 感染者,包括急性 HIV-1 感染者(AHI)。虽然抗逆转录病毒疗法的建议与慢性感染相似,但治疗急性 HIV 的疗效数据却很有限:这是一项为期96周的单臂研究,研究对象是AHI患者,采用每日一次的整合酶抑制剂(INSTI)治疗方案,使用艾维特格韦/可比司他/恩曲他滨/富马酸替诺福韦二吡呋酯(EVG/COBI/FTC/TDF)。主要终点是HIV-1 RNA结果的参与者比例:有 33 名 AHI 患者参加了研究,其中 31 人可用于分析。大多数为非洲裔美国人(61%)和男男性行为者(73%)。年龄中位数为 26 岁(IQR 22-42)。两组 AHI 患者的人口统计学特征相似。到第 24 周时,INSTI 和 NNRTI 队列中分别有 100% 和 99% 的人得出结论:在 AHI 期间,INSTI 抗逆转录病毒疗法能快速、持续地抑制病毒。在 96 周内,INSTI 组群的体重有所增加,但与历史上以 NNRTI 为基础的 AHI 组群的体重增幅相似。
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来源期刊
CiteScore
9.20
自引率
5.80%
发文量
423
审稿时长
2-4 weeks
期刊介绍: The Journal publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents. The Journal publishes primarily in human medicine, and articles in veterinary medicine likely to have an impact on global health.
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