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標題: | 比較 HIV 治療單錠處方與多錠處方的有效性及耐受性:回溯性世代追蹤研究 Comparison of effectiveness and tolerability between single and multiple-tablet HIV treatment regimens: a retrospective cohort study |
作者: | 鄭容 Jung Cheng |
指導教授: | 方啓泰 Chi-Tai Fang |
關鍵字: | 人類免疫缺乏病毒,愛滋病,高效能抗愛滋病毒治療,單錠處方,多錠處方, human immunodeficiency virus,acquired immunodeficiency syndrome,combination antiretroviral therapy,single-tablet regimen,multiple-tablet regimen, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 背景及目的
高效能抗愛滋病毒治療(combination antiretroviral therapy, cART)有效改善了人類免疫缺乏病毒(human immunodeficiency virus, HIV)感染者和愛滋病(acquired immunodeficiency syndrome, AIDS)患者的預後,亦降低了 HIV 的傳播。由於過去多錠處方(multiple-tablet regimens, MTRs)的藥物負擔和副作用仍然造成 HIV 的治療困難,近年來服藥依從性及療效較高的單錠藥物(single-tablet regimens, STRs)已逐漸成為主流。台灣疾病管制署於1997年4月開始提供 cART ,並自2016年6月起將 STR 列為第一線藥物,然目前仍然缺乏 STR 對開始治療後 HIV 病毒載量抑制和 CD4 恢復時間影響的數據,且 STR 對亞洲族群耐受性影響的研究也有限。因此,本研究旨在以台灣真實世界數據比較 MTR 和 STR 治療對於 HIV/AIDS 患者的有效性和耐受性。 材料與方法 本研究為回溯性世代追蹤研究,以2013年至2018年在台大醫院初次使用 cART 的 HIV/AIDS 患者進行分析。研究結果包括 CD4 回復(達到 CD4 計數 ≥ 500 cells/μL)、病毒抑制(達到 HIV 病毒量 ≤ 50 copies/mL)和耐受性(換藥或停藥),並以 Cox 回歸模型比較 MTR 組和 STR 組並估計危險比。 結果 MTR 組共691名患者,STR 組共345名患者。CD4 回復的調整後危險比為 1.39(95% CI 1.07-1.81,P值=0.0150),病毒抑制為 1.52(95% CI 1.25-1.84,P值<.0001),耐受性的調整後危險比為 0.58(95% CI 0.49-0.69,P值<.0001)。 結論 相較於 MTR 組別, STR 組別的有效性和耐受性較高,CD4 較快回復及較快達到病毒抑制,且停藥或換藥率亦較低。 Background. Combination antiretroviral therapy (cART) is an effective way to improve the prognosis among human immunodeficiency virus (HIV) infected and acquired immunodeficiency syndrome (AIDS) patients and prevent the transmission of HIV. Due to treatment barriers caused by the pill burden and side effects of multiple-tablet regimens (MTRs) in the past, single-tablet regimens (STRs) have become mainstream with their higher adherence and effectiveness nowadays. Taiwan Centers for Disease Control started to provide cART for HIV patients in April 1997 and listed STRs as the recommended first-line treatment since June 2016. However, there is a lack of data on the real-world impact of STRs on the time to HIV viral load suppression and CD4 recovery after starting treatment and limited data on the impact of STRs on tolerability in Asian populations. Therefore, this study aims to compare the real-world effectiveness and tolerability of HIV/AIDS patients treated with MTRs and STRs through Taiwanese data. Materials and Methods. This retrospective cohort study analyzes the HIV/AIDS patients who initiated MTRs and STRs from 2013 to 2018 in the National Taiwan University Hospital. The study outcomes were CD4 recovery (reaching a CD4 count ≥ 500 cells/μL), viral suppression (reaching an HIV viral load ≤ 50 copies/mL), and tolerability (treatment interruption or switching to alternative treatments). The hazard ratios (HRs) of the STRs compared to the MTRs were estimated by Cox regression models. Results. There were 691 patients in the MTR group and 345 patients in the STR group. The adjusted HRs were 1.39 (95% CI 1.07-1.81, P-value=0.0150) for CD4 recovery, 1.52 (95% CI 1.25-1.84, P-value<.0001) for viral suppression, and 0.58 (95% CI 0.49-0.69, P-value<.0001) for tolerability. Conclusion. STRs were associated with faster CD4 recovery and viral suppression and a lower probability of treatment interruption or switching to alternative treatments, suggesting better effectiveness and tolerability compared to MTRs. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/89207 |
DOI: | 10.6342/NTU202302550 |
全文授權: | 未授權 |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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