ZHANG Wei, LI Qisui, DENG Changgang, HUANG Wei, SUN Yanyu, YUAN Jing
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Objective To understand the efficacy of antiretroviral therapy (ART) initiated on the day of diagnosis in treatment-naive HIV/AIDS patients, and compare the virological suppression rate, treatment maintenance rate and maintenance rate of original ART regimen between different ART regimens. Methods Patients who initially treated with ART in Chongqing Public Health Medical Treatment Center from January 1, 2022 to December 31, 2022 were retrospectively identified. Their ART was initiated within 24 hours on the day of diagnosis. The patients were assigned to one of the following four group according to the ART regimen they received: three-drug combination (STR-3D), two-drug combination (STR-2D), or multi-drug combination (MTR1: 2NRTIs+NNRTIs, MTR2: 2NRTIs+LPV/r). Results A total of 163 treatment-naive HIV/AIDS patients were included in the study. Overall, 70.6% (115/163) of the patients were males, with a mean baseline age of (49.9±17.2) years and median CD4+ T lymphocytes count of 222.0 (136.0, 306.0) /μL. The median value of HIV RNA was 112 000 (46 700, 51 400) copies/mL. There were 105 (64.4%) patients in STR-3D group, 22 (13.5%) patients in STR-2D group, 34 (20.9%) patients in MTR1 group and 2 (1.2%) patients in MTR2 group. Only the first three ART regimens were statistically analyzed because the number of patient was too small in MTR2 group. The overall virologic suppression rate was 85.0% (113/133) at 24 weeks after ART-initiation in patients with viral load results, specifically 90.0% (81/90) in STR-3D group, 94.4% (17/18) in STR-2D group and 65.2% (15/23) in MTR1 group. Significant difference was found among the three groups (P = 0.011). The median increase of CD4+ T lymphocytes at 24 weeks was 106.5 (59.0, 185.3) cells/μL, of which the increase was 122.0 (64.0, 202.0) /μL in STR-3D group, 98.0 (49.5, 155.5)/μL in STR-2D group and 78.0 (8.0, 137.0) /μL in MTR1 group (P = 0.047). Among the patients with viral load results at 48 weeks of follow-up, the overall virological suppression rate was 97.7% (128/131), specifically 97.8% (88/90) in STR-3D group, 100% (13/13) in STR-2D group, and 96.2% (25/26) in MTR1 group (P = 0.664). At week 48, the median increase of CD4+ T lymphocytes was 144.5 (63.3, 234.8) /μL, specifically 148.5 (67.8, 241.0) /μL, 171.0 (63.5, 266.5) /μL, and 109.0 (46.0, 215.0) /μL in the three groups, respectively (P = 0.431). After 48 weeks of follow-up, the overall treatment maintenance rate was 91.4% (149/163). After excluding the 6 patients who died, the treatment maintenance rate was 98.0% (98/100) in STR-3D group, 90.9% (20/22) in STR-2D group, and 87.9% (29/33) in MTR1 group (P = 0.040). The overall maintenance rate of the original ART regimen within 48 weeks was 87.1% (142/163), and 94.3% (99/105), 77.3% (17/22), and 73.5% (25/34) in the three groups, respectively (P = 0.001). Conclusions The virological suppression rate, treatment maintenance rate and the maintenance rate of original ART regimen were high in treatment-naive HIV/AIDS patients who initiated ART on the same day of diagnosis. The early treatment effect of single-tablet ART was significantly better than that of multi-tablet ART. It is recommended to initiate single-tablet ART containing three drugs on the same day of diagnosis.
