Switching from efavirenz to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide reduces central nervous system symptoms in people living with HIV  

作　　者：Huan Xia Xiao-Jie Huang Yue Hu Li-Ying Gao Yue Wu Hao Wu Zhong-Fang Yan Ping Ma 

机构地区：[1]Department of Infectious Diseases,Tianjin Second People’s Hospital,Tianjin 300192,China [2]Center for Infectious Diseases,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China.

出　　处：《Chinese Medical Journal》2021年第23期2850-2856,共7页中华医学杂志（英文版）

基　　金：the 13th Five-year National Major Project for HIV/AIDS and Hepatitis B Control and Prevention and the Chinese Ministry of Science and Technology(No.2017ZX10202102005004).

摘　　要：Background:Central nervous system(CNS)symptoms after efavirenz(EFV)treatment in people living with human immunodeficiency virus(HIV)could persist and impact their quality of life.We assessed the impact of EFV-based regimen replacement with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide(E/C/F/TAF),which is considered an alternative option for subjects who do not tolerate EFV.Most specifically,we assessed the safety and the efficacy of E/C/F/TAF and its effects on the participants’neuropsychiatric toxicity symptoms in a real-life setting.Methods:A prospective cohort study was conducted among virologic suppressed HIV-positive participants receiving EFV-based regimens with ongoing CNS toxicity≥grade 2.The participants were switched to single-pill combination regimens E/C/F/TAF and followed up for 48 weeks.The neuropsychiatric toxicity symptoms were measured using a CNS side effects questionnaire,as well as the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index.The primary outcome measure was the proportion of participants experiencing grade 2 or higher CNS toxicity after EFV switch off at weeks 12,24,and 48.Secondary endpoints included virologic and immunological responses and the effect on fasting lipids at week 48 after switch.Results:One hundred ninety-six participants(96.9%men,median age:37.5 years,median:3.7 years on prior EFV-containing regimens)were included in the study.Significant improvements in anxiety and sleep disturbance symptoms were observed at 12,24,and 48 weeks after switching to E/C/F/TAF(P<0.05).No significant change in depression symptom scores was observed.At 48 weeks after switch,HIV viral load<50 copies/mL was maintained in all of the participants,median fasting lipid levels were moderately increased(total cholesterol[TC]:8.2 mg/dL,low-density lipoprotein cholesterol[LDL-C]:8.5 mg/dL,high-density lipoprotein cholesterol[HDL-C]:2.9 mg/dL,and triglyceride(TG):1.6 mg/dL,and the TC:HDL-C ratio remained stable.Conclusions:The single-pill combination regime

关 键 词：HIV EFAVIRENZ Elvitegravir Tenofovir alafenamide Central nervous system 

分 类 号：R512.91[医药卫生—内科学]