■我们的目的是确定与持续dolutegravirl-相比,在HIV(PWH)患者中,切换到比特拉韦在维持不可检测的病毒载量(<50拷贝/mL)中的有效性,efavirenz-,或基于raltegravir的抗逆转录病毒治疗使用来自墨西哥的全国观察数据。
■我们模拟了3个目标试验,比较了切换到bictegravir与继续使用dolutegravir,efavirenz,或者Raltegravir.合格标准是年龄≥16岁的PWH,病毒载量<50拷贝/mL,并且至少接受3个月的当前抗逆转录病毒治疗(dolutegravir,efavirenz,或raltegravir)在2019年7月至2021年9月之间。在研究期间模拟每周目标试验,如果个人继续符合资格,他们将被包括在每一个仿真中。主要结果是3个月时检测不到病毒载量的可能性,这是通过调整后的逻辑回归模型估计的。通过差异比较估计的概率,95%CI是通过Bootstrap计算的。结果也在12个月时确定,并进行敏感性分析以检验我们的分析选择。
■我们分析了3028619PWH(63581个独特个体)的数据。3个月时检测不到病毒载量的概率为2.9%(95%CI,1.9%-3.8%),1.3%(95%CI,.9%-1.6%),和1.2%(95%CI,.8%-1.7%)更高,当切换到比替格韦与继续与dolutegravir相比,efavirenz,还有Raltegravir,分别。在12个月和其他敏感性分析中观察到类似的结果。
■我们的研究结果表明,与继续使用dolutegravir相比,改用bictegravir可能更有效地维持病毒抑制,efavirenz,或者Raltegravir.
UNASSIGNED: We aimed to determine the effectiveness of switching to
bictegravir in maintaining an undetectable viral load (<50 copies/mL) among people with HIV (PWH) as compared with continuing dolutegravir-, efavirenz-, or raltegravir-based antiretroviral therapy using nationwide observational data from Mexico.
UNASSIGNED: We emulated 3 target trials comparing switching to
bictegravir vs continuing with dolutegravir, efavirenz, or raltegravir. Eligibility criteria were PWH aged ≥16 years with a viral load <50 copies/mL and at least 3 months of current antiretroviral therapy (dolutegravir, efavirenz, or raltegravir) between July 2019 and September 2021. Weekly target trials were emulated during the study period, and individuals were included in every emulation if they continued to be eligible. The main outcome was the probability of an undetectable viral load at 3 months, which was estimated via an adjusted logistic regression model. Estimated probabilities were compared via differences, and 95% CIs were calculated via bootstrap. Outcomes were also ascertained at 12 months, and sensitivity analyses were performed to test our analytic choices.
UNASSIGNED: We analyzed data from 3 028 619 PWH (63 581 unique individuals). The probability of an undetectable viral load at 3 months was 2.9% (95% CI, 1.9%-3.8%), 1.3% (95% CI, .9%-1.6%), and 1.2% (95% CI, .8%-1.7%) higher when switching to
bictegravir vs continuing with dolutegravir, efavirenz, and raltegravir, respectively. Similar results were observed at 12 months and in other sensitivity analyses.
UNASSIGNED: Our findings suggest that switching to
bictegravir could be more effective in maintaining viral suppression than continuing with dolutegravir, efavirenz, or raltegravir.