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比克替拉韦/恩曲他滨/丙酚替诺福韦(B/F/TAF)在快速启动抗反转录病毒治疗中的应用

Application of bictegravir/emtricitabine/tenofovir alafenamide in rapid initiation of antiretroviral therapy: a review

  • 摘要: 快速启动HIV感染抗反转录病毒治疗(ART)可带来提高疗启动率、维持率及病毒学抑制率,降低病死率等多方面临床获益,对我国乃至全球范围内“三个95%”目标的达成至关重要。比克替拉韦/恩曲他滨/丙酚替诺福韦(B/F/TAF)是基于第二代整合酶抑制剂比克替拉韦的复方单片制剂。B/F/TAF具有耐药屏障高、安全性良好、无需等待基线检测结果即可启动等特点,不仅是最新权威指南一致推荐的一线ART方案,亦是目前唯一被国内外指南一致推荐用于快速启动的单片制剂方案。目前国内外正在积极开展多项关于B/F/TAF应用于快速启动的前瞻性临床试验及队列研究,其中不乏使用当日启动的研究。本文旨在汇总现有临床证据,并探讨部分特殊人群使用B/F/TAF进行快速启动时的考量,希望为从事HIV诊疗的医务人员的临床实践提供参考。

     

    Abstract: Rapid initiation of antiretroviral therapy (rapid ART) has multiple clinical benefits, such as increasing the rates of treatment initiation, retention in care, and virologic suppression, and reducing the mortality rate. It is crucial for the achievement of the “95%–95%–95%” goal in China and the globe. Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a single-tablet combination based on the second-generation integrase inhibitor bictegravir. B/F/TAF has a high resistance barrier and a favourable safety profile, and can be initiated before baseline laboratory results are available. It is not only a first-line ART regimen recommended by the latest established guidelines but also the only single-tablet regimen unanimously recommended by local and international guidelines for rapid ART. A number of prospective clinical trials and cohort studies on the use of B/F/TAF for rapid ART are currently ongoing in China and across the world, including studies using same-day initiation. This article summarizes the existing clinical evidence and briefly discusses the considerations for the use of B/F/TAF for rapid ART in some special populations, aiming to inform the clinical practice of medical personnel engaged in the diagnosis and treatment of HIV infection.

     

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