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TDF/3TC aizsargefekts
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12.07.2020


HIV pozitīvie pacienti ir mazāk jutīgi pret Covid-19, ja viņi lieto tenofovīra (TDF formā)/emtricitabīna kombināciju, liecina Spānijā veiktā kohortas pētījuma rezultāti.
Pētījums tika veikts 60 klīnikās, kas atrodas dažādās valsts daļās, un tajā piedalījās 77590 pacientu, kuriem diagnosticēts HIV. 236 no viņiem tika diagnosticēts Covid-19, no kuriem 151 tika nogādāts slimnīcās (15 nonāca intensīvās terapijas nodaļās, 20 cilvēki nomira).
Pētījuma rezultāti liecina, ka risks saslimt ar Covid-19 HIV pacientiem nav lielāks kā pārējai populācijai. Turklāt tie, kuri lieto tenofovīru (TDF)/emtricitabīnu (FTC) (kombinācija, ko izmanto HIV infekcijas ārstēšanai un HIV pirmskontakta profilaksei), ir mazāk jutīgi pret Covid-19 nekā pacienti, kas ārstēti, izmantojot citas shēmas.
Žurnālā Annals of Internal Medicine publicētā pētījuma autori uzskata, ka nepieciešami papildu testi, lai apstiprinātu dažādu antiretrovīrusu preparātu efektivitāti Covid-19 ārstēšanā. Šo datu apstiprināšana būtu liels sasniegums, lai novērstu medicīnas personāla un cilvēku no īpašā riska grupu inficēšanos.
Spānijā vairāk nekā 90% HIV pozitīvu cilvēku saņem antiretrovīrusu terapiju.
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Source: Annals of Internal Medicine | «Incidence and Severity of Covid-19 in HIV-Positive Persons Receiving Antiretroviral Therapy. A Cohort Study» | https://www.acpjournals.org/doi/10.7326/M20-3689 |
<... Abstract
Background:
The incidence and severity of coronavirus disease 2019 (Covid-19) among HIV-positive persons receiving antiretroviral therapy (ART) have not been characterized in large populations.
Objective:
To describe the incidence and severity of Covid-19 by nucleos(t)ide reverse transcriptase inhibitor (NRTI) use among HIV-positive persons receiving ART.
Design:
Cohort study.
Setting:
HIV clinics in 60 Spanish hospitals between 1 February and 15 April 2020.
Participants:
77 590 HIV-positive persons receiving ART.
Measurements:
Estimated risks (cumulative incidences) per 10 000 persons and 95% CIs for polymerase chain reaction–confirmed Covid-19 diagnosis, hospitalization, intensive care unit (ICU) admission, and death. Risk and 95% CIs for Covid-19 diagnosis and hospital admission by use of the NRTIs tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and others were estimated through Poisson regression models.
Results:
Of 77 590 HIV-positive persons receiving ART, 236 were diagnosed with Covid-19, 151 were hospitalized, 15 were admitted to the ICU, and 20 died. The risks for Covid-19 diagnosis and hospitalization were greater in men and persons older than 70 years. The risk for Covid-19 hospitalization was 20.3 (95% CI, 15.2 to 26.7) among patients receiving TAF/FTC, 10.5 (CI, 5.6 to 17.9) among those receiving TDF/FTC, 23.4 (CI, 17.2 to 31.1) among those receiving ABC/3TC, and 20.0 (CI, 14.2 to 27.3) for those receiving other regimens. The corresponding risks for Covid-19 diagnosis were 39.1 (CI, 31.8 to 47.6), 16.9 (CI, 10.5 to 25.9), 28.3 (CI, 21.5 to 36.7), and 29.7 (CI, 22.6 to 38.4), respectively. No patient receiving TDF/FTC was admitted to the ICU or died.
Limitation:
Residual confounding by comorbid conditions cannot be completely excluded.
Conclusion:
HIV-positive patients receiving TDF/FTC have a lower risk for Covid-19 and related hospitalization than those receiving other therapies. These findings warrant further investigation in HIV preexposure prophylaxis studies and randomized trials in persons without HIV. ...>




 
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