Rizzardi G P, Tambussi G, Bart P A, Chapuis A G, Lazzarin A, Pantaleo G
Department of Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland.
AIDS. 2000 Oct 20;14(15):2257-63. doi: 10.1097/00002030-200010200-00006.
When to start highly active antiretroviral therapy (HAART) in asymptomatic chronically HIV-1-infected subjects with CD4 cell counts of 300 x 10(6)-500 x 10(6)/l is debated extensively. Retrospective analyses of virological and immunological responses following HAART have been evaluated in both blood and lymph nodes according to pre-treatment levels of CD4 cells either above or below 500 x 10(6)/l.
Open-label, observational, non-randomized, prospective study.
Outpatients attending the Centre of Clinical Investigation in Infectious Diseases, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland.
Fifty-four HIV-1-infected antiretroviral-naive subjects with CD4 cell count > or = 250 x 10(6)/l and plasma viraemia > or = 5000 copies/ml who had been treated with HAART for at least 48 weeks. Controls were 49 HIV-negative subjects.
All patients received abacavir, nelfinavir, saquinavir soft gel capsules, and amprenavir in varying combinations for 72 weeks.
The extent of immune reconstitution following HAART in 43 and 11 subjects with either more or fewer than 500 x 10(6) CD4 cells/l at baseline was evaluated in blood and lymph node, and compared with immunological measures observed in 49 HIV-negative controls.
After 48 weeks of therapy, plasma viraemia was suppressed effectively in both groups of patients. Normalization of both CD4 cell count in blood, divided equally between memory and naive cells, and percentage of CD4 cells in lymph nodes occurred in the two groups. Consistently, the net increase over baseline in CD4 cell count and in memory and naive CD4 subsets was greater in patients with fewer than 500 x 10(6) CD4 cells/l at baseline. Recovery of HIV-specific responses was similar in the two groups.
This study suggests that virological and immunological responses are comparable in asymptomatic therapy-naive HIV-1-infected subjects with CD4 cell counts above or below 500 x 10(6)/l.
对于CD4细胞计数为300×10⁶ - 500×10⁶ /升的无症状慢性HIV-1感染受试者，何时开始高效抗逆转录病毒治疗（HAART）存在广泛争议。根据治疗前CD4细胞水平高于或低于500×10⁶ /升，对HAART后的病毒学和免疫反应进行了血液和淋巴结的回顾性分析。
开放标签、观察性、非随机前瞻性研究。
瑞士洛桑大学沃州大学医院传染病临床研究中心的门诊患者。
54例未接受过抗逆转录病毒治疗的HIV-1感染受试者，CD4细胞计数≥250×10⁶ /升且血浆病毒血症≥5000拷贝/毫升，接受HAART治疗至少48周。对照组为49例HIV阴性受试者。
所有患者接受阿巴卡韦、奈非那韦、沙奎那韦软胶囊和安普那韦的不同组合治疗72周。
在血液和淋巴结中评估了43例基线时CD4细胞高于500×10⁶ /升和11例低于500×10⁶ /升的受试者在HAART后的免疫重建程度，并与49例HIV阴性对照的免疫指标进行比较。
治疗48周后，两组患者的血浆病毒血症均得到有效抑制。两组患者血液中CD4细胞计数均恢复正常，记忆细胞和初始细胞平分，淋巴结中CD4细胞百分比也恢复正常。一致的是，基线时CD4细胞计数低于500×10⁶ /升的患者，其CD4细胞计数以及记忆和初始CD4亚群较基线的净增加更大。两组中HIV特异性反应的恢复相似。
本研究表明，CD4细胞计数高于或低于500×10⁶ /升的无症状未接受过治疗的HIV-1感染受试者的病毒学和免疫反应相当。
