Becker S L, Raffanti S R, Hansen N I, Fusco J S, Fusco G P, Slatko G H, Igboko E F, Graham N M
Pacific Horizon Medical Group, San Francisco, California 94115, USA.
J Acquir Immune Defic Syndr. 2001 Jan 1;26(1):72-81. doi: 10.1097/00126334-200101010-00011.
Optimal sequencing of zidovudine and stavudine in antiretroviral therapy has not been elucidated.
To examine the impact of the sequence of therapeutic regimens containing zidovudine and stavudine on HIV-1 RNA and CD4 lymphocyte counts over 12 months.
Observational, multicenter, longitudinal cohort study.
Four large outpatient, HIV practices participating in the community-based Collaborations in HIV Outcomes Research-U.S. (CHORUS) cohort study.
940 HIV-infected patients.
Comparison of HIV-1 RNA and CD4 lymphocyte responses in patients sequenced from zidovudine to stavudine or from stavudine to zidovudine using repeated measures regression models fit to outcomes by application of generalized estimating equation (GEE) methodology.
Patients treated with zidovudine prior to stavudine (n = 834) achieved a greater mean drop from baseline HIV-1 RNA (p = .01) and higher proportion of undetectable HIV-1 RNA results (p = .05) over 12 months than those sequenced from stavudine to zidovudine (n = 106). CD4+ lymphocyte increases did not differ between the groups (p = .6).
Prior zidovudine therapy was not associated with long-term attenuation of HIV-1 RNA or CD4 response to subsequent stavudine-containing regimens. Zidovudine before stavudine may have benefit in a strategic long-term therapeutic plan.
抗逆转录病毒治疗中齐多夫定和司他夫定的最佳用药顺序尚未明确。
研究包含齐多夫定和司他夫定的治疗方案顺序对12个月内HIV-1 RNA和CD4淋巴细胞计数的影响。
观察性、多中心、纵向队列研究。
四家大型门诊HIV诊疗机构参与了基于社区的美国HIV结局研究协作组（CHORUS）队列研究。
940例HIV感染患者。
使用广义估计方程（GEE）方法对结局进行重复测量回归模型拟合，比较从齐多夫定换用司他夫定或从司他夫定换用齐多夫定的患者的HIV-1 RNA和CD4淋巴细胞反应。
先使用齐多夫定后使用司他夫定治疗的患者（n = 834）在12个月内，相较于先使用司他夫定后使用齐多夫定的患者（n = 106），从基线HIV-1 RNA的平均下降幅度更大（p = 0.01），HIV-1 RNA检测不到的结果比例更高（p = 0.05）。两组间CD4 +淋巴细胞增加情况无差异（p = 0.6）。
先前的齐多夫定治疗与HIV-1 RNA的长期衰减或对后续含司他夫定方案的CD4反应无关。在长期战略治疗计划中，先使用齐多夫定再使用司他夫定可能有益。
