Carbonara S, Fiorentino G, Serio G, Maggi P, Ingravallo G, Monno L, Bruno F, Coppola S, Pastore G, Angarano G
Clinic of Infectious Diseases, University of Bari, Italy.
J Infect. 2001 May;42(4):251-6. doi: 10.1053/jinf.2001.0833.
To investigate the response of HIV-associated severe thrombocytopenia (STP) to highly active antiretroviral therapy (HAART) including protease-inhibitors.
In this retrospective study, 15 patients with HIV-associated STP (platelet count < 50 x 10(9)/l mostly antiretroviral experienced (13/15), underwent HAART for at least 6 months (median 21; range 6-41 months) during which the platelet (PLT) count and plasmatic HIV-RNA were monitored. The PLT response was compared to that observed in 19 patients previously treated with zidovudine (AZT) monotherapy.
HAART induced a significant increase in the PLT count (chi(2)=10.53, P=0.01) within the third month which was sustained up to the sixth month of therapy. No STP relapse was observed among eight PLT responders followed for longer than 6 months (median 27; range 7-41 months). The PLT increase after HAART was similar to that observed with AZT monotherapy, but a greater number of HAART patients were antiretroviral-experienced. HAART determined a PLT response in 10/13 subjects whose thrombocytopenia had not improved after previous AZT monotherapy. After 6 months of HAART, a complete platelet response occurred more frequently in patients with undetectable plasma HIV-RNA levels (P=0.01).
HAART induces a sustained PLT response in HIV-associated STP, even in antiretroviral-experienced subjects and in those with AZT-resistant thrombocytopenia. An undetectable plasma HIV viraemia induced by HAART is necessary for STP recovery.
研究包括蛋白酶抑制剂在内的高效抗逆转录病毒疗法（HAART）对HIV相关严重血小板减少症（STP）的反应。
在这项回顾性研究中，15例HIV相关STP患者（血小板计数<50×10⁹/L，大多数有抗逆转录病毒治疗经历，13/15）接受HAART治疗至少6个月（中位数21；范围6 - 41个月），在此期间监测血小板（PLT）计数和血浆HIV-RNA。将PLT反应与19例先前接受齐多夫定（AZT）单药治疗的患者进行比较。
HAART在第三个月内使PLT计数显著增加（χ² = 10.53，P = 0.01），并持续到治疗的第六个月。在8例随访超过6个月（中位数27；范围7 - 41个月）的PLT反应者中未观察到STP复发。HAART后PLT的增加与AZT单药治疗观察到的相似，但更多接受HAART的患者有抗逆转录病毒治疗经历。HAART使13例先前AZT单药治疗后血小板减少未改善的患者中有10例出现PLT反应。HAART治疗6个月后，血浆HIV-RNA水平不可检测的患者更频繁地出现完全血小板反应（P = 0.01）。
HAART在HIV相关STP中诱导持续的PLT反应，即使在有抗逆转录病毒治疗经历的受试者和对AZT耐药的血小板减少症患者中也是如此。HAART诱导的血浆HIV病毒血症不可检测是STP恢复所必需的。
