Hasson H, Saniabadi A, Alfano M, Trabattoni D, Ferrante P, Lillo F, Clerici M, Lazzarin A, Beretta A
Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy.
J Biol Regul Homeost Agents. 2002 Jan-Mar;16(1):58-63.
Current antiretroviral regimens (HAART) are generally effective in reducing viral replication to undetectable levels and inducing a raise in CD4 T cells. However, in approximately 5 to 15% of patients suppression of viral replication is not followed by an increase in CD4 T cells. Such patients may be at increased risk for opportunistic infections. Here we report the results from a phase II open label randomised trial on 30 patients classified as poor responders to HAART who were either subjected to eight consecutive cycles of selective monocyte apheresis or maintained under HAART alone. The results show that monocyte apheresis results in increased CD4 T cell counts which are maintained for at least 31 weeks after last apheresis. This effect was observed only on patients with complete suppression of viral replication. Other effects of monocyte apheresis included a strong reduction of TNF-alpha production in patients with high baseline levels of this cytokine and activation of resting T cells during the apheresis cycles. In two patients with high cellular HIV DNA load apheresis was followed by a 98% reduction, suggesting purging of infected cells. There was no evidence of increased viral replication during or after the apheresis cycles. The data show that monocyte apheresis is safe, well tolerated and may be indicated in patients who respond poorly to HAART.
目前的抗逆转录病毒疗法（高效抗逆转录病毒疗法，HAART）通常能有效将病毒复制降低到检测不到的水平，并促使CD4 T细胞数量增加。然而，约5%至15%的患者在病毒复制受到抑制后，CD4 T细胞数量并未增加。这类患者发生机会性感染的风险可能更高。在此，我们报告了一项针对30例被归类为HAART疗效不佳的患者的II期开放标签随机试验结果，这些患者要么接受连续8个周期的选择性单核细胞去除术，要么仅维持HAART治疗。结果显示，单核细胞去除术可使CD4 T细胞计数增加，且在最后一次去除术后至少31周内保持这一水平。仅在病毒复制完全受到抑制的患者中观察到了这种效果。单核细胞去除术的其他效果包括，对于该细胞因子基线水平较高的患者，肿瘤坏死因子-α（TNF-α）的产生大幅减少，以及在去除术周期中静息T细胞被激活。在两名细胞内HIV DNA载量较高的患者中，去除术后该载量降低了98%，提示清除了被感染细胞。在去除术周期期间及之后，均未发现病毒复制增加的迹象。数据表明，单核细胞去除术安全、耐受性良好，对于HAART疗效不佳的患者可能是一种可行的治疗方法。
