Bongiovanni Marco, Bini Teresa, Adorni Fulvio, Meraviglia Paola, Capetti Amedeo, Tordato Federica, Cicconi Paola, Chiesa Elisabetta, Cordier Laura, Cargnel Antonietta, Landonio Simona, Rusconi Stefano, d'Arminio Monforte Antonella
Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy.
Antivir Ther. 2003 Jun;8(3):209-14.
We evaluated the virological outcome of lopinavir/ritonavir (LPV/RTV) in 224 HIV-1-infected and protease inhibitor (PI)-experienced patients showing virological failure to a highly active antiretroviral therapy (HAART) regimen and followed up for at least 3 months. At baseline, the median level of plasma viraemia was 4.61 log10 copies/ml (range 3-6.48) and the median CD4 cell count was 219 cells/mm3 (range 1-836). During a median follow-up of 272 days (range 92-635), we observed an increase in the number of CD4 cells (P=0.02) and a dramatic decrease in plasma viraemia levels (P=0.0001), which became undetectable in 122 patients (54.5%). The closely related predictive factors were baseline plasma viraemia levels and the number of mutations known to reduce susceptibility to LPV/RTV. Thirty-one patients (13.8%) discontinued LPV/RTV during the follow-up, and one AIDS event and three deaths were recorded. Of the 134 patients (59.8%) who underwent a baseline genotype resistance test, 22 (16.4%) had > or = 6 mutations known to reduce LPV/RTV susceptibility; plasma viraemia became undetectable in 76 patients (56.7%), only five of whom harboured > or = 6 mutations at baseline (P=0.0001). The independent predictive factors related to virological success were plasma viraemia levels and the number of mutations reducing susceptibility to LPV/RTV at baseline; each additional log10 copies/ml of HIV RNA reduced the probability of virological success by 34.0% and each extra mutation by 14.5%.
我们评估了洛匹那韦/利托那韦（LPV/RTV）对224例感染HIV-1且曾接受蛋白酶抑制剂（PI）治疗但对高效抗逆转录病毒治疗（HAART）方案出现病毒学失败的患者的病毒学转归，并对其进行了至少3个月的随访。基线时，血浆病毒血症的中位数水平为4.61 log10拷贝/毫升（范围3 - 6.48），CD4细胞计数的中位数为219个细胞/立方毫米（范围1 - 836）。在中位随访272天（范围92 - 635）期间，我们观察到CD4细胞数量增加（P = 0.02），血浆病毒血症水平显著下降（P = 0.0001），122例患者（54.5%）的病毒血症变为检测不到。密切相关的预测因素是基线血浆病毒血症水平以及已知会降低对LPV/RTV敏感性的突变数量。31例患者（13.8%）在随访期间停用了LPV/RTV，记录到1例艾滋病事件和3例死亡。在134例（59.8%）进行了基线基因型耐药检测的患者中，22例（16.4%）有≥6个已知会降低LPV/RTV敏感性的突变；76例患者（56.7%）的血浆病毒血症变为检测不到，其中只有5例在基线时携带≥6个突变（P = 0.0001）。与病毒学成功相关的独立预测因素是血浆病毒血症水平以及基线时降低对LPV/RTV敏感性的突变数量；HIV RNA每增加1 log10拷贝/毫升，病毒学成功的概率降低34.0%，每增加一个额外突变，概率降低14.5%。
