Matheron Sophie, Pueyo Sophie, Damond Florence, Simon François, Leprêtre Annie, Campa Pauline, Salamon Roger, Chêne Genevieve, Brun-Vezinet Françoise
Service des Maladies Infectieuses et Tropicales A, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, France.
AIDS. 2003 Dec 5;17(18):2593-601. doi: 10.1097/00002030-200312050-00006.
To identify factors associated with clinical progression in HIV-2 infected patients.
French prospective cohort initiated in 1994.
Follow-up data are collected twice a year; viral load is assessed once a year by cellular viraemia, quantitative proviral DNA and plasma RNA. A Cox proportional-hazards model was used for studying baseline factors associated with clinical progression.
By December 2001, 217 patients had been enrolled. At inclusion, 80%, 6% and 14% were Centers for Disease Control and Prevention (CDC) group A, B and C, respectively. Median CD4 cell count was 436 x 10(6)/l. In the 48% of positive specimens, the median plasma RNA titre was 3.0 log10 copies/ml. Mean follow-up of the 179 patients seen at least twice was 34.4 months. Of these 13 died and nine progressed to group C. Ninety-three (52%) received antiretroviral therapy during a mean of 33 months, including a protease inhibitor in 48%. The probability of remaining AIDS-free was 97% and 95% at 1 and 3 years, respectively. Independent variables associated with clinical progression were age > or = 40 years [hazard ratio (HR), 11; 95% confidence interval (CI), 1.4-91.8; P = 0.03] and plasma RNA (HR, 2.5 per additional log10 copies/ml; 95% CI, 1.3-4.7, P < 0.01). Prior group B symptoms and CD4 cell count < 200 x 10(6)/l were associated with progression to AIDS. AIDS and plasma RNA were predictive of death.
Considering the limited progression rate of HIV-2 infection, combined antiretroviral therapy should be discussed in patients with high plasma RNA titres, which threshold value remains to be defined. It is recommended in case of AIDS, CDC group B symptoms or CD4 cell count < 200 x 10(6)/l.
确定与HIV-2感染患者临床进展相关的因素。
始于1994年的法国前瞻性队列研究。
每年收集两次随访数据；每年通过细胞病毒血症、定量前病毒DNA和血浆RNA评估病毒载量。采用Cox比例风险模型研究与临床进展相关的基线因素。
到2001年12月，共纳入217例患者。纳入时，分别有80%、6%和14%的患者属于美国疾病控制与预防中心（CDC）A、B和C组。CD4细胞计数中位数为436×10⁶/l。在48%的阳性标本中，血浆RNA滴度中位数为3.0 log₁₀拷贝/ml。179例至少接受过两次随访的患者平均随访时间为34.4个月。其中13例死亡，9例进展为C组。93例（52%）患者在平均33个月期间接受了抗逆转录病毒治疗，其中48%使用了蛋白酶抑制剂。1年和3年时无艾滋病的概率分别为97%和95%。与临床进展相关的独立变量为年龄≥40岁[风险比（HR），11；95%置信区间（CI），1.4 - 91.8；P = 0.03]和血浆RNA（HR，每增加1 log₁₀拷贝/ml为2.5；95% CI，1.3 - 4.7，P < 0.01）。既往B组症状和CD4细胞计数<200×10⁶/l与进展为艾滋病相关。艾滋病和血浆RNA可预测死亡。
考虑到HIV-2感染的进展速度有限，对于血浆RNA滴度高的患者应讨论联合抗逆转录病毒治疗，其阈值仍有待确定。对于艾滋病患者、CDC B组症状患者或CD4细胞计数<200×10⁶/l的患者，建议进行治疗。
Zotero 插件