Waters L, Stebbing J, Jones R, Michailidis C, Sawleshwarkar S, Mandalia S, Bower M, Nelson M, Gazzard B
St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
J Antimicrob Chemother. 2004 Aug;54(2):503-7. doi: 10.1093/jac/dkh329. Epub 2004 Jun 16.
To compare the immunological response to highly active antiretroviral therapy (HAART) in treatment-naive patients with a baseline CD4 count of <200 cells/mm(3).
We identified treatment-naive human immunodeficiency virus (HIV-1)-infected individuals who had commenced HAART since 1996 and who had a starting CD4 count of <200 cells/mm(3). Immunological success was defined as achieving a CD4 count of >200 cells/mm(3) and treatments were compared using univariate and multivariate Cox's proportional hazards models in order to establish whether protease inhibitor (PI)-based regimens were significantly different to regimens based on non-nucleoside reverse transcriptase inhibitors (NNRTIs). Both regimens utilize a nucleoside analogue (NA) backbone.
A total of 599 patients were identified. When the variables were entered into a multivariate analysis, no significant differences between HAART regimens were found. We showed that compared with efavirenz regimens a two NA plus one PI regimen was not significantly less likely to achieve immunological success (adjusted HR: 0.65, 95% CI 0.41-1.03, P=0.07). Two NA and boosted PI (adjusted HR: 1.33, 95% CI 0.81 to 2.16) or two NA and nevirapine (adjusted HR: 0.93, 95% CI 0.67-1.29) regimens were also not significantly different from efavirenz-based regimens, based on the endpoint of immunological success.
PI-, boosted PI- and NNRTI-based HAART regimens are not significantly different in achieving increased CD4 counts in individuals who commence therapy with a low CD4 count.
比较初治且基线CD4细胞计数<200个/mm³的患者对高效抗逆转录病毒疗法（HAART）的免疫反应。
我们确定了自1996年起开始接受HAART治疗、起始CD4细胞计数<200个/mm³的初治人类免疫缺陷病毒（HIV-1）感染个体。免疫成功定义为CD4细胞计数>200个/mm³，并使用单变量和多变量Cox比例风险模型比较治疗方案，以确定基于蛋白酶抑制剂（PI）的方案与基于非核苷类逆转录酶抑制剂（NNRTIs）的方案是否存在显著差异。两种方案均采用核苷类似物（NA）主干。
共识别出599例患者。将变量纳入多变量分析时，未发现HAART方案之间存在显著差异。我们发现，与依非韦伦方案相比，两核苷类似物加一种蛋白酶抑制剂方案实现免疫成功的可能性并无显著降低（调整后风险比：0.65，95%置信区间0.41 - 1.03，P = 0.07）。基于免疫成功这一终点，两核苷类似物与增强型蛋白酶抑制剂方案（调整后风险比：1.33，95%置信区间0.81至2.16）或两核苷类似物与奈韦拉平方案（调整后风险比：0.93，95%置信区间0.67 - 1.29）与基于依非韦伦的方案也无显著差异。
对于初始CD4细胞计数较低的个体，基于蛋白酶抑制剂、增强型蛋白酶抑制剂和非核苷类逆转录酶抑制剂的HAART方案在提高CD4细胞计数方面并无显著差异。
