Flynn Patricia M, Rudy Bret J, Douglas Steven D, Lathey Janet, Spector Stephen A, Martinez Jaime, Silio Margarita, Belzer Marvin, Friedman Lawrence, D'Angelo Lawrence, McNamara James, Hodge Janice, Hughes Michael D, Lindsey Jane C
Department of Infectious Diseases, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
J Infect Dis. 2004 Jul 15;190(2):271-9. doi: 10.1086/421521. Epub 2004 Jun 18.
Adolescents represent the fastest growing demographic group of new human immunodeficiency virus (HIV) infections in the United States. At present, there is little information available about their response to therapy.
We studied 120 adolescents infected via high-risk behaviors who began receiving highly active antiretroviral therapy (HAART), to determine their virologic and immunologic response to therapy.
Subjects were enrolled at 28 sites of the Pediatric Acquired Immunodeficiency Syndrome Clinical Trials Group. After 16-24 weeks of HAART, 59% of subjects had reproducible undetectable virus loads, according to repeat measurements (virologic success). As enumerated by flow-cytometric analysis, increases in levels of CD4 helper cells (both naive and memory) and decreases in levels of CD8 suppressor cells were observed. Partial restoration of some immunologic parameters for patients who did not achieve virologic success was also observed, but to a more limited extent than for adolescents with virologic success. Adherence to HAART was the only predictor of achieving undetectable virus loads.
Adolescents have the capacity to improve their immunologic status with HAART. Lower than expected success in virologic control is related to lack of adherence, and efforts to improve treatment outcome must stress measures to assure adherence to medication.
在美国，青少年是新增人类免疫缺陷病毒（HIV）感染人群中增长最快的群体。目前，关于他们对治疗反应的信息很少。
我们研究了120名通过高危行为感染HIV并开始接受高效抗逆转录病毒治疗（HAART）的青少年，以确定他们对治疗的病毒学和免疫学反应。
受试者在儿科获得性免疫缺陷综合征临床试验组的28个地点入组。接受HAART治疗16 - 24周后，根据重复测量结果，59%的受试者病毒载量持续检测不到（病毒学成功）。通过流式细胞术分析发现，CD4辅助细胞（包括初始细胞和记忆细胞）水平升高，CD8抑制细胞水平降低。对于未实现病毒学成功的患者，也观察到一些免疫参数的部分恢复，但程度比病毒学成功的青少年更有限。坚持HAART治疗是实现病毒载量检测不到的唯一预测因素。
青少年有能力通过HAART改善免疫状态。病毒学控制成功率低于预期与治疗依从性差有关，改善治疗结果的努力必须强调确保坚持用药的措施。
