Achenbach C J, Till M, Palella F J, Knoll M D, Terp S M, Kalnins A U, Murphy R L
Division of Infectious Diseases, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
HIV Med. 2005 Jan;6(1):7-12. doi: 10.1111/j.1468-1293.2005.00257.x.
Evaluation of extended treatment interruption (TI) in chronic HIV infection among patients successfully treated with antiretroviral therapy.
An observational analysis of 25 patients in a prospectively followed cohort with chronic HIV infection, viral loads <500 HIV-1 RNA copies/mL for at least 6 months, and an interruption in therapy of >/=28 days duration was carried out. Follow up was divided into 3-month time periods for analysis. The effects of time period, stratification group and stratification group by time period interactions on CD4 counts were tested using a mixed model. Univariate comparisons among patient characteristics and responses were performed using Fisher's exact test or the Wilcoxon rank sum test.
At initiation of TI, the median CD4 count was 799 cells/microL. TI duration was a median of 7.1 months. HIV RNA rebounded to a median maximum level of 75 000 copies/mL. Maximum viral rebound was significantly greater in patients who were male, had lipodystrophy and had zenith HIV RNA prior to TI of >/=50 000 copies/mL. Lower CD4 cell counts were observed during TI in patients with lipodystrophy, zenith HIV RNA >/=50 000 copies/mL, history of AIDS, HIV infection >/=5 years and presuppression CD4 count </=350 cells/muL. Patients who reinitiated therapy had shorter TI duration, presuppression CD4 count </=350 cells/microL, previous AIDS diagnosis and lipodystrophy. No patients developed adverse or AIDS-defining events during TI.
Long-term TI resulted in greater immune deterioration in patients with high viral set points or low CD4 cell counts prior to initiation of suppressive antiretroviral therapy.
评估接受抗逆转录病毒治疗成功的慢性HIV感染患者延长治疗中断（TI）的情况。
对25例慢性HIV感染患者进行观察性分析，这些患者来自一个前瞻性随访队列，病毒载量<500 HIV-1 RNA拷贝/mL至少6个月，且治疗中断持续时间≥28天。随访分为3个月时间段进行分析。使用混合模型测试时间段、分层组以及时间段与分层组的交互作用对CD4细胞计数的影响。患者特征和反应之间的单变量比较采用Fisher精确检验或Wilcoxon秩和检验。
在TI开始时，CD4细胞计数中位数为799个/微升。TI持续时间中位数为7.1个月。HIV RNA反弹至中位数最高水平75000拷贝/mL。男性、有脂肪代谢障碍且TI前HIV RNA峰值≥50000拷贝/mL的患者最大病毒反弹明显更大。脂肪代谢障碍、HIV RNA峰值≥50000拷贝/mL、有AIDS病史、HIV感染≥5年以及抑制前CD4细胞计数≤350个/微升的患者在TI期间观察到较低的CD4细胞计数。重新开始治疗的患者TI持续时间较短、抑制前CD4细胞计数≤350个/微升、既往有AIDS诊断和脂肪代谢障碍。TI期间没有患者发生不良事件或AIDS定义事件。
长期TI导致在开始抑制性抗逆转录病毒治疗前病毒载量高或CD4细胞计数低的患者免疫功能恶化更严重。
