van Leth Frank, Huisamen Casper B, Badaro Roberto, Vandercam Bernard, de Wet Joss, Montaner Julio S G, Hall David B, Wit Ferdinand W N M, Lange Joep M A
International Antiviral Therapy Evaluation Center, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
J Acquir Immune Defic Syndr. 2005 Mar 1;38(3):296-300.
The initial rate of plasma HIV-1 RNA (pVL) decline has been proposed as a marker of early efficacy of antiretroviral therapy (ART) and a possible predictor of late efficacy. We compared the rate of pVL decline in patients starting ART with nevirapine (NVP), efavirenz (EFV), or both drugs combined in addition to lamivudine (3TC) and stavudine (d4T).
Analysis of the viral decay constant (VDc) during the first 2 weeks of treatment in patients enrolled in the 2NN study who remained on allocated treatment.
The median VDc (log10 copies per day, [interquartile range]) was similar for NVP (0.30 [0.25-0.36], EFV (0.31 [0.27-0.37]), and NVP + EFV (0.30 [0.27-0.36]). Patients with a baseline pVL >100,000 copies/mL were 8.7 (95% confidence interval [CI]: 6.2-12.3) times more likely to have a VDc >75th percentile. A high VDc was not associated with plasma drug concentration or with a decreased risk of virologic failure at week 48 after the start of therapy (hazard ratio = 0.8, 95% CI: 0.6-1.2).
NVP, EFV, or NVP + EFV in combination with 3TC and d4T show similar rates of pVL decline during the first 2 weeks of treatment. The VDc with these regimens is not predictive of late virologic efficacy.
血浆HIV-1 RNA（pVL）下降的初始速率已被提议作为抗逆转录病毒疗法（ART）早期疗效的标志物以及晚期疗效的可能预测指标。我们比较了开始接受包含奈韦拉平（NVP）、依非韦伦（EFV）或两种药物联合（同时使用拉米夫定（3TC）和司他夫定（d4T））的ART治疗患者的pVL下降速率。
对参加2NN研究且继续接受分配治疗的患者治疗前2周的病毒衰减常数（VDc）进行分析。
NVP组（0.30[0.25 - 0.36]）、EFV组（0.31[0.27 - 0.37]）和NVP + EFV组（0.30[0.27 - 0.36]）的VDc中位数（每天log10拷贝数，[四分位间距]）相似。基线pVL>100,000拷贝/mL的患者VDc>第75百分位数的可能性高8.7倍（95%置信区间[CI]：6.2 - 12.3）。高VDc与血浆药物浓度无关，也与治疗开始后第48周病毒学失败风险降低无关（风险比 = 0.8，95%CI：0.6 - 1.2）。
NVP、EFV或NVP + EFV与3TC和d4T联合使用时，在治疗的前2周显示出相似的pVL下降速率。这些治疗方案的VDc不能预测晚期病毒学疗效。
