Martinez Valérie, Marcelin Anne-Geneviève, Morini Jean-Pierre, Deleuze Jean, Krivine Anne, Gorin Isabelle, Yerly Sabine, Perrin Luc, Peytavin Gilles, Calvez Vincent, Dupin Nicolas
Service de Dermatologie, Hôpital Tarnier-Cochin, 89, rue d'Assas, 75006 Paris, France.
AIDS. 2005 Jul 1;19(10):1065-9. doi: 10.1097/01.aids.0000174453.55627.de.
It has been demonstrated that, in patients treated by protease-inhibitor-based regimen, intermittent viraemia occurred frequently and was associated with higher concentrations of residual replication but not with virological failure. Risk factors associated with intermittent viraemia and its impact in patients treated by non-nucleoside-reverse-transcriptase-inhibitor-based (NNRTI) regimen need to be evaluated.
We analyzed the occurrence of blips (one HIV-1 RNA > 50 copies/ml with a subsequent value < 50 copies/ml), the level of these blips (between 3 and 50 copies/ml) and their effect on CD4 cell count and the occurrence of virological failure in 43 patients with stable suppression of HIV-1 plasma viraemia (< 50 copies/ml) under NNRTI-based therapy.
Eight out of 43 patients had one episode of blips during the follow-up (median = 350 copies/ml). Comparing patients with and without blips, the median level of HIV-1 RNA at baseline was 7.5 versus 3 copies/ml (P = 0.008), respectively. Patients with blips had a significantly lower CD4 cell count after 12 and 18 months than the others. Plasma concentrations of NNRTI before, during, and after the blips were adequate. In addition, the occurrence of blips was not associated with virological failure.
These results suggest that blips may reflect ongoing viraemia of below 50 copies/ml and can impair the CD4 cell count recovery under an NNRTI regimen. The impairment of CD4 cell count recovery seems to be affected more by the occurrence of blips than by the level of viraemia (< 50 copies/ml) itself. Nevertheless, despite a tight genetic barrier for resistance with NNRTI drugs, no virologic failure occurred during the follow-up.
已证实，在接受基于蛋白酶抑制剂方案治疗的患者中，间歇性病毒血症频繁发生，且与残余复制浓度较高有关，但与病毒学失败无关。需要评估与间歇性病毒血症相关的危险因素及其对接受基于非核苷类逆转录酶抑制剂（NNRTI）方案治疗的患者的影响。
我们分析了43例在基于NNRTI的治疗下HIV-1血浆病毒血症稳定抑制（<50拷贝/毫升）的患者中，病毒载量波动（一次HIV-1 RNA>50拷贝/毫升，随后的值<50拷贝/毫升）的发生情况、这些波动的水平（3至50拷贝/毫升之间）及其对CD4细胞计数的影响以及病毒学失败的发生情况。
43例患者中有8例在随访期间出现一次病毒载量波动（中位数=350拷贝/毫升）。比较有和没有病毒载量波动的患者，基线时HIV-1 RNA的中位数水平分别为7.5拷贝/毫升和3拷贝/毫升（P=0.008）。出现病毒载量波动的患者在12个月和18个月后的CD4细胞计数明显低于其他患者。病毒载量波动前后及期间NNRTI的血浆浓度均充足。此外，病毒载量波动的发生与病毒学失败无关。
这些结果表明，病毒载量波动可能反映了低于50拷贝/毫升的持续病毒血症，并且在NNRTI方案下会损害CD4细胞计数的恢复。CD4细胞计数恢复的损害似乎更多地受病毒载量波动发生的影响，而不是病毒血症水平（<50拷贝/毫升）本身。然而，尽管NNRTI药物具有严格的耐药基因屏障，但随访期间未发生病毒学失败。
