Palmisano Lucia, Giuliano Marina, Nicastri Emanuele, Pirillo Maria Franca, Andreotti Mauro, Galluzzo Clementina M, Bucciardini Raffaella, Fragola Vincenzo, Andreoni Massimo, Vella Stefano
Istituto Superiore di Sanità, Department of Drug Research and Evaluation, Rome, Italy.
AIDS. 2005 Nov 4;19(16):1843-7. doi: 10.1097/01.aids.0000188426.87538.ed.
To determine factors associated with < 2.5 copies/ml plasma HIV RNA in subjects treated with highly active antiretroviral therapy (HAART) and with viraemia < 50 copies/ml.
Cross-sectional analysis of 84 HIV-positive patients taking HAART with plasma HIV RNA < 50 copies/ml for at least 6 months and no history of virological failure.
Current HAART therapy was based on a non-nucleoside reverse transcriptase inhibitor (NNRTI) in 66%, a protease inhibitor in 26% and nucleoside reverse transcriptase inhibitors in 7%. Viraemia levels were measured using a modified ultrasensitive Roche Amplicor HIV-1 Monitor test able to quantify plasma HIV RNA to a lower limit of 2.5 copies /ml; proviral DNA was measured with a real-time polymerase chain reaction assay. Analysis of variance and multiple logistic regression analysis were utilized to test for associations between residual replication and other variables.
Residual HIV viraemia > 2.5 copies/ml was found in 50% of subjects; 94% of subjects had detectable proviral DNA (>or= 20 copies/10(6) peripheral blood mononuclear cells) and 21% had archived mutations. Usage of a NNRTI-based HAART was the only independent predictor of viral suppression below the cut-off value of the modified ultrasensitive assay.
In our population, NNRTI-based HAART seems to have a stronger impact on residual replication than protease inhibitor-based HAART. This finding may be considered in therapeutic decisions such as the choice of initial HAART regimen and the interruption or simplification of treatment.
确定在接受高效抗逆转录病毒治疗（HAART）且病毒血症低于50拷贝/毫升的受试者中，与血浆HIV RNA低于2.5拷贝/毫升相关的因素。
对84例接受HAART治疗且血浆HIV RNA低于50拷贝/毫升至少6个月且无病毒学失败史的HIV阳性患者进行横断面分析。
目前的HAART治疗方案中，66%基于非核苷类逆转录酶抑制剂（NNRTI），26%基于蛋白酶抑制剂，7%基于核苷类逆转录酶抑制剂。使用改良的超灵敏罗氏Amplicor HIV-1监测试验测量病毒血症水平，该试验能够将血浆HIV RNA定量至下限2.5拷贝/毫升；使用实时聚合酶链反应测定法测量前病毒DNA。采用方差分析和多元逻辑回归分析来检验残余复制与其他变量之间的关联。
50%的受试者中发现残余HIV病毒血症>2.5拷贝/毫升；94%的受试者可检测到前病毒DNA（≥20拷贝/10⁶外周血单个核细胞），21%的受试者存在存档突变。基于NNRTI的HAART治疗是病毒抑制低于改良超灵敏检测临界值的唯一独立预测因素。
在我们的研究人群中，基于NNRTI的HAART似乎比基于蛋白酶抑制剂的HAART对残余复制的影响更大。这一发现可在治疗决策中予以考虑，如初始HAART方案的选择以及治疗的中断或简化。
