Toulson Adrienne R, Harrigan Richard, Heath Katherine, Yip Benita, Brumme Zabrina L, Harris Marianne, Hogg Robert S, Montaner Julio S G
BC Centre for Excellence in HIV/AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
J Infect Dis. 2005 Nov 15;192(10):1787-93. doi: 10.1086/491738. Epub 2005 Oct 5.
The goal of the present study was to characterize outcome and predictors of outcome of treatment interruption (TI) in highly active antiretroviral therapy (HAART)-treated patients.
A systematic chart/database review was conducted to identify patients with nadir CD4 cell counts >200 cells/mm(3) and without acquired immunodeficiency syndrome-defining illnesses who underwent a TI. Collected data included duration and reason for TI, demographic characteristics, CD4 cell count, and plasma viral load. Human immunodeficiency virus (HIV) envelope (V3) loop genotyping was performed on plasma HIV RNA. The presence of basic residues at aa 11 and/or 25 (the "11/25" genotype) was a further possible prognostic variable of interest. Cox proportional hazards models were used to assess characteristics associated with time to HAART reinitiation after TI.
A total of 208 of 4461 (4.7%) patients underwent TI. The study group consisted of 197 (94.7%) of 208 participants for whom V3 genotyping was successful. The median CD4 cell count at time of the initiation of TI was 620 cells/mm(3). A total of 59 (29.9%) patients reinitiated HAART after a median of 15 months. At the time of the reinitiation of HAART, the median plasma viral load was >100,000 copies/mL, and the median CD4 cell count was 260 cells/mm(3). Among the 197 study patients, there were 6 deaths, none of which was attributable to the TI. A total of 81% had plasma viral loads <50 copies/mL by 15 months of follow-up after reinitiation of HAART. In multivariate analysis, a nadir CD4 cell count < or =250 cells/mm(3) (risk ratio [RR], 2.79 [95% confidence interval [CI], 1.60-4.86]; P < .001) and the presence of the 11/25 genotype (RR, 2.07 [95% CI, 1.07-4.02]; P = .031) were positively and independently associated with faster time to HAART reinitiation, after adjusting for age and plasma virus load at the start of TI.
Our study suggests that TI is a viable option for HIV-positive adults with nadir CD4 cell counts >250 cells/mm(3). A nadir CD4 cell count of 200-250 cells/mm(3) and the 11/25 viral genotype were found to be associated with a faster HAART reinitiation.
本研究的目的是描述接受高效抗逆转录病毒治疗（HAART）的患者治疗中断（TI）的结局及结局预测因素。
进行系统的图表/数据库回顾，以确定最低点CD4细胞计数>200个细胞/mm³且无获得性免疫缺陷综合征定义疾病的接受TI的患者。收集的数据包括TI的持续时间和原因、人口统计学特征、CD4细胞计数及血浆病毒载量。对血浆HIV RNA进行人类免疫缺陷病毒（HIV）包膜（V3）环基因分型。第11和/或25位氨基酸处存在碱性残基（“11/25”基因型）是另一个可能感兴趣的预后变量。使用Cox比例风险模型评估与TI后重新开始HAART时间相关的特征。
4461例患者中有208例（4.7%）接受了TI。研究组包括208例参与者中的197例（94.7%），其V3基因分型成功。TI开始时的CD4细胞计数中位数为620个细胞/mm³。共有59例（29.9%）患者在中位数15个月后重新开始HAART。重新开始HAART时，血浆病毒载量中位数>100,000拷贝/mL，CD4细胞计数中位数为260个细胞/mm³。在197例研究患者中，有6例死亡，均与TI无关。重新开始HAART后随访15个月时，共有81%的患者血浆病毒载量<50拷贝/mL。多因素分析显示，最低点CD4细胞计数≤250个细胞/mm³（风险比[RR]，2.79[95%置信区间[CI]，1.60 - 4.86]；P <.001）和存在11/25基因型（RR，2.07[95%CI，1.07 - 4.02]；P = 0.031）在调整TI开始时的年龄和血浆病毒载量后，与更快重新开始HAART的时间呈正相关且独立相关。
我们的研究表明，对于最低点CD4细胞计数>250个细胞/mm³的HIV阳性成人，TI是一种可行的选择。发现最低点CD4细胞计数为200 - 250个细胞/mm³和11/25病毒基因型与更快重新开始HAART相关。
