Moore David M, Hogg Robert S, Yip Benita, Wood Evan, Tyndall Mark, Braitstein Paula, Montaner Julio S G
British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
J Acquir Immune Defic Syndr. 2005 Nov 1;40(3):288-93. doi: 10.1097/01.qai.0000182847.38098.d1.
To examine the independent association of discordant virologic and immunologic responses to highly active antiretroviral therapy (HAART) with mortality.
A population-based study of 1527 treatment-naive individuals initiating HAART used Cox proportional hazards modeling to determine the independent association of treatment response at 3 to 9 months with nonaccidental mortality. Logistic regression was used to examine associations with discordant responses.
Viral load (VL)/CD4 discordant responses were seen in 235 (15.4%) of subjects, and VL/CD4 responses were seen in 179 (11.7%) of subjects. In adjusted Cox regression models, discordant responses were found to be independently associated with an increased risk of mortality (VL/CD4: relative hazard [RH] = 1.87, 95% confidence interval [CI]: 1.15 to 3.04; VL/CD4: RH = 2.47, 95% CI: 1.54 to 3.95). VL/CD4 discordance was found to be associated with increasing age, baseline HIV RNA load <100,000 copies/mL, baseline CD4 counts <50 cells/muL, the use of lamivudine (3TC)/zidovudine (ZDV), and poor adherence to therapy. VL/CD4 discordance was associated with younger age; injection drug use; baseline HIV RNA load >100,000 copies/mL; the use of 3TC/ZDV, didanosine (ddI)/3TC, or ddI/stavudine; and poor adherence to therapy.
Discordant responses are independently associated with an increased risk of mortality and are, in turn, associated with poor adherence to therapy.
探讨高效抗逆转录病毒治疗（HAART）中病毒学和免疫学反应不一致与死亡率之间的独立关联。
一项基于人群的研究，对1527例初治并开始接受HAART的个体，采用Cox比例风险模型来确定3至9个月时治疗反应与非意外死亡率之间的独立关联。采用逻辑回归分析不一致反应的相关性。
235例（15.4%）受试者出现病毒载量（VL）/CD4反应不一致，179例（11.7%）受试者出现VL/CD4反应一致。在调整后的Cox回归模型中，发现不一致反应与死亡风险增加独立相关（VL/CD4：相对风险[RH]=1.87，95%置信区间[CI]：1.15至3.04；VL/CD4：RH=2.47，95%CI：1.54至3.95）。发现VL/CD4不一致与年龄增加、基线HIV RNA载量<100,000拷贝/mL、基线CD4计数<50个细胞/μL、使用拉米夫定（3TC）/齐多夫定（ZDV）以及治疗依从性差有关。VL/CD4不一致与年龄较小、注射吸毒、基线HIV RNA载量>100,000拷贝/mL、使用3TC/ZDV、去羟肌苷（ddI）/3TC或ddI/司他夫定以及治疗依从性差有关。
不一致反应与死亡风险增加独立相关，反过来又与治疗依从性差有关。
