Vallejo Alejandro, Valladares Angela, De Felipe Beatriz, Vivancos Jorge, Gutierrez Sonia, Soriano-Sarabia Natalia, Ruiz-Mateos Ezequiel, Lissen Eduardo, Leal Manuel
Group for the Study of Viral Hepatitis and AIDS, Service of Internal Medicine and Biochemistry Department, University Hospital Virgen del Rocio, Seville, Spain.
Viral Immunol. 2005;18(4):740-6. doi: 10.1089/vim.2005.18.740.
One of the strategies that has been investigated to reduce antiretroviral treatment toxicity in patients infected with human immunodeficiency virus (HIV) is structured treatment interruption (STI). Our aim was to analyze early viral and immune dynamics after interruption of highly active antiretroviral therapy (HAART) and to determine whether thymic function-related markers play a role in preventing CD4 count decline caused by increased viral replication. This was a prospective study of an open cohort of 47 HIV-infected patients with a median 969 CD4 count and prolonged viral suppression. They were followed every 4 weeks though week 24. Thymic volume and TREC level were analyzed at baseline. Increased thymic volume was associated with higher plasma viral load and greater CD4 count decline early after interruption. Three virologic patterns were observed: rapid/high (RH), delayed/high (DH), and low/slow (LS) viral replication. RH correlated with higher thymic volume at baseline and with higher CD4 count decline at week 4. Patients with greater thymic volume was associated with an immune and virologic impairment only early after interruption, probably because of infection of the increased number of available target cells. As the long-term consequences of these observations are unknown, the safety of treatment interruption must be further studied.
为降低人类免疫缺陷病毒（HIV）感染患者抗逆转录病毒治疗毒性而进行研究的策略之一是结构化治疗中断（STI）。我们的目的是分析高效抗逆转录病毒疗法（HAART）中断后的早期病毒和免疫动力学，并确定胸腺功能相关标志物是否在预防因病毒复制增加导致的CD4细胞计数下降中起作用。这是一项对47例HIV感染患者的开放队列进行的前瞻性研究，这些患者的CD4细胞计数中位数为969，且病毒得到长期抑制。在第24周之前，每4周对他们进行一次随访。在基线时分析胸腺体积和TREC水平。胸腺体积增加与中断治疗后早期较高的血浆病毒载量和更大的CD4细胞计数下降相关。观察到三种病毒学模式：快速/高（RH）、延迟/高（DH）和低/慢（LS）病毒复制。RH与基线时较高的胸腺体积以及第4周时较高的CD4细胞计数下降相关。胸腺体积较大的患者仅在中断治疗后早期与免疫和病毒学损害相关，这可能是由于可用靶细胞数量增加导致感染。由于这些观察结果的长期后果尚不清楚，治疗中断的安全性必须进一步研究。
