Gandhi Tejal, Wei Wei, Amin Kamal, Kazanjian Powel
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Clin Infect Dis. 2006 Mar 15;42(6):878-84. doi: 10.1086/500210. Epub 2006 Feb 8.
We evaluated the effect of maintaining highly active antiretroviral therapy (HAART) on the development of new acquired immunodeficiency syndrome (AIDS)-related events in patients with late-stage human immunodeficiency virus (HIV) infection who had suboptimal CD4+ cell count and viral load responses to HIV therapy.
In patients with pretreatment CD4+ cell counts of <200 cells/mm3, incidence rates of new AIDS-related events occurring during HIV treatment were calculated during period 1 (pre-HAART era, 1990-1995; 88 patients) and period 2 (HAART era, 1996-2004; 214 patients) according to CD4+ cell count responses while receiving treatment. Cox multivariate model was used to compare rates of AIDS-related events from period 2 with those from period 1 according to specific CD4+ cell count response categories and rates of AIDS-related events for various viral load ranges within CD4+ cell count categories during period 2.
For period 2 patients with CD4+ cell counts <50 cells/mm3 and viral loads >100,000 copies/mL, the rate of AIDS-related events (39.3 events per 100 person-years) was significantly lower than that for period 1 patients with CD4+ cell counts <50 cells/mm3 (76.4 events per 100 person-years; P=.02). This held true for patients with CD4+ cell counts <100 cells/mm3; there were also significantly fewer AIDS-related events in period 2 (18 events per 100 person-years) than in period 1 (65.2 events per 100 person-years; P=.001), including those events occurring among period 2 patients with viral loads >100,000 copies/mL (29.5 events per 100 person-years; P=.01). Similarly, for patients with CD4+ cell counts of 100-200 cells/mm3, there were fewer AIDS-related events in period 2 (7.8 events per 100 person-years) than in period 1 (34.5 events per 100 person-years; P=.001); even for patients in period 2 with viral loads >100,000 copies/mL (15.4 events per 100 person-years; P=.04).
Our data suggest that, even among patients with late-stage HIV infection and inadequate CD4+ cell count and viral load responses to HIV therapy, maintaining HAART may reduce the incidence of AIDS-related events.
我们评估了维持高效抗逆转录病毒疗法（HAART）对晚期人类免疫缺陷病毒（HIV）感染患者新获得性免疫缺陷综合征（AIDS）相关事件发生情况的影响，这些患者对HIV治疗的CD4+细胞计数和病毒载量反应欠佳。
对于预处理时CD4+细胞计数<200个/立方毫米的患者，根据治疗期间的CD4+细胞计数反应，计算HIV治疗期间新发生的AIDS相关事件的发生率，分为第1阶段（HAART治疗前时代，1990 - 1995年；88例患者）和第2阶段（HAART治疗时代，1996 - 2004年；214例患者）。采用Cox多变量模型，根据特定的CD4+细胞计数反应类别，比较第2阶段与第1阶段AIDS相关事件的发生率，并比较第2阶段CD4+细胞计数类别内不同病毒载量范围的AIDS相关事件发生率。
对于第2阶段CD4+细胞计数<50个/立方毫米且病毒载量>100,000拷贝/毫升的患者，AIDS相关事件的发生率（每100人年39.3例）显著低于第1阶段CD4+细胞计数<50个/立方毫米的患者（每100人年76.4例；P = 0.02）。CD4+细胞计数<100个/立方毫米的患者也是如此；第2阶段的AIDS相关事件（每100人年18例）也显著少于第1阶段（每100人年65.2例；P = 0.001），包括第2阶段病毒载量>100,000拷贝/毫升的患者中发生的事件（每100人年29.5例；P = 0.01）。同样，对于CD4+细胞计数为100 - 200个/立方毫米的患者，第2阶段的AIDS相关事件（每100人年7.8例）少于第1阶段（每100人年34.5例；P = 0.001）；即使是第2阶段病毒载量>100,000拷贝/毫升的患者（每100人年15.4例；P = 0.04）也是如此。
我们的数据表明，即使在晚期HIV感染且对HIV治疗的CD4+细胞计数和病毒载量反应不足的患者中，维持HAART治疗也可能降低AIDS相关事件的发生率。
