Battegay Manuel, Nüesch Reto, Hirschel Bernard, Kaufmann Gilbert R
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Lancet Infect Dis. 2006 May;6(5):280-7. doi: 10.1016/S1473-3099(06)70463-7.
Potent antiretroviral therapy has dramatically improved the prognosis of patients infected with HIV-1. Primary and secondary prophylaxis against Pneumocystis carinii, Mycobacterium avium, cytomegalovirus, and other pathogens can be discontinued safely once CD4 cell counts have increased beyond pathogen-specific thresholds. Approximately one-third of individuals receiving antiretroviral therapy will not reach CD4 cell counts above 500 cells per muL after 5 years despite continuous suppression of plasma HIV-1 RNA. Whether this failure represents a risk factor for the long-term incidence of opportunistic diseases--eg, tuberculosis or malignancies--remains uncertain. We describe the time course of CD4 cell concentrations in patients whose plasma HIV-1 RNA is durably suppressed by antiretroviral therapy, in patients with incomplete suppression of plasma HIV-1 RNA, and during treatment interruptions. In addition, immune reconstitution disease, an inflammatory syndrome associated with immunological recovery occurring days to weeks after the start of antiretroviral therapy, is briefly described.
强效抗逆转录病毒疗法显著改善了HIV-1感染患者的预后。一旦CD4细胞计数增加到超过病原体特异性阈值，就可以安全地停止对卡氏肺孢子虫、鸟分枝杆菌、巨细胞病毒和其他病原体的一级和二级预防。尽管血浆HIV-1 RNA持续受到抑制，但接受抗逆转录病毒治疗的个体中约有三分之一在5年后CD4细胞计数仍未达到每微升500个细胞以上。这种失败是否代表机会性疾病（如结核病或恶性肿瘤）长期发病的危险因素仍不确定。我们描述了抗逆转录病毒疗法使血浆HIV-1 RNA得到持久抑制的患者、血浆HIV-1 RNA抑制不完全的患者以及治疗中断期间患者的CD4细胞浓度随时间的变化过程。此外，还简要描述了免疫重建疾病，这是一种与抗逆转录病毒治疗开始数天至数周后发生的免疫恢复相关的炎症综合征。
