Mocroft Amanda, Phillips Andrew N, Ledergerber Bruno, Katlama Christine, Chiesi Antonio, Goebel Frank-Detlef, Knysz Brygioa, Antunes Francisco, Reiss Peter, Lundgren Jens D
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
AIDS. 2006 May 12;20(8):1141-50. doi: 10.1097/01.aids.0000226954.95094.39.
It is unknown if the CD4 cell count response differs according to antiretroviral drugs used in combination antiretroviral therapy (cART) in patients with maximal virological suppression [viral load (VL) < 50 copies/ml].
To compare the change in CD4 cell count over consecutive measurements with VL < 50 copies/ml at both time-points according to nucleoside backbones and other antiretrovirals used.
Generalized linear models, accounting for multiple measurements within patients, were used to compare CD4 cell count changes after adjustment for antiretrovirals, time from starting cART, age, CD4 at first VL < 50 copies/ml, prior antiretroviral treatment, and change in CD4 cell count since starting cART.
We studied 28418 instances of VL < 50 copies/ml in 4041 patients. The mean annual change in CD4 cell count was +45.5/microl [95% confidence interval (CI) +39.4 to +51.6/microl). Comparing two drug nucleoside backbones, there was a lower annual change in CD4 cell count for zidovudine/lamivudine (n = 13038; -15.4/microl; P = 0.012) and for those on tenofovir (n = 1809; -27.3/microl; P = 0.029) compared to lamivudine/stavudine (n = 7339). Compared to the boosted-protease inhibitor regimen (n = 5915), use of an abacavir-based triple-nucleoside regimen was associated with a lower annual change in CD4 cell count (n = 2504 pairs; -26.1/microl; P = 0.011).
A nucleoside backbone of zidovudine/lamivudine or any tenofovir-based backbone was associated with significantly poorer increases in CD4 cell count compared to a nucleoside backbone of stavudine/lamivudine, as was an abacavir-based triple nucleoside regimen compared to a boosted protease inhibitor regimen. Long-term studies are needed to determine whether the differences in immunological response seen here translate into differences in the risk of clinical disease.
在病毒学得到最大程度抑制（病毒载量[VL]<50拷贝/毫升）的患者中，联合抗逆转录病毒疗法（cART）所使用的抗逆转录病毒药物不同，其CD4细胞计数反应是否存在差异尚不清楚。
根据核苷类主干药物和使用的其他抗逆转录病毒药物，比较在两个时间点病毒载量均<50拷贝/毫升时连续测量的CD4细胞计数变化。
采用广义线性模型，考虑患者内部的多次测量，在对抗逆转录病毒药物、开始cART后的时间、年龄、首次病毒载量<50拷贝/毫升时的CD4细胞计数、既往抗逆转录病毒治疗以及开始cART后CD4细胞计数的变化进行调整后，比较CD4细胞计数的变化。
我们研究了4041例患者的28418次病毒载量<50拷贝/毫升的情况。CD4细胞计数的年均变化为+45.5/微升[95%置信区间（CI）+39.4至+51.6/微升]。与拉米夫定/司他夫定（n = 7339）相比，齐多夫定/拉米夫定（n = 13038；-15.4/微升；P = 0.012）以及使用替诺福韦的患者（n = 1809；-27.3/微升；P = 0.029）的CD4细胞计数年均变化较低。与增强型蛋白酶抑制剂方案（n = 5915）相比，使用基于阿巴卡韦的三联核苷方案与CD4细胞计数的年均变化较低相关（n = 2504对；-26.1/微升；P = 0.011）。
与司他夫定/拉米夫定的核苷类主干药物相比，齐多夫定/拉米夫定的核苷类主干药物或任何基于替诺福韦的主干药物与CD4细胞计数的显著较差增加相关，与增强型蛋白酶抑制剂方案相比，基于阿巴卡韦的三联核苷方案也是如此。需要进行长期研究以确定此处观察到的免疫反应差异是否转化为临床疾病风险的差异。
