Schechter Mauro, Tuboi Suely Hiromi
Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro Av. Brigadeiro Trompowski s/n, Ilha do Fundão, Rio de Janeiro 21941-590, Brazil.
J Antimicrob Chemother. 2006 Sep;58(3):506-10. doi: 10.1093/jac/dkl263. Epub 2006 Jul 19.
In response to antiretroviral therapy, some patients experience what has been termed a discordant response, characterized either by a sustained CD4+ cell count rise despite persistent viraemia or by HIV-1 RNA plasma levels below the limit of detection accompanied by a blunted CD4+ cell count response. In part because of a lack of universally accepted definitions, published estimates of the frequency of discordant responses vary considerably. Little is known about the pathogenesis of discordant responses, which seems to depend on the interaction of a multitude of viral, host and treatment-related factors. Available evidence indicates that discordant responses are associated with an intermediate risk of death or clinical progression. At present, recommendations for the clinical management of patients with discordant responses to antiretroviral therapy are largely based on observational, uncontrolled data. The development of standardized and universally accepted definitions of discordant responses is necessary to allow meaningful comparisons between studies to be made, as well as to help in the design of trials of possible therapeutic interventions.
在接受抗逆转录病毒治疗时，一些患者会出现所谓的不一致反应，其特征要么是尽管病毒血症持续存在，但CD4+细胞计数持续上升，要么是血浆HIV-1 RNA水平低于检测下限，同时伴有CD4+细胞计数反应迟钝。部分由于缺乏普遍接受的定义，已发表的关于不一致反应频率的估计差异很大。关于不一致反应的发病机制知之甚少，这似乎取决于多种病毒、宿主和治疗相关因素的相互作用。现有证据表明，不一致反应与死亡或临床进展的中度风险相关。目前，对抗逆转录病毒治疗有不一致反应的患者的临床管理建议主要基于观察性、非对照数据。制定标准化且普遍接受的不一致反应定义对于进行有意义的研究间比较以及帮助设计可能的治疗干预试验是必要的。
