Gras Luuk, Kesselring Anouk M, Griffin James T, van Sighem Ard I, Fraser Christophe, Ghani Azra C, Miedema Frank, Reiss Peter, Lange Joep M A, de Wolf Frank
HIV Monitoring Foundation, Amsterdam, The Netherlands.
J Acquir Immune Defic Syndr. 2007 Jun 1;45(2):183-92. doi: 10.1097/QAI.0b013e31804d685b.
CD4 cell count changes in therapy-naive patients were investigated during 7 years of highly active antiretroviral therapy (HAART) in an observational cohort.
Three endpoints were studied: (1) time to >or=800 CD4 cells/mm in 5299 therapy-naive patients starting HAART, (2) CD4 cell count changes during 7 years of uninterrupted HAART in a subset of 544 patients, and (3) reaching a plateau in CD4 cell restoration after 5 years of HAART in 366 virologically suppressed patients.
Among patients with <50, 50 to 200, 200 to 350, 350 to 500, and >or=500 CD4 cells/mm at baseline, respectively, 20%, 26%, 46%, 73%, and 87% reached >or=800 CD4 cells/mm within 7 years of starting HAART. Periods with HIV RNA levels >500 copies/mL and age >or=50 years were associated with lesser increases in CD4 cell counts between 6 months and 7 years. Having reached >or=800 CD4 cells/mm at 5 years, age >or=50 years, and >or=1 HIV RNA measurement >1000 copies/mL between 5 and 7 years were associated with a plateau in CD4 cell restoration.
Restoration to CD4 cell counts >or=800 cells/mm is feasible within 7 years of HAART in most HIV-infected patients starting with >or=350 cells/mm and achieving sufficient suppression of viral replication. Particularly in patients >or=50 years of age, it may be beneficial to start earlier than current guidelines recommend.
在一项观察性队列研究中，对初治患者在7年高效抗逆转录病毒治疗（HAART）期间的CD4细胞计数变化进行了调查。
研究了三个终点：（1）5299例开始接受HAART的初治患者达到CD4细胞计数≥800个/mm³的时间；（2）544例患者亚组在7年不间断HAART期间的CD4细胞计数变化；（3）366例病毒学抑制患者在HAART 5年后CD4细胞恢复达到平台期的情况。
基线时CD4细胞计数分别＜50、50至200、200至350、350至500以及≥500个/mm³的患者中，分别有20%、26%、46%、73%和87%在开始HAART后7年内达到CD4细胞计数≥800个/mm³。HIV RNA水平＞500拷贝/mL的时期以及年龄≥50岁与6个月至7年期间CD4细胞计数增加较少相关。在5年时达到CD4细胞计数≥800个/mm³、年龄≥50岁以及在5至7年期间≥1次HIV RNA测量＞1000拷贝/mL与CD4细胞恢复达到平台期相关。
对于大多数开始时CD4细胞计数≥350个/mm³且实现病毒复制充分抑制的HIV感染患者，在HAART 7年内将CD4细胞计数恢复至≥800个/mm³是可行的。特别是对于年龄≥50岁的患者，比当前指南建议更早开始治疗可能有益。
