Grinsztejn Beatriz, Veloso Valdilea G, Pilotto José Henrique, Campos Dayse Pereira, Keruly Jeanne C, Moore Richard D
Instituto de Pesquisa Clinica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil.
J Acquir Immune Defic Syndr. 2007 Aug 15;45(5):515-20. doi: 10.1097/QAI.0b013e3180decb6a.
US and Brazilian studies indicate that highly active antiretroviral therapy (HAART) has been effective in reducing morbidity and mortality from HIV/AIDS. Differences exist in the adoption and patterns of antiretroviral drug use and in the incidence of AIDS-defining illness (ADI) between the 2 countries, however, and there has not been a direct comparison of clinical response between Brazil and the United States. We sought to determine if there have been differences in the clinical response to HAART from HIV clinical practices in the United States and Brazil.
We compared 2 similarly designed clinical cohorts from Baltimore, Maryland and Rio de Janeiro, Brazil. Patients who started HAART from 1997 to 2004 were compared for HIV-1 RNA suppression and CD4+ T-lymphocyte count change by 1 year of therapy and for development of an ADI up to 6 years of follow-up. A total of 1368 patients from Baltimore and 1045 patients from Rio de Janeiro were studied.
There was no difference by location in achieving an HIV-1 RNA level <400 copies/mL (46.9% in Rio de Janeiro, 50.8% in Baltimore), in the log change in HIV-1 RNA level (-1.65 log in Rio de Janeiro, - 1.63 log in Baltimore), or in the change in CD4 count (116 cells/mm3 in Rio de Janeiro, 122 cells/mm3 in Baltimore) by 12 months after starting HAART. By Kaplan-Meier analysis and Cox regression adjusted for demographic and clinical prognostic factors, there was no difference by location in development of the first ADI after starting HAART (relative hazard = 1.02; 95% confidence interval: 0.82 to 1.25 for Rio de Janeiro vs. Baltimore). The most commonly occurring ADI in Rio de Janeiro was tuberculosis (27.7% of patients), and the most commonly occurring ADI in Baltimore was esophageal candidiasis (36.8% of patients).
There were only minor differences in clinical response to the use of HAART comparing Rio de Janeiro with Baltimore, despite differences in patterns of antiretroviral drug use and ADI incidence. This analysis indicates that HAART can be similarly effective in treating HIV/AIDS in countries with different economies.
美国和巴西的研究表明，高效抗逆转录病毒疗法（HAART）在降低HIV/AIDS的发病率和死亡率方面已取得成效。然而，两国在抗逆转录病毒药物的使用情况和模式以及艾滋病界定疾病（ADI）的发病率方面存在差异，而且巴西和美国之间尚未对临床反应进行直接比较。我们试图确定美国和巴西的HIV临床实践中对HAART的临床反应是否存在差异。
我们比较了来自美国马里兰州巴尔的摩市和巴西里约热内卢的两个设计相似的临床队列。对1997年至2004年开始接受HAART治疗的患者，比较其治疗1年后HIV-1 RNA抑制情况、CD4 + T淋巴细胞计数变化以及随访6年内ADI的发生情况。共研究了来自巴尔的摩的1368例患者和来自里约热内卢的1045例患者。
在实现HIV-1 RNA水平<400拷贝/mL方面（里约热内卢为46.9%，巴尔的摩为50.8%）、HIV-1 RNA水平的对数变化方面（里约热内卢为-1.65对数，巴尔的摩为-1.63对数）或开始HAART治疗12个月后CD4计数变化方面（里约热内卢为116个细胞/mm³，巴尔的摩为122个细胞/mm³），两地之间没有差异。通过Kaplan-Meier分析和针对人口统计学及临床预后因素进行调整的Cox回归分析，开始HAART治疗后首次发生ADI的情况在两地之间没有差异（相对风险=1.02；里约热内卢与巴尔的摩相比，95%置信区间：0.82至1.25）。里约热内卢最常见的ADI是结核病（占患者的27.7%），巴尔的摩最常见的ADI是食管念珠菌病（占患者的36.8%）。
尽管抗逆转录病毒药物的使用模式和ADI发病率存在差异，但比较里约热内卢和巴尔的摩，在使用HAART的临床反应方面仅存在微小差异。该分析表明，HAART在不同经济水平的国家治疗HIV/AIDS方面同样有效。
