在原发性HIV-1感染期间启动的抗逆转录病毒治疗中断:在ANRS 095随机研究中,与单独使用白细胞介素(IL)-2相比,联合IL-2的治疗性疫苗接种策略的影响。

Interruption of antiretroviral therapy initiated during primary HIV-1 infection: impact of a therapeutic vaccination strategy combined with interleukin (IL)-2 compared with IL-2 alone in the ANRS 095 Randomized Study.

作者信息

Goujard Cécile, Marcellin Fabienne, Hendel-Chavez Houria, Burgard Marianne, Meiffrédy Vincent, Venet Alain, Rouzioux Christine, Taoufik Yacine, El Habib Raphaëlle, Beumont-Mauviel Maria, Aboulker Jean-Pierre, Lévy Yves, Delfraissy Jean-François

机构信息

Service de Médecine Interne, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, Paris, France.

出版信息

AIDS Res Hum Retroviruses. 2007 Sep;23(9):1105-13. doi: 10.1089/aid.2007.0047.

Abstract

HIV-specific T cell responses play a critical role in the control of infection. We evaluated the impact of immune-based interventions in patients first treated during primary HIV-1 infection (PHI). Forty-three patients were randomized within three groups, to receive either interleukin-2 (IL-2 group), or boosts of ALVAC-HIV (vCP1433) and LIPO-6T followed by interleukin-2 (Vac-IL2 group), compared with no immune intervention (control group), and were monitored for T cell responses. Impact of strategies on viral replication was subsequently assessed during long-term treatment interruption. HIV-specific CD4(+) T cell responses did not change during the study period in immunized patients relative to controls, and vaccination had only a transient effect on interferon-gamma-producing CD8 responses. Viral rebound after treatment interruption was similar in immunized patients and controls. Forty percent of patients had HIV RNA values <10,000 copies/ml 12 weeks after interruption. The cumulative time off treatment represented almost half the total follow-up period. Immunological and virological status during PHI and HIV DNA load at interruption were predictive of the level of viral rebound after treatment interruption, whereas HIV RNA level during PHI and HIV DNA level at interruption were predictive of the time off treatment. Treatment interruption is safe in patients treated early after primary HIV infection. On the basis of this pilot study, HIV immunizations and interleukin-2 appear to have no supplementary benefit.

摘要

HIV特异性T细胞反应在感染控制中起着关键作用。我们评估了免疫干预对初次HIV-1感染(PHI)期间首次接受治疗的患者的影响。43名患者被随机分为三组,分别接受白细胞介素-2(IL-2组),或ALVAC-HIV(vCP1433)和LIPO-6T加强免疫后再接受白细胞介素-2(Vac-IL2组),与不进行免疫干预的对照组相比,并对T细胞反应进行监测。随后在长期治疗中断期间评估这些策略对病毒复制的影响。与对照组相比,免疫患者在研究期间HIV特异性CD4(+) T细胞反应没有变化,疫苗接种对产生干扰素-γ的CD8反应只有短暂影响。免疫患者和对照组在治疗中断后的病毒反弹情况相似。40%的患者在中断治疗12周后HIV RNA值<10,000拷贝/ml。累计停药时间几乎占总随访期的一半。PHI期间的免疫和病毒学状态以及中断时HIV DNA载量可预测治疗中断后病毒反弹的水平,而PHI期间的HIV RNA水平和中断时的HIV DNA水平可预测停药时间。在原发性HIV感染后早期接受治疗的患者中,治疗中断是安全的。基于这项初步研究,HIV免疫接种和白细胞介素-2似乎没有额外益处。

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