法国原发性感染时接受治疗的HIV-1耐药患者对高效抗逆转录病毒治疗的反应：法国国家艾滋病研究机构耐药性网络

Response to HAART in French patients with resistant HIV-1 treated at primary infection: ANRS Resistance Network.

作者信息

Chaix Marie-Laure, Desquilbet Loic, Descamps Diane, Costagliola Dominique, Deveau Christiane, Galimand Julie, Goujard Cécile, Signori-Schmuck Anne, Schneider Veronique, Tamalet Catherine, Pellegrin Isabelle, Wirden Marc, Masquelier Bernard, Brun-Vezinet Francoise, Rouzioux Christine, Meyer Laurence

机构信息

EA 3620, Université Paris Descartes, Service de Virologie, CHU Necker-Enfants Malades, Paris, France.

出版信息

Antivir Ther. 2007;12(8):1305-10.

PMID:18240870

Abstract

OBJECTIVE

The aim of the study was to analyse the response to highly active antiretroviral therapy (HAART) initiated at the time of primary HIV infection (PHI) in patients infected with a virus resistant to > or = 1 drug of their treatment compared with patients infected with a wild-type virus.

METHODS

We analysed data from 350 patients who were enrolled from 1996-2004 in the French ANRS PRIMO Cohort or in the ANRS Resistance Group and treated with HAART during PHI. During the study period, HAART was initiated before the result of the genotypic resistance test was available. We compared patients infected with a virus resistant to > or = 1 drug of their regimen (GR group, n = 46) with patients harbouring a wild-type virus (WT group, n = 304). Virological and immunological response to treatment according to drug-resistance profile was analysed 3 months and 6 months after HAART initiation.

RESULTS

In GR and WT groups, HIV RNA level was < 400 copies/ml in 68% and 83% (P = 0.02) and < 50 copies/ml in 23% and 40% (P = 0.08) 3 months after HAART initiation. In multivariable logistic regression taking into account gender, age, boosted PI regimen, plasma HIV RNA and CD4+ T-cell count at HAART initiation, patients with virus resistant to > or = 1 drug of their regimen were significantly less likely to achieve undetectable viral load at month 3 (odds ratio 0.32, 95% confidence interval 0.15-0.72) than the others. This difference was sustained up to month 6.

CONCLUSION

In this large cohort of HAART-treated PHI-patients, the presence of drug resistance mutations led to suboptimal response to early therapy.

摘要

目的

本研究旨在分析原发性HIV感染（PHI）时开始接受高效抗逆转录病毒治疗（HAART）的患者，与感染野生型病毒的患者相比，感染对其治疗中≥1种药物耐药的病毒患者的治疗反应。

方法

我们分析了1996年至2004年期间纳入法国ANRS PRIMO队列或ANRS耐药组并在PHI期间接受HAART治疗的350例患者的数据。在研究期间，在基因型耐药测试结果出来之前就开始了HAART。我们将感染对其治疗方案中≥1种药物耐药的病毒的患者（GR组，n = 46）与携带野生型病毒的患者（WT组，n = 304）进行了比较。在HAART开始后3个月和6个月，根据耐药情况分析了对治疗的病毒学和免疫学反应。

结果

在GR组和WT组中，HAART开始后3个月时，HIV RNA水平<400拷贝/ml的患者分别为68%和83%（P = 0.02），<50拷贝/ml的患者分别为23%和40%（P = 0.08）。在多变量逻辑回归中，考虑到性别、年龄、增强型蛋白酶抑制剂方案、HAART开始时的血浆HIV RNA和CD4 + T细胞计数，感染对其治疗方案中≥1种药物耐药的病毒的患者在第3个月时病毒载量不可检测的可能性显著低于其他患者（比值比0.32，95%置信区间0.15 - 0.72）。这种差异一直持续到第6个月。