Madge S, Smith C J, Lampe F, Sabin C A, Youle M, Johnson M A, Phillips A N
Royal Free Centre for HIV Medicine, Royal Free and University College London Medical School, London, UK.
HIV Med. 2008 Apr;9(4):208-13. doi: 10.1111/j.1468-1293.2008.00548.x. Epub 2008 Feb 21.
To assess the prevalence of an undetectable viral load (VL) (<50 HIV-1 RNA copies/mL) in a clinical population and to identify those viraemic and at risk of failing antiretroviral therapy (ART).
An audit of a complete clinical population on 1 January 2005 via a clinical database and clinical note review.
On 1 January 2005, 1910 patients were under care; 1229/1332 (92%) of those exposed to ART for >16 weeks had a VL of <50 copies/mL. We examined 49/56 case notes of viraemic patients to identify explanations for viraemia. Common reasons included previous initial mono- or dual therapy, adherence problems, more advanced HIV disease, concomitant medications, physical and mental health issues and being less well linked into the service. A review of these patients' current status on 1 April 2007 showed that six of the 49 had since died. However, of those still alive, 20 (47%) had a VL <500 copies/mL.
The proportion of patients on ART with detectable viraemia is low in current clinical practice. New drugs may help those who are failing because of resistance. However, there is a small minority of patients who, for various reasons, appear unable to maintain sufficient adherence to ART.
评估临床人群中病毒载量不可测（<50 个 HIV-1 RNA 拷贝/毫升）的患病率，并识别那些病毒血症患者以及有抗逆转录病毒疗法（ART）治疗失败风险的患者。
通过临床数据库和临床记录回顾，对 2005 年 1 月 1 日的全部临床人群进行审查。
2005 年 1 月 1 日，有 1910 名患者正在接受治疗；在接受 ART 治疗超过 16 周的患者中，1229/1332（92%）的病毒载量<50 拷贝/毫升。我们检查了 49/56 例病毒血症患者的病历，以找出病毒血症的原因。常见原因包括先前的初始单药或双药治疗、依从性问题、HIV 病情更严重、合并用药、身心健康问题以及与医疗服务的联系较差。对这些患者 2007 年 4 月 1 日的当前状况进行审查发现，49 名患者中有 6 人已死亡。然而，在仍存活的患者中，20 人（47%）的病毒载量<500 拷贝/毫升。
在当前临床实践中，接受 ART 治疗且病毒血症可检测到的患者比例较低。新药可能有助于那些因耐药而治疗失败的患者。然而，有一小部分患者由于各种原因似乎无法维持对 ART 的足够依从性。
