Burman William, Grund Birgit, Neuhaus Jacqueline, Douglas John, Friedland Gerald, Telzak Edward, Colebunders Robert, Paton Nicholas, Fisher Martin, Rietmeijer Cornelis
Denver Public Health, 605 Bannock Street, Denver, CO 80204, USA.
J Acquir Immune Defic Syndr. 2008 Oct 1;49(2):142-50. doi: 10.1097/QAI.0b013e318183a9ad.
To compare the HIV transmission risk among patients randomized to episodic versus continuous antiretroviral therapy.
This was a substudy of the Strategies of Management of Antiretroviral Therapy study, in which patients were randomized to continuous versus CD4-guided episodic antiretroviral therapy. Participants were surveyed about sexual activity and needle sharing and had laboratory testing for gonorrhea, chlamydia, and syphilis.
A total of 883 patients were enrolled in this study, the mean age of the patients was 45 years, 25% were women, and 78% were on antiretroviral therapy. At baseline, 136 participants (15.4%) had high-risk behavior (vaginal or anal sex without a condom, needle sharing, or incident bacterial sexually transmitted infection). After randomization, the proportion of participants reporting high-risk behavior was stable and did not differ by randomized arm (P = 0.39). Among participants off therapy at baseline, high-risk behavior was less common 4 months after randomization among those who were randomized to start antiretroviral therapy (P = 0.03). HIV transmission risk (high-risk behavior while HIV RNA level >1500 copies/mL) with partners perceived to be HIV uninfected was higher in the episodic therapy arm (P = 0.02).
Patients on episodic antiretroviral therapy did not decrease high-risk behavior, and because HIV RNA levels were higher, this strategy may result in increased HIV transmission.
比较随机接受间歇性抗逆转录病毒治疗与持续抗逆转录病毒治疗的患者的HIV传播风险。
这是抗逆转录病毒治疗管理策略研究的一项子研究，其中患者被随机分配接受持续或CD4指导的间歇性抗逆转录病毒治疗。对参与者进行了关于性活动和共用针头的调查，并对淋病、衣原体和梅毒进行了实验室检测。
本研究共纳入883例患者，患者的平均年龄为45岁，25%为女性，78%正在接受抗逆转录病毒治疗。基线时，136名参与者（15.4%）有高危行为（无避孕套的阴道或肛交、共用针头或新发细菌性性传播感染）。随机分组后，报告高危行为的参与者比例稳定，且在随机分组的两组中无差异（P = 0.39）。在基线时未接受治疗的参与者中，随机分组后开始接受抗逆转录病毒治疗的参与者在4个月时高危行为较少见（P = 0.03）。在间歇性治疗组中，与被认为未感染HIV的性伴发生HIV传播风险（HIV RNA水平>1500拷贝/mL时的高危行为）更高（P = 0.02）。
接受间歇性抗逆转录病毒治疗的患者并未减少高危行为，且由于HIV RNA水平较高，该策略可能导致HIV传播增加。
