Mussini Cristina, Manzardo Christian, Johnson Margaret, Monforte Antonella d'Arminio, Uberti-Foppa Caterina, Antinori Andrea, Gill M John, Sighinolfi Laura, Borghi Vanni, Lazzarin Adriano, Miró José M, Sabin Caroline
Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Modena, and Azienda Policlinico, Modena, Italy.
AIDS. 2008 Nov 30;22(18):2461-9. doi: 10.1097/QAD.0b013e328314b5f1.
Many patients infected with HIV still present with an AIDS diagnosis. The aim of this study was to evaluate the virological, immunological and clinical outcomes of HAART in these patients.
The present study was a multi-cohort study. All patients with an AIDS diagnosis between 30 days before and 14 days after HIV diagnosis, recruited between 1997 and 2004 from eight hospital cohorts, were evaluated.
A total of 760 patients were included [268 (35.3%) had pneumocystis and 168 (22.1%) tuberculosis]. Six hundred and twenty-four patients (82.1%) started HAART a median of 31 days after HIV diagnosis. One hundred and fifty-three patients started a nonnucleoside transcriptase inhibitor-based regimen (20.1%), 409 a protease inhibitor-based regimen (53.8%) and 62 other regimens (8.2%). In adjusted analyses, HAART was started sooner in more recent years, in patients with lower CD4 cell count and in those with Kaposi's sarcoma, whereas it was started later in those with tuberculosis. Five hundred and five patients (89%) attained a viral load of less than 500 copies/ml. The factors associated with a better virological response were later calendar year, lower initial viral load and cytomegalovirus disease. Virological rebound was more common in those receiving nucleoside reverse transcriptase inhibitor-based regimens, in those with tuberculosis and in earlier calendar years. One hundred and twenty-five (16%) patients died; 61 had received HAART (48.6%). Mortality was more likely in those who were older, those with a higher viral load at diagnosis, those with nonsexual HIV risks and those with lower CD4 cell count and haemoglobin levels over follow-up.
Virological suppression was achieved in most AIDS patients, though mortality remains high in these individuals.
许多感染艾滋病毒的患者仍被诊断为艾滋病。本研究的目的是评估这些患者接受高效抗逆转录病毒治疗（HAART）后的病毒学、免疫学和临床结局。
本研究为多队列研究。对1997年至2004年从8个医院队列中招募的、在艾滋病毒诊断前30天至诊断后14天内被诊断为艾滋病的所有患者进行了评估。
共纳入760例患者[268例（35.3%）患有肺孢子菌病，168例（22.1%）患有结核病]。624例患者（82.1%）在艾滋病毒诊断后中位数31天开始接受HAART治疗。153例患者开始使用基于非核苷类转录酶抑制剂的方案（20.1%），409例使用基于蛋白酶抑制剂的方案（53.8%），62例使用其他方案（8.2%）。在调整分析中，近年来、CD4细胞计数较低的患者以及患有卡波西肉瘤的患者开始HAART治疗的时间较早，而患有结核病的患者开始治疗的时间较晚。505例患者（89%）的病毒载量降至500拷贝/毫升以下。与更好的病毒学反应相关的因素包括较晚的日历年、较低的初始病毒载量和巨细胞病毒病。病毒学反弹在接受基于核苷类逆转录酶抑制剂方案的患者、患有结核病的患者以及较早的日历年中更为常见。125例（16%）患者死亡；61例接受了HAART治疗（48.6%）。年龄较大、诊断时病毒载量较高、有非性传播艾滋病毒风险以及随访期间CD4细胞计数和血红蛋白水平较低的患者死亡的可能性更大。
大多数艾滋病患者实现了病毒学抑制，尽管这些患者的死亡率仍然很高。
