National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, Australia.
HIV Med. 2009 Mar;10(3):143-51. doi: 10.1111/j.1468-1293.2008.00663.x. Epub 2008 Dec 20.
The aim of the study was to determine the effect of nucleoside reverse transcriptase inhibitors (NRTIs) on CD4 recovery in HIV-1-infected individuals receiving long-term suppressive combination antiretroviral therapy (cART).
A retrospective cohort study was carried out. The mean time-weighted CD4 change from baseline was determined at weeks 48, 96 and 144: its associations with exposure to NRTIs were assessed using linear regression.
One hundred and five patients were included. Their median baseline CD4 count was 225 (interquartile range 91-362) cells/microL. A trend of greater CD4 change from baseline was observed for individuals who at baseline had CD4 counts >200 cells/microL (138 vs. 113, 176 vs. 134 and 204 vs. 173 cells/microL), or were </=40 years old (136 vs. 118, 182 vs. 150, 208 vs. 174) at weeks 48, 96 and 144, respectively; however, all P-values were >0.05. Lower CD4 increases were observed in patients exposed to didanosine (ddI) or a combination of ddI and stavudine, although the difference was not statistically significant. For patients that commenced cART with CD4 count </=200 cells/microL, a trend towards a CD4 count response <250 cells/microL at weeks 48, 96 and 144 was observed in patients receiving zidovudine.
Exposure to different NRTIs in initial cART was not significantly associated with variable rises in CD4 cell count. However, these findings need to be confirmed in larger studies.
本研究旨在确定核苷逆转录酶抑制剂（NRTIs）对接受长期抑制性联合抗逆转录病毒治疗（cART）的 HIV-1 感染者 CD4 恢复的影响。
进行了一项回顾性队列研究。从基线开始，通过线性回归评估每周 48、96 和 144 时的时间加权 CD4 变化平均值与其暴露于 NRTIs 的相关性。
共纳入 105 例患者。其基线 CD4 计数中位数为 225（四分位距 91-362）个细胞/μL。基线时 CD4 计数>200 个细胞/μL（138 比 113，176 比 134 和 204 比 173 个细胞/μL）或年龄≤40 岁（136 比 118，182 比 150，208 比 174）的患者，在第 48、96 和 144 周时从基线开始的 CD4 变化趋势更大；然而，所有 P 值均>0.05。与接受齐多夫定（AZT）或 AZT 与司他夫定联合治疗的患者相比，暴露于双脱氧肌苷（ddI）或 ddI 与司他夫定联合治疗的患者的 CD4 增加较低，但差异无统计学意义。对于初始 cART 时 CD4 计数≤200 个细胞/μL 的患者，接受 AZT 治疗的患者在第 48、96 和 144 周时 CD4 计数反应<250 个细胞/μL 的趋势。
在初始 cART 中使用不同的 NRTIs 与 CD4 细胞计数的不同升高无显著相关性。然而，这些发现需要在更大的研究中得到证实。
