Danel Christine, Gabillard Delphine, Inwoley Andre, Chaix Marie Laure, Toni Thomas D'aquin, Moh Raoul, Messou Eugene, Bissagnene Emmanuel, Salamon Roger, Eholie Serge, Anglaret Xavier
INSERM U897, Université Victor Segalen Bordeaux 2, Bordeaux, France.
AIDS Res Hum Retroviruses. 2009 Aug;25(8):783-93. doi: 10.1089/aid.2009.0018.
West African adults with warning signs of failure of antiretroviral treatment (ART) at 6 months were assessed for the probability and factors associated with success at 36 months. After 6 months on ART, patients were included if they had a bad immunologic response (BIR) (month 6 CD4 count < pre-ART CD4 count + 50/mm(3)), incomplete virologic suppression (IVS) (month 6 plasma HIV-1 RNA >300 copies/ml), or both (Dual). They were followed for 30 months after inclusion. CD4 counts and HIV-1 RNA were measured every 3 months. We estimated the probability of reaching immunovirologic success (CD4 count >350/mm(3) and plasma HIV-1 RNA <300 copies/ml) and looked for determinants using Cox analysis. A total of 208 adults were included. Among patients in the IVS and Dual groups, 23% and 38% had at least one genotypic resistance mutation at month 6. The 36-month cumulative probability of immunovirologic success was 0.84 in BIR, 0.81 in IVS, and 0.67 in Dual (p = 0.02). Adjusting for CD4 count, viral load, ART regimen, and morbidity, patients who had no genotypic resistance mutations at month 6 or a medication possession ratio (MPR) >90% between month 6 and month 36 had a likelihood of success 3.8 and 3.6 higher than other patients. The 36-month probability of success was 0.56 and 0.86 in patients with an MPR <90% and >90% and 0.59 and 0.84 in patients with and without resistance. After warning signs of failure at 6 months, a large proportion of patients reaches immunovirologic success before 36 months provided there is a high rate of adherence to medication and the absence of early resistance mutations.
对出现抗逆转录病毒治疗（ART）6个月失败警示信号的西非成年人，评估其36个月时治疗成功的概率及相关因素。接受ART治疗6个月后，若患者出现不良免疫反应（BIR）（第6个月时CD4细胞计数<ART治疗前CD4细胞计数+50/mm³）、病毒学抑制不完全（IVS）（第6个月时血浆HIV-1 RNA>300拷贝/ml）或两者皆有（双重情况），则纳入研究。纳入后对他们进行30个月的随访。每3个月测量一次CD4细胞计数和HIV-1 RNA。我们估计了实现免疫病毒学成功（CD4细胞计数>350/mm³且血浆HIV-1 RNA<300拷贝/ml）的概率，并使用Cox分析寻找决定因素。共纳入208名成年人。在IVS组和双重情况组的患者中，分别有23%和38%在第6个月时至少有一个基因型耐药突变。BIR组、IVS组和双重情况组36个月时免疫病毒学成功的累积概率分别为0.84、0.81和0.67（p = 0.02）。在对CD4细胞计数、病毒载量、ART方案和发病率进行校正后，第6个月时无基因型耐药突变或第6个月至第36个月期间药物持有率（MPR）>90%的患者成功的可能性比其他患者高3.8倍和3.6倍。MPR<90%和>90%的患者36个月时成功的概率分别为0.56和0.86，有耐药和无耐药患者的概率分别为0.59和0.84。在6个月出现失败警示信号后，只要药物依从率高且无早期耐药突变，很大一部分患者在36个月前可实现免疫病毒学成功。
