Castagna Antonella, Galli Laura, Torti Carlo, D'Arminio Monforte Antonella, Mussini Cristina, Antinori Andrea, Cozzi-Lepri Alessandro, Ladisa Nicoletta, De Luca Andrea, Seminari Elena, Gianotti Nicola, Lazzarin Adriano
Infectious Diseases Department, San Raffaele Scientific Institute, Milan, Italy.
Antivir Ther. 2010;15(2):165-75. doi: 10.3851/IMP1513.
The extent of short-term CD4(+) T-cell recovery in patients tolerating first-line highly active antiretroviral therapy (HAART) and attaining undetectable HIV RNA levels is inadequately defined.
We retrospectively analysed patients in four Italian cohorts who started HAART between January 1996 and September 2006. All patients had known HCV coinfection status, did not modify the regimen for 6 months and had <50 HIV RNA copies/ml at the end of the sixth month.
The analysis involved 1,488 patients (1,096 males, 73.7%) with a median age of 43 years (interquartile range [IQR] 39-49); 435 (29.2%) were positive for HCV, 71 (4.8%) were positive for hepatitis B surface antigen (HBsAg) and 76 (5.1%) had experienced a previous AIDS-defining event. At baseline, patient CD4(+) T-cell counts were 226 cells/microl (IQR 99-332), CD4(+) T-cell percentages were 14.7% (IQR 8.7-21.2) and HIV RNA levels were 4.91 log(10) copies/ml (IQR 4.38-5.34). Overall, 24-week CD4(+) T-cell recovery was 144 cells/microl (IQR 70-240). At multivariable analysis, T-cell recovery was positively related to the use of a boosted protease inhibitor (P<0.0001) or thymidine analogues (P<0.0001), baseline HIV RNA levels (P<0.0001), the baseline percentage of CD4(+) T-cells (P<0.0001) and the absence of HCV coinfection (P=0.006). Age, gender, baseline CD4(+)/CD8(+) T-cell ratio and a history of AIDS-defining events had no independent effect on CD4(+) T-cell recovery.
Among HIV-infected patients tolerating first-line HAART and with undetectable HIV RNA after 6 months, CD4(+) T-cell recovery is significantly greater in those without HCV coinfection, with a high baseline viral load, a high baseline percentage of CD4(+) T-cells and in those treated with a boosted protease inhibitor.
对于接受一线高效抗逆转录病毒治疗（HAART）且HIV RNA水平检测不到的患者，其短期CD4(+) T细胞恢复程度尚未明确界定。
我们回顾性分析了1996年1月至2006年9月期间在四个意大利队列中开始接受HAART治疗的患者。所有患者均已知丙型肝炎病毒（HCV）合并感染状态，6个月内未更改治疗方案，且在第六个月末HIV RNA拷贝数<50/ml。
分析纳入了1488例患者（1096例男性，占73.7%），中位年龄为43岁（四分位间距[IQR] 39 - 49岁）；435例（29.2%）HCV检测呈阳性，71例（4.8%）乙肝表面抗原（HBsAg）检测呈阳性，76例（5.1%）曾有过界定艾滋病的事件。基线时，患者的CD4(+) T细胞计数为226个/微升（IQR 99 - 332），CD4(+) T细胞百分比为14.7%（IQR 8.7 - 21.2），HIV RNA水平为4.91 log(10)拷贝/ml（IQR 4.38 - 5.34）。总体而言，24周时CD4(+) T细胞恢复量为144个/微升（IQR 70 - 240）。在多变量分析中，T细胞恢复与使用增强型蛋白酶抑制剂（P<0.0001）或胸苷类似物（P<0.0001）、基线HIV RNA水平（P<0.0001）、CD4(+) T细胞基线百分比（P<0.0001）以及无HCV合并感染（P = 0.006）呈正相关。年龄、性别、基线CD4(+)/CD8(+) T细胞比值以及界定艾滋病的事件史对CD4(+) T细胞恢复无独立影响。
在接受一线HAART治疗且6个月后HIV RNA检测不到的HIV感染患者中，无HCV合并感染、基线病毒载量高、CD4(+) T细胞基线百分比高以及接受增强型蛋白酶抑制剂治疗的患者，其CD4(+) T细胞恢复明显更大。
