CD4+ 细胞计数在病毒载量抑制期间的增加率：与之前病毒学失败次数的关系。

Rate of CD4+ cell count increase over periods of viral load suppression: relationship with the number of previous virological failures.

机构信息

Clinical Department, National Institute for Infectious Diseases L. Spallanzani, Roma, Italy.

出版信息

Clin Infect Dis. 2010 Aug 15;51(4):456-64. doi: 10.1086/655151.

DOI:10.1086/655151

PMID:20597690

Abstract

BACKGROUND

Although the kinetics of CD4(+) cell counts have been extensively studied in antiretroviral-naive HIV-infected patients, data on individuals who have failed combination antiretroviral therapy (cART) are lacking.

METHODS

This analysis was based on the ICONA Foundation Study. Subjects with > or = 1 episode of viral suppression after starting first-line cART were included (n = 3537). Following a viral rebound, patients who achieved another episode of viral suppression could reenter the analysis. The percentage of patients with an increase in CD4(+) cell count >300 cells/mm(3) was estimated using Kaplan-Meier techniques; the rate of CD4(+) cell count increase per year was estimated using a multivariable, multilevel linear model with fixed effects of intercept and slope. Multivariable models were also fitted to include several covariates.

RESULTS

The median time to reach a CD4(+) cell count increase >300 cells/mm(3) from baseline was significantly associated with the number of failed regimens: 34 months, 41 months, 51 months, and 45 months in subjects without evidence of previous virological failure, or 1, 2, or > or = 3 previous virologically failed regimens, respectively (P < .001, by log-rank test). The annual estimated increases in CD4(+) cell count were 36 cells/mm(3) (95% confidence interval [CI], 34-38 cells/mm(3)), 28 cells/mm(3) (95% CI, 11-21 cells/mm(3)), 31 cells/mm(3) (95% CI, 26-36 cells/mm(3)), and 26 cells/mm(3) (95% CI, 18-33 cells/mm(3)), respectively. Differences in the annual CD4(+) cell count increase were observed between specific antiretrovirals.

CONCLUSIONS

Subjects with > or = 1 virological failure took a longer time to reach a CD4(+) cell count >300 cell/mm(3) and had a slower annual increase than those without virological failure. Efforts should be made to optimize first-line cART, because this represents the best chance of achieving an effective CD4(+) response.

摘要

背景

尽管在未接受过抗逆转录病毒治疗的 HIV 感染者中，已经广泛研究了 CD4(+)细胞计数的动力学，但缺乏关于已接受过联合抗逆转录病毒治疗（cART）失败的个体的数据。

方法

本分析基于 ICONA 基金会研究。纳入了首次接受一线 cART 治疗后有≥1 次病毒抑制的患者（n=3537）。在病毒反弹后，再次获得病毒抑制的患者可重新进入分析。使用 Kaplan-Meier 技术估计 CD4(+)细胞计数增加>300 个细胞/mm(3)的患者比例；使用固定截距和斜率的多变量、多层次线性模型估计 CD4(+)细胞计数每年的增加率。还拟合了多变量模型以纳入多个协变量。

结果

从基线到达到 CD4(+)细胞计数增加>300 个细胞/mm(3)的中位时间与失败方案的数量显著相关：无先前病毒学失败证据的患者分别为 34 个月、41 个月、51 个月和 45 个月，而分别有 1、2 或>或=3 次先前病毒学失败的患者分别为 34 个月、41 个月、51 个月和 45 个月（P<0.001，对数秩检验）。每年估计的 CD4(+)细胞计数增加分别为 36 个细胞/mm(3)（95%置信区间[CI]，34-38 个细胞/mm(3)）、28 个细胞/mm(3)（95% CI，11-21 个细胞/mm(3)）、31 个细胞/mm(3)（95% CI，26-36 个细胞/mm(3)）和 26 个细胞/mm(3)（95% CI，18-33 个细胞/mm(3)）。特定抗逆转录病毒之间观察到 CD4(+)细胞计数年增长率的差异。