Ségéral Olivier, Limsreng Setha, Nouhin Janin, Hak ChanRoeurn, Ngin Sopheak, De Lavaissière Marc, Goujard Cécile, Taburet Anne-Marie, Nerrienet Eric, Delfraissy Jean-François, Ouk Vara, Dulioust Anne
Department of Medicine, Bicêtre Hospital, Le Kremlin Bicêtre, France.
AIDS Res Hum Retroviruses. 2011 Jun;27(6):597-603. doi: 10.1089/AID.2010.0125. Epub 2011 Jan 17.
There are few long-term data on ART-experienced patients in resource-limited settings. We performed a cross-sectional study of HIV-infected patients included in the ESTHER program in Calmette hospital, Phnom Penh, Cambodia, after 36 ± 3 months of cART. Therapeutic, clinical, and immunovirological outcomes were compared between patients who stated they were ART-naive (naive group), dual nucleoside reverse-transcriptase inhibitor (two-NRTI group), or fixed-dose combination of stavudine/lamivudine/nevirapine experienced (three-drug group) at entry to the program. A logistic regression model was used to evaluate the factors associated with virological failure (PCR HIV > 250 copies/ml). Among the 256 patients included in the analysis, 148 (58%) were ART naive while 50 (20%) had previously received two NRTIs and 58 (22%) three drugs. At entry to the program, all the patients received two NRTIs and one nonnucleoside reverse-transcriptase inhibitor (NNRTI). At evaluation, 46 patients (18%) were switched to a protease inhibitor-based regimen (9%, 32%, and 29% of the naive, two-NRTI, and three-drug groups; p < 0.0001). The median CD4 cell count increase was 180/μl overall (IQR: 96-276) and was higher in ART-naive than ART-experienced patients. In the intent-to-treat analysis, virological success was achieved in 83.5%, 67%, and 69% of the naive, two-NRTI, and three-drug groups, respectively (p = 0.002). Factors associated with virological failure were suboptimal previous ART exposure and WHO immunological failure criteria. The long-term efficacy of first-line cART is maintained in Cambodia. In ART-experienced patients, viral load monitoring needs to be available to establish early virological failure and preserve the potency of second line regimens.
在资源有限的环境中，关于有抗逆转录病毒治疗（ART）经验患者的长期数据很少。我们对柬埔寨金边卡尔梅特医院ESTHER项目中接受36±3个月联合抗逆转录病毒治疗（cART）的HIV感染患者进行了一项横断面研究。比较了在项目开始时自称未接受过ART（初治组）、接受过双核苷类逆转录酶抑制剂治疗（双NRTI组）或接受过司他夫定/拉米夫定/奈韦拉平固定剂量联合治疗（三联药物组）的患者的治疗、临床和免疫病毒学结果。使用逻辑回归模型评估与病毒学失败（PCR检测HIV>250拷贝/ml）相关的因素。在纳入分析的256例患者中，148例（58%）为初治患者，50例（20%）曾接受过两种NRTI治疗，58例（22%）接受过三联药物治疗。在项目开始时，所有患者均接受两种NRTI和一种非核苷类逆转录酶抑制剂（NNRTI）治疗。在评估时，46例患者（18%）改用了基于蛋白酶抑制剂的治疗方案（初治组、双NRTI组和三联药物组分别为9%、32%和29%；p<0.0001）。总体CD4细胞计数中位数增加180/μl（四分位间距：96 - 276），初治患者高于有ART经验的患者。在意向性分析中，初治组、双NRTI组和三联药物组的病毒学成功率分别为83.5%、67%和69%（p = 0.002）。与病毒学失败相关的因素是既往ART暴露不理想和世界卫生组织免疫失败标准。柬埔寨一线cART的长期疗效得以维持。对于有ART经验的患者，需要进行病毒载量监测以早期发现病毒学失败并保持二线治疗方案的效力。
