Chaiwarith Romanee, Praparattanapan Jutarat, Nuntachit Nontakan, Kotarathitithum Wilai, Sirisanthana Thira, Supparatpinyo Khuanchai
Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Curr HIV Res. 2011 Mar;9(2):82-7. doi: 10.2174/157016211795569131.
Current guidelines for HIV management recommend monitoring plasma HIV-1 RNA level every 3-6 months in patients on a stable antiretroviral regimen. However, cost is the major obstacle to follow the guidelines in resource-limited settings.
This study aimed to compare the outcome of antiretroviral therapy among HIV-infected patients on a stable regimen who had plasma HIV-1 RNA monitoring once vs. twice yearly.
A retrospective cohort study was conducted among HIV-infected patients receiving antiretroviral therapy since 2002 at Chiang Mai University Hospital, Thailand. We evaluated the incidence of virological failure and number of reverse transcriptase (RT) mutations between groups.
Of 551 patients on a stable antiretroviral regimen, 405 (73.5%) and 146 (26.5%) patients had plasma HIV-1 RNA measurement once and twice yearly, respectively. Forty-seven of 405 patients (11.6%) in once-yearly group and 15 of 146 patients (10.3%) in twice-yearly group developed virological failure, giving the incidence rate of 2.03/100 and 1.95/100 person-years, respectively. The probability of virological failure did not differ between groups (p=0.897, log-rank test). The number of RT mutations was not statistically different between groups (all p-values>0.05). The predicting factors for virological failure from a multivariate analysis were adherence rate <95% and baseline CD4 cell count <50 cells/mm3 but not the frequency of HIV-1 RNA monitoring.
The incidence of virological failure and the number of RT mutations were not different between groups. Therefore, in resource-limited settings, the recommendation to perform plasma HIV-1 RNA measurement once yearly in patients on a stable antiretroviral regimen is justified.
目前的HIV管理指南建议，接受稳定抗逆转录病毒治疗方案的患者每3至6个月监测一次血浆HIV-1 RNA水平。然而，在资源有限的环境中，费用是遵循该指南的主要障碍。
本研究旨在比较接受稳定治疗方案的HIV感染患者中，每年进行一次与每年进行两次血浆HIV-1 RNA监测的抗逆转录病毒治疗效果。
对自2002年以来在泰国清迈大学医院接受抗逆转录病毒治疗的HIV感染患者进行回顾性队列研究。我们评估了两组之间病毒学失败的发生率和逆转录酶（RT）突变的数量。
在551例接受稳定抗逆转录病毒治疗方案的患者中，分别有405例（73.5%）和146例（26.5%）患者每年进行一次和两次血浆HIV-1 RNA检测。每年检测一次组的405例患者中有47例（11.6%）发生病毒学失败，每年检测两次组的146例患者中有15例（10.3%）发生病毒学失败，发生率分别为2.03/100人年和1.95/100人年。两组之间病毒学失败的概率没有差异（p=0.897，对数秩检验）。两组之间RT突变的数量没有统计学差异（所有p值>0.05）。多变量分析中病毒学失败的预测因素是依从率<95%和基线CD4细胞计数<50个细胞/mm3，而不是HIV-1 RNA监测的频率。
两组之间病毒学失败的发生率和RT突变的数量没有差异。因此，在资源有限的环境中，建议对接受稳定抗逆转录病毒治疗方案的患者每年进行一次血浆HIV-1 RNA检测是合理的。
