与 B 亚型相比，白人感染 HIV-1 非 B 亚型的病毒学结果得到改善。

Improved virological outcome in White patients infected with HIV-1 non-B subtypes compared to subtype B.

机构信息

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Switzerland.

出版信息

Clin Infect Dis. 2011 Dec;53(11):1143-52. doi: 10.1093/cid/cir669. Epub 2011 Oct 13.

DOI:10.1093/cid/cir669

PMID:21998284

Abstract

BACKGROUND

Antiretroviral compounds have been predominantly studied in human immunodeficiency virus type 1 (HIV-1) subtype B, but only ~10% of infections worldwide are caused by this subtype. The analysis of the impact of different HIV subtypes on treatment outcome is important.

METHODS

The effect of HIV-1 subtype B and non-B on the time to virological failure while taking combination antiretroviral therapy (cART) was analyzed. Other studies that have addressed this question were limited by the strong correlation between subtype and ethnicity. Our analysis was restricted to white patients from the Swiss HIV Cohort Study who started cART between 1996 and 2009. Cox regression models were performed; adjusted for age, sex, transmission category, first cART, baseline CD4 cell counts, and HIV RNA levels; and stratified for previous mono/dual nucleoside reverse-transcriptase inhibitor treatment.

RESULTS

Included in our study were 4729 patients infected with subtype B and 539 with non-B subtypes. The most prevalent non-B subtypes were CRF02_AG (23.8%), A (23.4%), C (12.8%), and CRF01_AE (12.6%). The incidence of virological failure was higher in patients with subtype B (4.3 failures/100 person-years; 95% confidence interval [CI], 4.0-4.5]) compared with non-B (1.8 failures/100 person-years; 95% CI, 1.4-2.4). Cox regression models confirmed that patients infected with non-B subtypes had a lower risk of virological failure than those infected with subtype B (univariable hazard ratio [HR], 0.39 [95% CI, .30-.52; P < .001]; multivariable HR, 0.68 [95% CI, .51-.91; P = .009]). In particular, subtypes A and CRF02_AG revealed improved outcomes (multivariable HR, 0.54 [95% CI, .29-.98] and 0.39 [95% CI, .19-.79], respectively).

CONCLUSIONS

Improved virological outcomes among patients infected with non-B subtypes invalidate concerns that these individuals are at a disadvantage because drugs have been designed primarily for subtype B infections.

摘要

背景

抗逆转录病毒化合物主要在人类免疫缺陷病毒 1 型（HIV-1）亚型 B 中进行研究，但全世界只有约 10%的感染是由该亚型引起的。分析不同 HIV 亚型对治疗结果的影响非常重要。

方法

分析 HIV-1 亚型 B 和非 B 在接受联合抗逆转录病毒治疗（cART）时发生病毒学失败的时间。其他研究这个问题的研究受到亚型和种族之间强相关性的限制。我们的分析仅限于瑞士 HIV 队列研究中在 1996 年至 2009 年间开始接受 cART 的白人患者。使用 Cox 回归模型进行分析；调整年龄、性别、传播类别、首次 cART、基线 CD4 细胞计数和 HIV RNA 水平；并分层分析先前的单/双核苷逆转录酶抑制剂治疗。

结果

我们的研究纳入了 4729 名感染 B 亚型和 539 名感染非 B 亚型的患者。最常见的非 B 亚型是 CRF02_AG（23.8%）、A（23.4%）、C（12.8%）和 CRF01_AE（12.6%）。与感染 B 亚型的患者相比，感染非 B 亚型的患者病毒学失败的发生率更高（4.3 例/100 人年；95%置信区间[CI]，4.0-4.5]）。Cox 回归模型证实，感染非 B 亚型的患者病毒学失败的风险低于感染 B 亚型的患者（单变量风险比[HR]，0.39[95%CI，0.30-0.52；P<0.001]；多变量 HR，0.68[95%CI，0.51-0.91；P=0.009]）。特别是，亚型 A 和 CRF02_AG 显示出更好的结果（多变量 HR，0.54[95%CI，0.29-0.98]和 0.39[95%CI，0.19-0.79]）。