Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
PLoS One. 2011;6(11):e27463. doi: 10.1371/journal.pone.0027463. Epub 2011 Nov 15.
Long-term benefits of combination antiretroviral therapy (cART) initiation during primary HIV-1 infection are debated.
The evolution of plasma HIV-RNA (432 measurements) and cell-associated HIV-DNA (325 measurements) after cessation of cART (median exposure 18 months) was described for 33 participants from the Zurich Primary HIV Infection Study using linear regression and compared with 545 measurements from 79 untreated controls with clinically diagnosed primary HIV infection, respectively a known date for seroconversion.
On average, early treated individuals were followed for 37 months (median) after cART cessation; controls had 34 months of pre-cART follow-up. HIV-RNA levels one year after cART interruption were -0.8 log₁₀ copies/mL [95% confidence interval -1.2;-0.4] lower in early treated patients compared with controls, but this difference was no longer statistically significant by year three of follow-up (-0.3 [-0.9; 0.3]). Mean HIV-DNA levels rebounded from 2 log₁₀ copies [1.8; 2.3] on cART to a stable plateau of 2.7 log₁₀ copies [2.5; 3.0] attained 1 year after therapy stop, which was not significantly different from cross-sectional measurements of 9 untreated members of the control group (2.8 log₁₀ copies [2.5; 3.1]).
The rebound dynamics of viral markers after therapy cessation suggest that early cART may indeed limit reservoir size of latently infected cells, but that much of the initial benefits are only transient. Owing to the non-randomized study design the observed treatment effects must be interpreted with caution.
关于在原发性 HIV-1 感染期间启动联合抗逆转录病毒治疗（cART）的长期获益仍存在争议。
采用线性回归的方法，对来自苏黎世原发性 HIV 感染研究的 33 名参与者（cART 中位暴露时间为 18 个月）停止 cART 后（共 432 次血浆 HIV-RNA 测量值）和（共 325 次细胞相关 HIV-DNA 测量值）的病毒学指标演变进行描述，并与 79 名未经治疗的原发性 HIV 感染临床确诊患者（分别有明确的血清转换日期）的 545 次测量值进行比较。
平均而言，早期治疗的个体在停止 cART 后平均随访 37 个月（中位数）；对照组在 cART 前有 34 个月的随访。与对照组相比，cART 中断后一年时早期治疗患者的 HIV-RNA 水平低 0.8 log₁₀ 拷贝/mL[95%置信区间（CI）-1.2；-0.4]，但在随访的第三年时，这种差异无统计学意义（-0.3[-0.9；0.3]）。HIV-DNA 水平从 cART 时的 2 log₁₀ 拷贝[1.8；2.3]反弹至稳定平台期（治疗停止后 1 年时为 2.7 log₁₀ 拷贝[2.5；3.0]），与未经治疗的对照组 9 名成员的横断面测量值（2.8 log₁₀ 拷贝[2.5；3.1]）无显著差异。
治疗停止后病毒标志物的反弹动力学表明，早期 cART 确实可能限制潜伏感染细胞的储存库大小，但最初的大部分益处只是短暂的。由于非随机研究设计，必须谨慎解释观察到的治疗效果。
