Veterans Affairs North Texas Health Care System, Dallas, TX 75216, USA.
HIV Med. 2012 Jul;13(6):345-51. doi: 10.1111/j.1468-1293.2011.00981.x. Epub 2012 Jan 26.
The aim of the study was to determine the prognostic value of HIV replication capacity (RC) for subsequent antiretroviral (ARV) treatment response in ARV-experienced patients.
RC and phenotypic resistance testing were performed at baseline and week 12 on plasma samples from patients randomized to undergo a 12-week ARV drug-free period (ARDFP) or initiate immediate salvage therapy (no-ARDFP group) in the Options in Management with Antiretrovirals (OPTIMA) trial. Dichotomous and incremental phenotypic susceptibility scores (dPSSs and iPSSs, respectively) were calculated. The predictive value of RC and PSS for ARV therapy response and/or ARDFP was evaluated using multivariate regression analysis and Pearson correlations.
In 146 no-ARDFP subjects, baseline RC (50.8%) did not change at week 12 and was not correlated with CD4 cell count or viral load changes at week 12 (P=0.33 and P=0.79, respectively) or at week 24 (P=0.96 and P=0.14, respectively). dPSS predicted virological but not CD4 cell count response to ARV therapy at weeks 12, 24 and 48 (P=0.002, P<0.001 and P=0.005, respectively). RC was significantly correlated with dPSS and iPSS at baseline, but did not increase their predictive value. In the 137 ARDFP patients, RC increased significantly (from 52.4 to 85.8%), but did not predict CD4 cell count and viral load changes during ARDFP (P=0.92 and P=0.26, respectively). RC after ARDFP did not predict subsequent CD4 cell count and viral load changes 12 weeks following ARV treatment reinitiation (P=0.90 and P=0.29, respectively).
We found no additional predictive value of replication capacity for virological or immunological responses (above what PSS provides) in patients undergoing salvage ARV treatment.
本研究旨在确定 HIV 复制能力(RC)对接受过抗逆转录病毒(ARV)治疗的患者后续 ARV 治疗反应的预后价值。
在 OPTIMA 试验中,将患者随机分配至接受 12 周无 ARV 药物期(ARDFP)或立即开始挽救性治疗(无-ARDFP 组),在基线和第 12 周时对血浆样本进行 RC 和表型耐药检测。计算了二分和增量表型敏感性评分(dPSS 和 iPSS)。使用多变量回归分析和 Pearson 相关性评估 RC 和 PSS 对 ARV 治疗反应和/或 ARDFP 的预测价值。
在 146 例无-ARDFP 受试者中,基线 RC(50.8%)在第 12 周时没有变化,与第 12 周时 CD4 细胞计数或病毒载量变化(P=0.33 和 P=0.79)或第 24 周(P=0.96 和 P=0.14)均无相关性。dPSS 预测 ARV 治疗第 12、24 和 48 周时的病毒学但不是 CD4 细胞计数反应(P=0.002、P<0.001 和 P=0.005)。RC 与基线时的 dPSS 和 iPSS 显著相关,但并未增加它们的预测价值。在 137 例 ARDFP 患者中,RC 显著增加(从 52.4%增加到 85.8%),但在 ARDFP 期间不预测 CD4 细胞计数和病毒载量变化(P=0.92 和 P=0.26)。ARV 治疗重新开始后 12 周,RC 后不预测随后的 CD4 细胞计数和病毒载量变化(P=0.90 和 P=0.29)。
我们发现,在接受挽救性 ARV 治疗的患者中,RC 对病毒学或免疫学反应(超过 PSS 提供的反应)没有额外的预测价值。