Kings College Hospital National Health Service Foundation Trust, London, United Kingdom.
PLoS One. 2012;7(8):e43754. doi: 10.1371/journal.pone.0043754. Epub 2012 Aug 31.
The magnitude of HIV viral rebound following ART cessation has consequences for clinical outcome and onward transmission. We compared plasma viral load (pVL) rebound after stopping ART initiated in primary (PHI) and chronic HIV infection (CHI).
Two populations with protocol-indicated ART cessation from SPARTAC (PHI, n = 182) and SMART (CHI, n = 1450) trials.
Time for pVL to reach pre-ART levels after stopping ART was assessed in PHI using survival analysis. Differences in pVL between PHI and CHI populations 4 weeks after stopping ART were examined using linear and logistic regression. Differences in pVL slopes up to 48 weeks were examined using linear mixed models and viral burden was estimated through a time-averaged area-under-pVL curve. CHI participants were categorised by nadir CD4 at ART stop.
Of 171 PHI participants, 71 (41.5%) rebounded to pre-ART pVL levels, at a median of 50 (95% CI 48-51) weeks after stopping ART. Four weeks after stopping treatment, although the proportion with pVL ≥ 400 copies/ml was similar (78% PHI versus 79% CHI), levels were 0.45 (95% CI 0.26-0.64) log(10) copies/ml lower for PHI versus CHI, and remained lower up to 48 weeks. Lower CD4 nadir in CHI was associated with higher pVL after ART stop. Rebound for CHI participants with CD4 nadir >500 cells/mm(3) was comparable to that experienced by PHI participants.
Stopping ART initiated in PHI and CHI was associated with viral rebound to levels conferring increased transmission risk, although the level of rebound was significantly lower and sustained in PHI compared to CHI.
抗逆转录病毒治疗（ART）停止后 HIV 病毒载量（VL）反弹的幅度对临床结果和继续传播有影响。我们比较了原发性 HIV 感染（PHI）和慢性 HIV 感染（CHI）患者停止 ART 后血浆 VL 反弹的情况。
来自 SPARTAC（PHI，n=182）和 SMART（CHI，n=1450）试验的两组符合方案停止 ART 的患者。
采用生存分析评估 PHI 患者停止 ART 后 VL 达到治疗前水平的时间。用线性和逻辑回归分析停止 ART 后 4 周 PHI 和 CHI 患者之间 VL 的差异。用线性混合模型分析 48 周内 VL 斜率的差异，并通过时间平均 VL 曲线下面积来估计病毒载量。根据停止 ART 时的最低 CD4 水平对 CHI 患者进行分类。
171 例 PHI 患者中，71 例（41.5%）VL 反弹至治疗前水平，中位数为停止 ART 后 50（95%CI 48-51）周。停止治疗后 4 周，虽然 PHI 和 CHI 患者中 pVL≥400 拷贝/ml 的比例相似（78% PHI 与 79% CHI），但 PHI 患者的 VL 水平比 CHI 患者低 0.45（95%CI 0.26-0.64）log10 拷贝/ml，且在 48 周内仍较低。CHI 患者 CD4 最低点较低与停止 ART 后 VL 较高相关。CD4 最低点>500 个细胞/mm3 的 CHI 患者的病毒反弹与 PHI 患者相似。
PHI 和 CHI 患者停止 ART 后均会出现病毒反弹，达到增加传播风险的水平，但 PHI 患者的病毒反弹水平明显较低且持续时间较长。
