原发性感染中停止抗逆转录病毒治疗后HIV-1病毒抑制的持续时间与治疗时间相关。
Duration of HIV-1 viral suppression on cessation of antiretroviral therapy in primary infection correlates with time on therapy.
作者信息
Stöhr Wolfgang, Fidler Sarah, McClure Myra, Weber Jonathan, Cooper David, Ramjee Gita, Kaleebu Pontiano, Tambussi Giuseppe, Schechter Mauro, Babiker Abdel, Phillips Rodney E, Porter Kholoud, Frater John
机构信息
Medical Research Council Clinical Trials Unit, London, United Kingdom.
出版信息
PLoS One. 2013 Oct 25;8(10):e78287. doi: 10.1371/journal.pone.0078287. eCollection 2013.
OBJECTIVE
A minority of HIV-1 positive individuals treated with antiretroviral therapy (ART) in primary HIV-1 infection (PHI) maintain viral suppression on stopping. Whether this is related to ART duration has not been explored.
DESIGN
And Methods: Using SPARTAC trial data from individuals recruited within 6 months of seroconversion, we present an observational analysis investigating whether duration of ART was associated with post-treatment viraemic control. Kaplan-Meier estimates, logistic regression and Cox models were used.
RESULTS
165 participants reached plasma viral loads (VL) <400 copies/ml at the time of stopping therapy (ART stop). After ART stop, 159 experienced confirmed VL ≥400 copies/ml during median (IQR) follow-up of 167 (108,199) weeks. Most participants experienced VL rebound within 12 weeks from ART stop, however, there was a suggestion of a higher probability of remaining <400 copies/ml for those on ART >12 weeks compared to ≤12 weeks (p=0.061). Cumulative probabilities of remaining <400 copies/ml at 12, 52 and 104 weeks after ART stop were 21% (95%CI=13,30), 4% (1,9), and 4% (1,9) for ≤12 weeks ART, and 32% (22,42), 14% (7,22), and 5% (2,11) for >12 weeks. In multivariable regression, ART for >12 weeks was independently associated with a lower probability of being ≥400 copies/ml within 12 weeks of ART stop (OR=0.11 (95%CI=0.03,0.34), p<0.001)). In Cox models of time to VL ≥400 after 12 weeks, we only found an association with female sex (OR=0.2, p=0.001).
CONCLUSION
Longer ART duration in PHI was associated with a higher probability of viral control after ART stop.
TRIAL REGISTRATION
Controlled-Trials.com 76742797 http://www.controlled-trials.com/ISRCTN76742797.
目的
在原发性HIV-1感染（PHI）中接受抗逆转录病毒疗法（ART）治疗的少数HIV-1阳性个体在停药后维持病毒抑制状态。这是否与ART疗程有关尚未得到探究。
设计与方法
利用血清转化后6个月内招募的个体的SPARTAC试验数据，我们进行了一项观察性分析，以研究ART疗程是否与治疗后病毒血症控制相关。使用了Kaplan-Meier估计、逻辑回归和Cox模型。
结果
165名参与者在停止治疗（ART停药）时血浆病毒载量（VL）<400拷贝/毫升。在ART停药后，159名参与者在中位（四分位间距）随访167（108,199）周期间经历了确诊的VL≥400拷贝/毫升。大多数参与者在ART停药后12周内经历了病毒载量反弹，然而，与接受ART≤12周的参与者相比，接受ART>12周的参与者病毒载量保持<400拷贝/毫升的可能性更高（p=0.061）。在ART停药后12、52和104周时病毒载量保持<400拷贝/毫升的累积概率，接受ART≤12周的参与者分别为21%（95%CI=13,30）、4%（1,9）和4%（1,9），接受ART>12周的参与者分别为32%（22,42）、14%（7,22）和5%（2,11）。在多变量回归中，接受ART>12周与ART停药后12周内病毒载量≥400拷贝/毫升的可能性较低独立相关（OR=0.11（95%CI=0.03,0.34），p<0.001）。在12周后病毒载量≥400的Cox模型中，我们仅发现与女性性别有关（OR=0.2，p=0.001）。
结论
在PHI中ART疗程较长与ART停药后病毒控制的较高可能性相关。
试验注册
Controlled-Trials.com 76742797 http://www.controlled-trials.com/ISRCTN76742797
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