在病毒学得到持续抑制的HIV感染患者中，病毒载量波动和低水平病毒血症发作对抗逆转录病毒治疗有何影响？

Any impact of blips and low-level viraemia episodes among HIV-infected patients with sustained virological suppression on ART?

作者信息

Pernas Berta, Grandal Marta, Pertega Sonia, Cañizares Angelina, Castro-Iglesias Ángeles, Mena Álvaro, Rodriguez-Osorio Iria, Tabernilla Andrés, Pedreira José D, Poveda Eva

机构信息

Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain.

Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain.

出版信息

J Antimicrob Chemother. 2016 Apr;71(4):1051-5. doi: 10.1093/jac/dkv433. Epub 2015 Dec 24.

DOI:10.1093/jac/dkv433

PMID:26702924

Abstract

OBJECTIVES

The objective of this study was to evaluate the prevalence of blips and risk of virological failure (VF) among HIV-infected patients with sustained virological suppression (HIV-RNA <50 copies/mL) on ART.

METHODS

Newly diagnosed (2004-13) HIV-infected patients with sustained virological suppression on ART (minimum follow-up of 3 months) were identified. Risk of VF was evaluated according to different plasma HIV-RNA quantification values based on the limits of quantification/detection of current commercial assays (20 copies/mL). Kaplan-Meier and Cox proportional hazards models were used to compare the cumulative incidence of VF.

RESULTS

A total of 565 newly diagnosed HIV-infected patients were identified: 453 started ART and 354 achieved virological suppression. Prevalence of blips (isolated HIV-RNA ranging from 50 to 200 copies/mL) and VF (HIV-RNA ≥50 copies/mL) was 22.7% and 8.8%, respectively (mean follow-up of 42 months). Multivariate analysis identified differences between HIV-RNA values as an independent predictor of VF (P = 0.008); risk of VF was higher for patients with blips [HR 2.500 (95% CI 0.524-11.926)] and for those with at least three consecutive detected, but not quantified, HIV-RNA determinations (HIV-RNA <20 copies/mL) [HR 3.813 (95% CI 0.675-21.535)]. Moreover, only HIV-infected patients with at least three consecutive detected, but not quantified, HIV-RNA determinations showed a higher probability of virological rebound with >200 copies/mL [33.7% at 24 and 60 months versus <5% for other HIV-RNA values; HR 6.943 (0.728-66.261), P = 0.092].

CONCLUSIONS

Blips are frequent (22.7%) among HIV-infected patients with sustained virological suppression on ART. HIV patients with blips and at least three consecutive detected, but not quantified, HIV-RNA determinations (<20 copies/mL) had a higher risk of VF. These findings highlight the relevance of maintaining HIV-RNA levels below the limits of quantification of current assays (<20 copies/mL).

摘要

目的

本研究的目的是评估接受抗逆转录病毒治疗（ART）且病毒学持续抑制（HIV-RNA<50拷贝/毫升）的HIV感染患者中病毒载量波动（blips）的发生率和病毒学失败（VF）的风险。

方法

确定新诊断（2004 - 2013年）且接受ART治疗后病毒学持续抑制（最短随访3个月）的HIV感染患者。根据当前商业检测方法的定量/检测限（20拷贝/毫升），依据不同的血浆HIV-RNA定量值评估VF风险。采用Kaplan-Meier法和Cox比例风险模型比较VF的累积发生率。

结果

共确定565例新诊断的HIV感染患者：453例开始接受ART治疗，354例实现病毒学抑制。病毒载量波动（孤立的HIV-RNA范围为50至200拷贝/毫升）和VF（HIV-RNA≥50拷贝/毫升）的发生率分别为22.7%和8.8%（平均随访42个月）。多变量分析确定HIV-RNA值之间的差异是VF的独立预测因素（P = 0.008）；病毒载量波动的患者发生VF的风险更高[风险比（HR）2.500（95%置信区间0.524 - 11.926）]，以及那些至少有三次连续检测到但未定量的HIV-RNA测定结果（HIV-RNA<20拷贝/毫升）的患者[HR 3.813（95%置信区间0.675 - 21.535）]。此外，只有那些至少有三次连续检测到但未定量的HIV-RNA测定结果的HIV感染患者显示病毒学反弹至>200拷贝/毫升的概率更高[24个月和60个月时为33.7%，而其他HIV-RNA值<5%；HR 6.943（0.728 - 66.261），P = 0.092]。