Brima Nataliya, Lampe Fiona C, Copas Andrew, Gilson Richard, Williams Ian, Johnson Margaret A, Phillips Andrew N, Smith Colette J
UCL Institute of Global Health, London, UK.
Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK.
J Int AIDS Soc. 2017 Aug 30;20(1):21567. doi: 10.7448/IAS.20.21567.
For people living with HIV, the first antiretroviral treatment (ART) regimen offers the best chance for a good virological response. Early identification of those unlikely to respond to first-line ART could enable timely intervention and increase chances of a good initial treatment response. In this study we assess the extent to which the HIV RNA viral load (VL) at 1 and 3 months is predictive of first-line treatment outcome at 6 months. All previously ART-naive individuals starting ART at two London centres since 2000 with baseline (-180 to 3 days) VL >500 c/mL had a VL measurement between 6 and 12 months after starting ART, and at least one at month 1 (4-60 days) or month 3 (61-120 days) were included. Lack of treatment response was defined as (i) VL >200 copies/mL at 6 months or (ii) VL >200 copies/mL at 6 months or simultaneous switch in drugs from at least two different drug classes before 6 months. The association with VL measurements at 1 and 3 months post-ART; change from pre-ART in these values; and CD4 count measurements at 1 and 3 months were assessed using logistic regression models. The relative fit of the models was compared using the Akaike information criterion (AIC).
A total of 198 out of 3258 individuals (6%) experienced lack of treatment response at 6 months (definition i), increasing to 511 (16%) for definition (ii). Those with a 1-month (day 4-60 window) VL of <1000, 1000-9999, 10,000-99,999 and >100,000 copies/ml had a 4%, 8%, 23% and 24% chance, respectively, of subsequently experiencing treatment non-response at 6 months (definition (i)). When considering the 3-month (day 61-120 window) VL, the chances of subsequently experiencing treatment non-response were, respectively, 3%, 25%, 67% and 75%. Results were similar for definition (ii).
Whilst 3-month VL provides good discrimination between low and high risk of treatment failure, 1-month VL does not. Presence of a VL >10,000 copies/ml after 3 months of ART is a cutoff above which individuals are at a sufficiently higher risk of non-response that they may be considered for intervention.
对于感染艾滋病毒的人来说，首个抗逆转录病毒治疗（ART）方案提供了实现良好病毒学反应的最佳机会。尽早识别那些不太可能对一线ART产生反应的人，能够及时进行干预，并增加获得良好初始治疗反应的机会。在本研究中，我们评估了1个月和3个月时的艾滋病毒RNA病毒载量（VL）对6个月时一线治疗结果的预测程度。自2000年以来，在伦敦两个中心开始接受ART治疗的所有既往未接受过ART治疗且基线（-180至3天）VL>500拷贝/mL的个体，在开始ART治疗后6至12个月进行了VL测量，并且在第1个月（4 - 60天）或第3个月（61 - 120天）至少进行了一次测量，这些个体被纳入研究。治疗无反应的定义为：（i）6个月时VL>200拷贝/mL；或（ii）6个月时VL>200拷贝/mL，或在6个月前至少从两种不同药物类别同时换药。使用逻辑回归模型评估与ART治疗后1个月和3个月时VL测量值的关联；这些值相对于ART治疗前的变化；以及1个月和3个月时的CD4细胞计数测量值。使用赤池信息准则（AIC）比较模型的相对拟合度。
3258名个体中有198名（6%）在6个月时出现治疗无反应（定义i），对于定义（ii），这一比例增至511名（16%）。1个月时（第4 - 60天窗口）VL<1000、1000 - 9999、10000 - 99999和>100000拷贝/mL的个体，随后在6个月时出现治疗无反应（定义（i））的几率分别为4%、8%、23%和24%。当考虑3个月时（第61 - 120天窗口）的VL时，随后出现治疗无反应的几率分别为3%、25%、67%和75%。对于定义（ii），结果类似。
虽然3个月时的VL能很好地区分治疗失败的低风险和高风险，但1个月时的VL不能。ART治疗3个月后VL>10000拷贝/mL是一个临界值，高于此值的个体无反应风险足够高，可能需要考虑进行干预。
