初治联合抗反转录病毒治疗（ART）后 CD4 细胞计数应答在 HIV-2+ 患者与 HIV-1+ 患者中的比较：一项多国、多队列的欧洲研究。

CD4 cell count response to first-line combination ART in HIV-2+ patients compared with HIV-1+ patients: a multinational, multicohort European study.

机构信息

Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France.

CHU de Bordeaux, Pôle de santé publique, F-33000 Bordeaux, France.

出版信息

J Antimicrob Chemother. 2017 Oct 1;72(10):2869-2878. doi: 10.1093/jac/dkx210.

DOI:10.1093/jac/dkx210

PMID:29091198

Abstract

BACKGROUND

CD4 cell recovery following first-line combination ART (cART) is poorer in HIV-2+ than in HIV-1+ patients. Only large comparisons may allow adjustments for demographic and pretreatment plasma viral load (pVL).

METHODS

ART-naive HIV+ adults from two European multicohort collaborations, COHERE (HIV-1 alone) and ACHIeV2e (HIV-2 alone), were included, if they started first-line cART (without NNRTIs or fusion inhibitors) between 1997 and 2011. Patients without at least one CD4 cell count before start of cART, without a pretreatment pVL and with missing a priori-defined covariables were excluded. Evolution of CD4 cell count was studied using adjusted linear mixed models.

RESULTS

We included 185 HIV-2+ and 30321 HIV-1+ patients with median age of 46 years (IQR 36-52) and 37 years (IQR 31-44), respectively. Median observed pretreatment CD4 cell counts/mm3 were 203 (95% CI 100-290) in HIV-2+ patients and 223 (95% CI 100-353) in HIV-1+ patients. Mean observed CD4 cell count changes from start of cART to 12 months were +105 (95% CI 77-134) in HIV-2+ patients and +202 (95% CI 199-205) in HIV-1+ patients, an observed difference of 97 cells/mm3 in 1 year. In adjusted analysis, the mean CD4 cell increase was overall 25 CD4 cells/mm3/year lower (95% CI 5-44; P = 0.0127) in HIV-2+ patients compared with HIV-1+ patients.

CONCLUSIONS

A poorer CD4 cell increase during first-line cART was observed in HIV-2+ patients, even after adjusting for pretreatment pVL and other potential confounders. Our results underline the need to identify more potent therapeutic regimens or strategies against HIV-2.

摘要

背景

在接受一线联合抗逆转录病毒治疗（cART）后，HIV-2 感染患者的 CD4 细胞恢复情况较 HIV-1 感染患者更差。只有大规模的比较才可能对人口统计学和治疗前血浆病毒载量（pVL）进行调整。

方法

纳入了来自两个欧洲多队列合作组织 COHERE（仅 HIV-1）和 ACHIeV2e（仅 HIV-2）的初治 HIV 阳性成年人，如果他们在 1997 年至 2011 年期间开始一线 cART（无 NNRTIs 或融合抑制剂）。排除了至少在开始 cART 前一次 CD4 细胞计数、无治疗前 pVL 和缺少事先定义的协变量的患者。使用调整后的线性混合模型研究 CD4 细胞计数的变化。

结果

我们纳入了 185 名 HIV-2 感染患者和 30321 名 HIV-1 感染患者，中位年龄分别为 46 岁（IQR 36-52）和 37 岁（IQR 31-44）。中位观察到的治疗前 CD4 细胞计数/mm3 在 HIV-2 感染患者中为 203（95%CI 100-290），在 HIV-1 感染患者中为 223（95%CI 100-353）。从 cART 开始到 12 个月时，观察到的平均 CD4 细胞计数变化在 HIV-2 感染患者中为+105（95%CI 77-134），在 HIV-1 感染患者中为+202（95%CI 199-205），1 年内观察到的差异为 97 个/mm3。在调整分析中，与 HIV-1 感染患者相比，HIV-2 感染患者的 CD4 细胞平均增加量总体低 25 个/mm3/年（95%CI 5-44；P=0.0127）。