Department of Infectious Diseases, Alfred Hospital and Monash University.
The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia.
AIDS. 2019 Apr 1;33(5):773-791. doi: 10.1097/QAD.0000000000002113.
: Despite the benefits of antiretroviral therapy (ART) for people living with HIV, there has been a long-standing research interest in interrupting ART as a strategy to minimize adverse effects of ART as well as to test interventions aiming to achieve a degree of virological control without ART. We performed a systematic review of HIV clinical studies involving treatment interruption from 2000 to 2017 to describe the differences between treatment interruption in studies that contained and didn't contain an intervention. We assessed differences in monitoring strategies, threshold to restart ART, duration and adverse outcomes of treatment interruption, and factors aimed at minimizing transmission. We found that treatment interruption has been incorporated into 159 clinical studies since 2000 and is increasingly being included in trials to assess the efficacy of interventions to achieve sustained virological remission off ART. Great heterogeneity was noted in immunological, virological and clinical monitoring strategies, as well as in thresholds to recommence ART. Treatment interruption in recent intervention studies were more closely monitored, had more conservative thresholds to restart ART and had a shorter treatment interruption duration, compared with older treatment interruption studies that didn't include an intervention.
: 尽管抗逆转录病毒疗法(ART)对艾滋病毒感染者有很多益处,但长期以来,人们一直对中断 ART 作为一种策略感兴趣,旨在最大限度地减少 ART 的不良反应,同时测试旨在实现一定程度的病毒学控制而无需 ART 的干预措施。我们对涉及 2000 年至 2017 年治疗中断的 HIV 临床研究进行了系统回顾,以描述包含和不包含干预措施的研究中治疗中断之间的差异。我们评估了监测策略、重新开始 ART 的阈值、治疗中断的持续时间和不良后果,以及旨在最大限度减少传播的因素。我们发现,自 2000 年以来,治疗中断已被纳入 159 项临床研究中,并且越来越多地被纳入试验中,以评估实现无 ART 持续病毒学缓解的干预措施的疗效。在免疫、病毒学和临床监测策略方面,以及重新开始 ART 的阈值方面,存在很大的异质性。与不包括干预措施的较旧治疗中断研究相比,最近干预研究中的治疗中断得到了更密切的监测,重新开始 ART 的阈值更保守,治疗中断持续时间更短。