Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan.
J Formos Med Assoc. 2020 Jan;119(1 Pt 3):455-461. doi: 10.1016/j.jfma.2019.07.029. Epub 2019 Aug 10.
Lifelong antiretroviral therapy (ART) is recommended for HIV-1 infected patients but may lead to intolerance or poor adherence. Structured treatment interruption (STI) is a strategy for drug holiday or to boost HIV-specific immunity. But the long-term outcome of STI was never reported in literature.
This is a single-center observational study. We followed the HIV-infected patients who already had a stable viral suppression and voluntarily started temporary STI with a fixed 12-week interval after counseling, evaluation and education. HIV-1-specific T cell response was also measured in some patients.
Totally 34 HIV-infected patients received temporary STI since July, 2006. 18 patients completed 10-year follow-up. All patients received protease inhibitors (PI)-based ART before and during temporary STI. The patients received temporary STI with a period of 36-85 weeks. All of them reached viral suppression after 12 weeks of restarting continuous ART. No viral rebound or opportunistic disease was recorded during follow-up. No adverse event or comorbidity was attributed to STI. The plasma viral load (PVL) at the end of STI was significantly lower than baseline PVL in patients with a longer duration of STI (≤36 weeks vs. >36 weeks, P = 0.005). The T cell response study revealed that cyclically increased HIV-1-specific T cell response after starting STI in patients with baseline CD4+ count >350/μL.
Temporary STI may not lead to worse long-term outcome among highly selected patients. The policy may partially control viral replication through reminding the HIV-1 specific T cell immunity.
终身抗逆转录病毒疗法（ART）被推荐用于 HIV-1 感染患者，但可能导致不耐受或药物依从性差。 中断治疗（STI）是一种药物假期或增强 HIV 特异性免疫的策略。但 STI 的长期结果从未在文献中报道过。
这是一项单中心观察性研究。我们对已经稳定抑制病毒且自愿接受临时 STI 的 HIV 感染患者进行了随访，在咨询、评估和教育后，每隔 12 周进行一次固定时间的 STI。一些患者还测量了 HIV-1 特异性 T 细胞反应。
自 2006 年 7 月以来，共有 34 名 HIV 感染患者接受了临时 STI。18 名患者完成了 10 年随访。所有患者在接受临时 STI 之前和期间均接受了基于蛋白酶抑制剂（PI）的 ART。患者接受临时 STI 的时间为 36-85 周。所有患者在重新开始连续 ART 12 周后均达到病毒抑制。随访期间未记录到病毒反弹或机会性疾病。没有不良反应或合并症归因于 STI。STI 结束时的血浆病毒载量（PVL）明显低于基线 PVL，STI 持续时间较长的患者（≤36 周与>36 周，P=0.005）。T 细胞反应研究表明，在基线 CD4+计数>350/μL 的患者中，开始 STI 后 HIV-1 特异性 T 细胞反应周期性增加。
在高度选择的患者中，临时 STI 可能不会导致更差的长期结果。该策略可能通过提醒 HIV-1 特异性 T 细胞免疫来部分控制病毒复制。
