Palich R, Wirden M, Peytavin G, Lê M-P, Seang S, Abdi B, Schneider L, Tubiana R, Valantin M-A, Paccoud O, Soulié C, Calvez V, Katlama C, Marcelin A-G
Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France.
Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, F-75013 Paris, France.
J Antimicrob Chemother. 2020 Oct 1;75(10):2981-2985. doi: 10.1093/jac/dkaa273.
To assess genotypic sensitivity scores (GSSs), plasma antiretroviral concentrations (PACs) and immunovirological outcomes at Week 96 (W96) in patients with persistent low-level viraemia (LLV).
On 1 January 2017, we analysed data from patients on three-drug regimens with persistent LLV defined as at least two consecutive plasma viral loads (pVLs) between 21 and 200 copies/mL (including one pVL of ≥50 copies/mL), at the Pitié-Salpêtrière Hospital. Outcomes were: GSS, PACs and HIV-DNA load at study entry; and virological status and proportion of patients with resistance-associated mutations (RAMs) at W96.
Fifty-seven patients were included, with median age of 52.6 years (IQR 45.2-57.9), last CD4 count of 658 cells/mm3 (IQR 462-909) and total ART duration of 10.2 years (IQR 5.7-15.2). LLV duration was 14.0 months (IQR 5.5-22.3). GSS was 3 in 46/57 (81%) patients and PACs were adequate in 53/57 (93%) patients. Median total HIV-DNA was 2.65 log10 copies/106 cells (IQR 2.44-2.86). During follow-up, 26/57 (46%) had experienced ART modifications. At W96, 38/57 (67%) patients remained with LLV, 15/60 (26%) had achieved confirmed pVL of <20 copies/mL and 4/57 (7%) had virological failure. The four virological failures were due to three ART interruptions and one incomplete adherence (selection of Y181C RAM). No factors (patient characteristics at study entry, GSS, PACs, total HIV-DNA load and ART modification) were associated with W96 viral outcome, except for time from HIV diagnosis and the LLV duration at study entry.
A substantial number of patients harbouring LLV had no resistance to ART and adequate PACs. Two-thirds of these patients remained with this LLV status.
评估持续性低水平病毒血症（LLV）患者在第96周（W96）时的基因型敏感性评分（GSS）、血浆抗逆转录病毒药物浓度（PAC）和免疫病毒学结果。
2017年1月1日，我们分析了皮提耶-萨尔佩特里埃医院接受三联药物治疗且存在持续性LLV的患者数据，持续性LLV定义为至少两次连续血浆病毒载量（pVL）在21至200拷贝/毫升之间（包括一次pVL≥50拷贝/毫升）。观察指标包括：研究入组时的GSS、PAC和HIV-DNA载量；以及W96时的病毒学状态和耐药相关突变（RAM）患者比例。
纳入57例患者，中位年龄52.6岁（四分位间距45.2 - 57.9），末次CD4细胞计数为658个/立方毫米（四分位间距462 - 909），抗逆转录病毒治疗总疗程为10.2年（四分位间距5.7 - 15.2）。LLV持续时间为14.0个月（四分位间距5.5 - 22.3）。46/57（81%）患者的GSS为3，53/57（93%）患者的PAC充足。HIV-DNA总量中位数为2.65 log10拷贝/106细胞（四分位间距2.44 - 2.86）。随访期间，26/57（46%）患者接受了抗逆转录病毒治疗调整。在W96时，38/57（67%）患者仍处于LLV状态，15/60（26%）患者确认pVL<20拷贝/毫升，4/57（7%）患者出现病毒学失败。4例病毒学失败分别由于3次抗逆转录病毒治疗中断和1次不完全依从（选择Y181C RAM）。除了从HIV诊断开始的时间和研究入组时的LLV持续时间外，没有因素（研究入组时的患者特征、GSS、PAC、HIV-DNA总量和抗逆转录病毒治疗调整）与W96时的病毒学结果相关。
大量存在LLV的患者对抗逆转录病毒治疗无耐药且PAC充足。这些患者中有三分之二仍处于LLV状态。
