Jiamsakul Awachana, Rupasinghe Dhanushi, Woolley Ian, Choi Jun Yong, Templeton David J, Widhani Alvina, Petoumenos Kathy, Tanuma Junko
The Kirby Institute, UNSW Sydney, NSW, Australia.
Monash Infectious Diseases, Monash Health, and Monash University, Clayton, Victoria, Australia.
J Acquir Immune Defic Syndr. 2024 Dec 15;97(5):460-470. doi: 10.1097/QAI.0000000000003515.
Increasing numbers of people with HIV have received prolonged antiretroviral therapy (ART). We assessed long-term immunological and survival outcomes among people with HIV from Asia (TREAT Asia HIV Observational Database) and Australia (Australian HIV Observational Database).
People with HIV receiving ART for ≥10 years were included. Factors associated with CD4 counts in years 11-15 of ART were analyzed using repeated measures linear regression. Survival after 10 years was analyzed using competing risk regression.
There were 7139 people included: 4867 (68%) from the TREAT Asia HIV Observational Database and 2272 (32%) from the Australian HIV Observational Database. Higher CD4 levels after 10 years were observed if the nadir CD4 in the first decade was higher (CD4 (cells/µL) 101-200: difference = 35, 95% CI: 18 to 51; >200: difference = 125, 95% CI: 107 to 142) compared with ≤50. The same patterns were observed in those who achieved CD4 ≥500 cells/µL, which subsequently decreased to <500 (difference = 225, 95% confidence interval [CI]: 213 to 236), or in those who achieved and maintained CD4 ≥500 cells/µL (difference = 402, 95% CI: 384 to 420), compared with always <500 in the previous decade. Previous protease inhibitor (PI)-based regimen (difference=-17, 95% CI -33 to -1) compared with no PI, and previous treatment interruptions (TI) of 14 days to 3 months and >6 months were associated with lower CD4 counts after 10 years (difference = -38, 95% CI -62 to -15 and difference=-44, 95% CI -61 to -27, respectively) compared with no TI. The mortality rate was 1.04 per 100 person-years. Virological failure was associated with subsequent mortality (subhazard ratio = 1.34, 95% CI: 1.04 to 1.71).
Sustaining high CD4 levels and minimizing TI has far-reaching benefits well beyond the first decade of ART.
越来越多的艾滋病病毒感染者接受了长期抗逆转录病毒治疗（ART）。我们评估了来自亚洲（亚太地区艾滋病观察数据库）和澳大利亚（澳大利亚艾滋病观察数据库）的艾滋病病毒感染者的长期免疫和生存结果。
纳入接受ART治疗≥10年的艾滋病病毒感染者。使用重复测量线性回归分析与ART第11 - 15年CD4细胞计数相关的因素。使用竞争风险回归分析10年后的生存情况。
共纳入7139人：4867人（68%）来自亚太地区艾滋病观察数据库，2272人（32%）来自澳大利亚艾滋病观察数据库。与最低点CD4细胞计数≤50相比，如果第一个十年的最低点CD4细胞计数较高，则10年后CD4水平更高（CD4细胞/微升为101 - 200：差值 = 35，95%置信区间[CI]：18至51；>200：差值 = 125，95% CI：107至142）。在CD4细胞/微升达到≥500后又降至<500的人群中（差值 = 225，95%置信区间[CI]：213至236），以及在CD4细胞/微升达到并维持≥500的人群中（差值 = 402，95% CI：384至420），与前十年始终<500的人群相比，也观察到了相同的模式。与未使用蛋白酶抑制剂（PI）相比，既往基于PI的治疗方案（差值 = -17，95% CI -33至-1），以及既往14天至3个月和>6个月的治疗中断与10年后较低的CD4细胞计数相关（差值分别为 = -38，95% CI -62至-15和差值 = -44，95% CI -61至-27）。死亡率为每100人年1.04例。病毒学失败与随后的死亡率相关（亚风险比 = 1.34，95% CI：1.04至1.71）。
维持高CD4水平并尽量减少治疗中断在ART的第一个十年之后具有深远的益处。
