Havlir D, McLaughlin M M, Richman D D
Department of Medicine, University of California, San Diego, La Jolla, USA.
J Infect Dis. 1995 Nov;172(5):1379-83. doi: 10.1093/infdis/172.5.1379.
Treatment of human immunodeficiency virus (HIV) infection with nevirapine in patients with < 400 CD4 cells/mm3 rapidly selects for virus with reduced susceptibility to nevirapine. To test whether resistance would develop less quickly in patients with a lower virus burden, nevirapine was studied in asymptomatic patients with > 500 CD4 cells/mm3. With 400 mg of nevirapine daily, the median reduction in HIV RNA was 0.51 log10 copies/mL, and all isolates recovered by 12 weeks were resistant to nevirapine. As in patients with lower CD4 cell counts, some patients experienced sustained reduction in plasma HIV RNA despite the presence of resistant virus. These results suggest that lower levels of HIV RNA and immunosuppression did not retard the rate of emergence of nevirapine-resistant virus; also, a polymerase chain reaction-based HIV RNA assay is sufficiently sensitive to evaluate the antiviral effect of a drug in patients with > 500 CD4 cells/mm3.
在CD4细胞计数低于400个/mm³的患者中，使用奈韦拉平治疗人类免疫缺陷病毒（HIV）感染会迅速筛选出对奈韦拉平敏感性降低的病毒。为了测试在病毒载量较低的患者中耐药性是否会发展得较慢，对CD4细胞计数高于500个/mm³的无症状患者进行了奈韦拉平研究。每日服用400毫克奈韦拉平，HIV RNA的中位数降低为0.51 log10拷贝/毫升，到12周时回收的所有分离株均对奈韦拉平耐药。与CD4细胞计数较低的患者一样，一些患者尽管存在耐药病毒，但血浆HIV RNA仍持续降低。这些结果表明，较低水平的HIV RNA和免疫抑制并未延缓奈韦拉平耐药病毒的出现速度；此外，基于聚合酶链反应的HIV RNA检测方法足够灵敏，可用于评估药物对CD4细胞计数高于500个/mm³患者的抗病毒效果。
