Immunological and virological efficacy of different antiretroviral regimens initiated during acute/recent HIV infection
Immunological and virological efficacy of different antiretroviral regimens initiated during acute/recent HIV infection
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DOI：
10.1097/qad.0000000000002685
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发表时间：
2020-12-01
期刊：
影响因子：
3.8
通讯作者：
Miro, Jose M.
中科院分区：
文献类型：
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作者：
Ambrosioni, Juan;Farrera, Julia;Miro, Jose M.
目的：急性/近期 HIV 感染期间的抗逆转录病毒治疗 (ART) 可减少传播并优化免疫恢复，但在此情况下的最佳 ART 方案尚不清楚。目的是分析急性/近期 HIV 感染期间开始 ART 3 年后不同 ART 方案的病毒学疗效、免疫学重建和耐受性。设计：对感染后 6 个月内开始 ART 的连续急性/近期感染患者进行回顾性队列研究。方法：我们比较了基于蛋白酶抑制剂 (N = 28)、整合酶链转移抑制剂 (InSTI，N = 87) 和非核苷逆转录酶抑制剂 (N = 22) 的治疗方案。比较了病毒学抑制（病毒载量900个细胞/μl且CD4+/CD8+比率>1）和导致ART在1年和3年停止的不良事件。结果：各组之间的基线特征具有可比性。所有 ART 治疗方案中 1 年 (96%) 和 3 年 (99%) 的总体病毒抑制效果相当，InSTI 组的 InSTI 组中的多替拉韦和艾维拉韦也具有可比性。所有 ART 方案中 1 年时的 CD4(+) T 细胞计数相当。 1年和3年时CD4(+)细胞计数超过900个细胞/μl且CD4(+)/CD8(+)比率超过1的患者总体比例分别为36%和40%以及46%和63%，ART方案之间没有差异。在最早的 Fiebig 阶段（I-V 与 VI）开始 ART 与 3 年时 CD4(+) 细胞计数超过 900 个细胞/μl 的较高比率相关（P = 0.027）。与其他 ART 类别相比，非核苷类逆转录酶抑制剂因不良事件而停药的情况更为常见。结论：病毒抑制和免疫恢复效果非常好，ART 方案之间没有差异。较早开始 ART 与较高比例的长期免疫恢复相关。
Objectives: Antiretroviral treatment (ART) during acute/recent HIV infection decreases transmission and optimizes immune recovery but the optimal ART-regimen in this setting is unknown. The objectives were to analyze the virological efficacy, immunological reconstitution and tolerability of different ART-regimens at 3 years after starting ART during acute/recent HIV infection. Design: Retrospective cohort study of consecutive acutely/recently infected patients who started ART within 6 months postinfection. Methods: We compared regimens based on protease-inhibitors (N = 28), integrase-strand-transfer-inhibitors (InSTI, N = 87) and nonnucleoside-reverse-transcriptase-inhibitors (N = 22). Virological suppression (viral load 900 cells/mu l and CD4(+)/CD8(+) ratio >1) and adverse events leading to ART discontinuation at 1 and 3 years were compared. Results: Baseline characteristics were comparable among groups. Overall viral suppression at 1 (96%) and 3 years (99%) was comparable in all ART regimens and, InSTI group, comparable for dolutegravir and elvitegravir within InSTIs. CD4(+) T-cell counts at 1 year were comparable in all ART regimens. Overall proportion of patients reaching CD4(+) cell count more than 900 cells/mu l and CD4(+)/CD8(+) ratio more than 1 was 36% and 40% and 46% and 63% at 1 and 3 years, respectively with no differences among ART regimens. Starting ART during the earliest Fiebig stages (I-V vs. VI) was associated with higher rates of CD4(+) cell count more than 900 cells/mu l at 3 years (P = 0.027). Discontinuation due to adverse events was more frequent with nonnucleoside-reverse-transcriptase-inhibitors compared with other ART classes. Conclusion: Viral suppression and immunological recovery were excellent, with no differences between ART regimens. Earlier ART initiation was associated with a higher proportion of long-term immunological recovery.