CD4 count-based failure criteria combined with viral load monitoring may trigger worse switch decisions than viral load monitoring alone.
CD4 count-based failure criteria combined with viral load monitoring may trigger worse switch decisions than viral load monitoring alone.
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基于 CD4 计数的失败标准与病毒载量监测相结合可能会引发比单独病毒载量监测更糟糕的转换决策。
DOI：
10.1111/tmi.12639
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
vanZyl,GertU
中科院分区：
文献类型：
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作者：
Hoffmann,ChristopherJ;Maritz,Jean;vanZyl,GertU
CD 4计数下降通常会在资源有限的情况下触发抗逆转录病毒治疗方案的转换，即使在病毒载量检测可用的情况下。因此，我们比较了CD 4的失败和CD 4的趋势与病毒血症患者或不抗逆转录病毒resistance.MethodsRetrospective队列研究调查艾滋病毒耐药性与CD 4失败或CD 4的趋势在一线抗逆转录病毒治疗方案的患者在病毒血症。纳入了来自南非两个HIV治疗项目的病毒血症患者（HIV RNA >1000拷贝/ml）（n= 350）。我们使用卡方检验和线性混合模型研究了M184 V和NNRTI耐药与WHO免疫失败标准和CD 4计数趋势的相关性。ResultsM 184 V突变患者达到免疫失败标准的人数少于未达到免疫失败标准的患者：51/151（34%）vs. 90/199（45%）（P= 0.03）。类似地，220例主要NNRTI耐药患者中有79例（36%）发生免疫失败，而130例无耐药患者中有62例（48%）发生免疫失败（卡方P = 0.03）。与M184 V突变的患者之间的CD 4计数下降为2.5个细胞/mm 3/年，而在那些没有M184 V，它是14个细胞/mm 3/年（P= 0.1），但在CD 4计数下降与NNRTI resistance.ConclusionOur数据表明，CD 4计数监测可能会导致不适当的延迟治疗开关HIV耐药的患者。相反，病毒血症但无耐药性的患者更有可能发生CD 4计数下降，因此更有可能转换为二线治疗方案。
ObjectiveCD4 count decline often triggers antiretroviral regimen switches in resource‐limited settings, even when viral load testing is available. We therefore compared CD4 failure and CD4 trends in patients with viraemia with or without antiretroviral resistance.MethodsRetrospective cohort study investigating the association of HIV drug resistance with CD4 failure or CD4 trends in patients on first‐line antiretroviral regimens during viraemia. Patients with viraemia (HIV RNA >1000 copies/ml) from two HIV treatment programmes in South Africa (n= 350) were included. We investigated the association of M184V and NNRTI resistance with WHO immunological failure criteria and CD4 count trends, using chi‐square tests and linear mixed models.ResultsFewer patients with the M184V mutation reached immunologic failure criteria than those without: 51 of 151(34%)vs. 90 of 199 (45%) (P= 0.03). Similarly, 79 of 220 (36%) patients, who had major NNRTI resistance, had immunological failure, whereas 62 of 130 (48%) without (chi‐squareP= 0.03) did. The CD4 count decline among patients with the M184V mutation was 2.5 cells/mm3/year, whereas in those without M184V it was 14 cells/mm3/year (P= 0.1), but the difference in CD4 count decline with and without NNRTI resistance was marginal.ConclusionOur data suggest that CD4 count monitoring may lead to inappropriate delayed therapy switches for patients with HIV drug resistance. Conversely, patients with viraemia but no drug resistance are more likely to have a CD4 count decline and thus may be more likely to be switched to a second‐line regimen.