Virological Blips and Predictors of Post Treatment Viral Control After Stopping ART Started in Primary HIV Infection.
Virological Blips and Predictors of Post Treatment Viral Control After Stopping ART Started in Primary HIV Infection.
复制标题
DOI：
10.1097/qai.0000000000001220
复制
发表时间：
2017-02-01
期刊：
影响因子：
--
通讯作者：
Porter K
中科院分区：
文献类型：
--
作者：
Fidler S;Olson AD;Bucher HC;Fox J;Thornhill J;Morrison C;Muga R;Phillips A;Frater J;Porter K
在原发性HIV感染（PHI）中开始抗逆转录病毒治疗（ART）的个体在治疗停止后很少维持不可检测的病毒血症。鉴于这一现象对治愈研究的重要性，相关因素仍不清楚。在PHI中使用启动ART的血清转换者的CASCADE数据（血清转化≤ 6个月），我们估计了病毒感染率我们使用考克斯模型来检查从ART停止到失控的时间之间的关系。（2次连续测量> 1000拷贝/毫升）和ART时的信号幅度和频率，从血清转化到ART的时间，ART时间，调整ART时每年HIV-RNA测量的平均次数，以及其他混杂因素。778例血清转换者在PHI中开始抗逆转录病毒治疗，并进行了≥ 3次HIV-RNA测量。中位四分位距（IQR）ART持续时间为16.2（8.0 - 35.9）个月，在此期间，我们观察到13%的患者出现≥ 1次短暂发作。在228名停止抗逆转录病毒治疗的患者中，119人反弹;失控时间与血清转换和抗逆转录病毒治疗开始之间的较长时间间隔相关[风险比（HR）= 1.16每月; 1.04，1.28]，以及抗逆转录病毒治疗期间的短暂发作（HR = 1.71每次发作; 95%置信区间= 0.94至3.10）。ART治疗时间越长（HR = 0.84/月; 0.76，0.92），失控风险越低。在228例停止抗逆转录病毒治疗的患者中，22例（10%）维持治疗后控制（PTC），即在停止抗逆转录病毒治疗后≥ 24个月，HIV-RNA <50拷贝/毫升。在接受PHI治疗的个体中，治疗期间的HIV病毒暂时性发作与随后停止ART后的病毒反弹相关。ART持续时间越长，PTC的机会越大。
Few individuals commencing antiretroviral therapy (ART) in primary HIV infection (PHI) maintain undetectable viremia after treatment cessation. Associated factors remain unclear given the importance of the phenomenon to cure research. Using CASCADE data of seroconverters starting ART in PHI (≤6 months from seroconversion), we estimated proportions experiencing viral blips (>400 copies followed by <400 copies HIV-RNA/mL without alteration of regimen) while on ART. We used Cox models to examine the association between time from ART stop to loss of control (2 consecutive measurements >1000 copies per milliliter) and magnitude and frequency of blips while on ART, time from seroconversion to ART, time on ART, adjusting for mean number of HIV-RNA measurements/year while on ART, and other confounders. Seven hundred seventy-eight seroconverters started ART in PHI with ≥3 HIV-RNA measurements. Median interquartile range (IQR) ART duration was 16.2 (8.0–35.9) months, within which we observed 13% with ≥1 blip. Of 228 who stopped ART, 119 rebounded; time to loss of control was associated with longer interval between seroconversion and ART initiation [hazard ratio (HR) = 1.16 per month; 1.04, 1.28], and blips while on ART (HR = 1.71 per blip; 95% confidence interval = 0.94 to 3.10). Longer time on ART (HR = 0.84 per additional month; 0.76, 0.92) was associated with lower risk of losing control. Of 228 stopping ART, 22 (10%) maintained post treatment control (PTC), ie, HIV-RNA <50 copies per milliliter ≥24 months after ART cessation. HIV viral blips on therapy are associated with subsequent viral rebound on stopping ART among individuals treated in PHI. Longer duration on ART is associated with a greater chance of PTC.