Is Moderate HIV Viremia Associated With a Higher Risk of Clinical Progression in HIV-Infected People Treated With Highly Active Antiretroviral Therapy: Evidence From the Italian Cohort of Antiretroviral-Naive Patients Study
Is Moderate HIV Viremia Associated With a Higher Risk of Clinical Progression in HIV-Infected People Treated With Highly Active Antiretroviral Therapy: Evidence From the Italian Cohort of Antiretroviral-Naive Patients Study
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中度 HIV 病毒血症是否与接受高效抗逆转录病毒治疗的 HIV 感染者临床进展风险较高相关：来自意大利未接受过抗逆转录病毒治疗的患者队列研究的证据
DOI：
10.1097/01.qai.0000188337.76164.7a
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
A. Monforte
中科院分区：
文献类型：
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作者：
R. Murri;A. Lepri;P. Cicconi;A. Poggio;M. Arlotti;G. Tositti;D. Santoro;M. Soranzo;G. Rizzardini;V. Colangeli;M. Montroni;A. Monforte
目的：根据未完全抑制病毒载量（VL）的时间长度，与之前未接受抗逆转录病毒药物而开始高效抗逆转录病毒治疗（HAART）的 HIV 感染者的病毒血症稳定抑制期相关的时间，评估临床进展（CP）的风险。设计：一项队列研究，对象是在意大利未接受过抗逆转录病毒治疗的患者队列 (ICoNA) 入组后开始 HAART 并随访至少 6 个月的患者。方法：根据VL水平以及HAART开始前VL与最近一次值的变化，计算不同类别花费的人年。构建了包含潜在混杂因素的多变量泊松回归模型。结果：总共研究了 3023 名患者。 CP的总体发生率为每1000人年13.4例。有证据表明当前 VL >10,000 拷贝/mL 的人患 CP 的风险较高。 VL > 100,000 拷贝/mL 的 HAART 治疗时间每延长一年，观察到的风险就会增加 5 倍（相对风险 [RR] = 5.34，95% 置信区间 [CI]：2.83 至 1.08；P = 0.0001）。与抑制 >3 的患者相比，当前抑制 <1.5 log10 拷贝/mL 的患者（RR = 2.34，95% CI：1.16 至 4.74；P = 0.02）和无抑制或 VL 高于其设定点的患者（RR = 2.39，95% CI：1.17 至 4.89；P = 0.02）观察到 CP 风险增加log10 拷贝/mL，尽管并不显着。 HAART 持续时间较长且 VL 抑制在设定点以下似乎可以提供针对 CP 的保护。结论：抗逆转录病毒药物的病毒学失败很常见。尽管 HIV 病毒血症水平较低但可检测到，但 CP 的风险可能仍然较低。
Objective:To assess the risk of clinical progression (CP) according to the duration of time spent without complete viral load (VL) suppression compared with that associated with periods of stably suppressed viremia in HIV-infected people who started highly active antiretroviral therapy (HAART) when previously naïve to antiretrovirals. Design:A cohort study of patients having started HAART after enrollment in the Italian Cohort of Antiretroviral-Naive Patients (ICoNA) and being followed for at least 6 months. Methods:Person-years spent in different categories according to the VL level and the change in VL from the most recent value before the initiation of HAART were calculated. A multivariable Poisson regression model, including potential confounders, was constructed. Results:A total of 3023 patients were studied. The overall rate of CP was 13.4 per 1000 person-years. Evidence for a higher risk of CP was observed for people with a current VL >10,000 copies/mL. For each year longer spent on HAART with a VL >100,000 copies/mL, a 5-fold increased risk was observed (relative risk [RR] = 5.34, 95% confidence interval [CI]: 2.83 to 1.08; P = 0.0001). An increased risk of CP in patients with current suppression <1.5 log10 copies/mL (RR = 2.34, 95% CI: 1.16 to 4.74; P = 0.02) and in those with no suppression or a VL higher than their set point (RR = 2.39, 95% CI: 1.17 to 4.89; P = 0.02) was observed compared with those with suppression of >3 log10 copies/mL, although it was not significant. Longer duration on HAART with a VL suppressed below set point seemed to confer protection against CP. Conclusions:Virologic failure to antiretroviral drugs is common. The risk of CP may remain low despite a low but detectable level of HIV viremia.