Enhanced CD4+ T-cell recovery with earlier HIV-1 antiretroviral therapy.
Enhanced CD4+ T-cell recovery with earlier HIV-1 antiretroviral therapy.
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DOI：
10.1056/nejmoa1110187
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发表时间：
2013-01-17
期刊：
影响因子：
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通讯作者：
Ahuja SK
中科院分区：
文献类型：
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作者：
Le T;Wright EJ;Smith DM;He W;Catano G;Okulicz JF;Young JA;Clark RA;Richman DD;Little SJ;Ahuja SK
感染人类免疫缺陷病毒1型（HIV-1）后开始抗逆转录病毒治疗（ART）的时间与CD4 + T细胞计数恢复之间的关系尚不清楚。在急性或早期HIV-1感染者的前瞻性观察队列中，我们在部分重叠的研究集中确定了48个月期间CD4+计数的轨迹：研究组1包括384名在未接受ART的时间窗内的参与者，研究组2包括213名在研究进入后不久或之后某个时间接受ART的参与者，血浆HIV病毒载量。我们调查了在接受病毒载量抑制ART的受试者中，CD4 + T细胞在48个月内恢复到每立方毫米900个或更多细胞的可能性和比率。在未接受ART的受试者中，在HIV-1感染后不久，CD4+计数自发地从研究开始时的水平增加（中位数，每立方毫米495个细胞;四分位数范围，383至622），达到峰值（中位数，763个细胞/立方毫米;四分位数范围，573至987），并在此后逐渐下降。在较早开始抗逆转录病毒治疗的受试者中（HIV感染后≤ 4个月），约64%的受试者的CD4+细胞计数恢复到900个或更多细胞/立方毫米，而在较晚开始抗逆转录病毒治疗的受试者中（> 4个月），约34%的受试者恢复到900个或更多细胞/立方毫米（P <0.001）。在调整当CD 4+计数为每立方毫米500个或更多细胞或低于每立方毫米500个细胞时是否启动ART后，计数增加至每立方毫米900个或更多细胞的可能性降低了65%（比值比，0.35），并且如果ART较晚而不是较早开始，则恢复率慢56%（率比，0.44）。在开始ART时血浆HIV RNA水平与CD4 + T细胞恢复之间没有关联。在HIV-1感染后4个月的时间窗内，CD4 + T细胞计数出现短暂的自发恢复。在此期间开始抗逆转录病毒治疗与CD4+计数恢复的可能性增加有关。（由国家过敏和传染病研究所和其他机构资助。
The relationship between the timing of the initiation of antiretroviral therapy (ART) after infection with human immunodeficiency virus type 1 (HIV-1) and the recovery of CD4+ T-cell counts is unknown. In a prospective, observational cohort of persons with acute or early HIV-1 infection, we determined the trajectory of CD4+ counts over a 48-month period in partially overlapping study sets: study set 1 included 384 participants during the time window in which they were not receiving ART and study set 2 included 213 participants who received ART soon after study entry or sometime thereafter and had a suppressed plasma HIV viral load. We investigated the likelihood and rate of CD4+ T-cell recovery to 900 or more cells per cubic millimeter within 48 months while the participants were receiving viral-load–suppressive ART. Among the participants who were not receiving ART, CD4+ counts increased spontaneously, soon after HIV-1 infection, from the level at study entry (median, 495 cells per cubic millimeter; interquartile range, 383 to 622), reached a peak value (median, 763 cells per cubic millimeter; interquartile range, 573 to 987) within approximately 4 months after the estimated date of infection, and declined progressively thereafter. Recovery of CD4+ counts to 900 or more cells per cubic millimeter was seen in approximately 64% of the participants who initiated ART earlier (≤4 months after the estimated date of HIV infection) as compared with approximately 34% of participants who initiated ART later (>4 months) (P<0.001). After adjustment for whether ART was initiated when the CD4+ count was 500 or more cells per cubic millimeter or less than 500 cells per cubic millimeter, the likelihood that the count would increase to 900 or more cells per cubic millimeter was lower by 65% (odds ratio, 0.35), and the rate of recovery was slower by 56% (rate ratio, 0.44), if ART was initiated later rather than earlier. There was no association between the plasma HIV RNA level at the time of initiation of ART and CD4+ T-cell recovery. A transient, spontaneous restoration of CD4+ T-cell counts occurs in the 4-month time window after HIV-1 infection. Initiation of ART during this period is associated with an enhanced likelihood of recovery of CD4+ counts. (Funded by the National Institute of Allergy and Infectious Diseases and others.)