Outcomes of acutely HIV-1-infected individuals following rapid antiretroviral therapy initiation
Outcomes of acutely HIV-1-infected individuals following rapid antiretroviral therapy initiation
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DOI：
10.3851/imp3080
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发表时间：
2017-01-01
影响因子：
1.2
通讯作者：
Whitlock, Gary
中科院分区：
文献类型：
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作者：
Girometti, Nicolo;Nwokolo, Nneka;Whitlock, Gary
背景：关于急性HIV感染（AHI）快速开始抗逆转录病毒治疗的益处和可接受性的数据很少。我们分析了一大批开始抗逆转录病毒治疗（ART）的急性感染HIV患者，以确定其接受情况、与护理的联系以及实现病毒抑制的时间。方法：回顾2014年5月至2015年10月在英国伦敦迪恩街56号性健康诊所诊断为AHI的所有患者的病例记录。AHI是通过记录血浆HIV RNA阳性，血浆HIV RNA和p24抗原阳性，HIV酶免疫测定（EIA）试验阴性或HIV EIA试验在6周内由阴性转为阳性来定义的。采用log-rank检验对所选择的抗逆转录病毒治疗的病毒抑制时间进行组间比较。结果：我们确定了113例AHI患者。与护理的关联度为95%。77%的患者在首次就诊时开始抗逆转录病毒治疗：所有男男性行为者，中位年龄35岁，中位病毒载量（VL） log(10) 6.45，中位CD4+ t细胞计数483细胞/mm(3)。从诊断到开始抗逆转录病毒治疗的中位时间为20天。在24周时，没有患者停止抗逆转录病毒治疗；99%的患者在24周内实现了病毒抑制，记录在案的VL抑制的中位时间为74天。与其他方案相比，整合酶抑制剂的病毒抑制更快(中位41天vs 88.5天，P
Background: Few data exist on the benefits and acceptability of rapid initiation of antiretroviral treatment in acute HIV infection (AHI). We analysed a large cohort of acutely infected HIV patients starting antiretroviral therapy (ART) to determine uptake, linkage into care and time to achieve viral suppression.Methods: Case notes of all individuals diagnosed with AHI between May 2014 and October 2015 at 56 Dean Street, a sexual health clinic in London, UK were reviewed. AHI was defined through documentation of plasma HIV RNA positivity only, plasma HIV RNA and p24 antigen positivity with a negative HIV enzyme immunoassay (EIA) test or HIV EIA test switching from negative to positive within 6 weeks. Between-group comparisons of time to viral suppression according to ART chosen were performed using the log-rank test.Results: We identified 113 individuals with AHI. Linkage to care was 95%. 77% of patients started ART at first medical appointment: all men who have sex with men, median age 35 years, median viral load (VL) log(10) 6.45, median CD4+ T-cell count 483 cells/mm(3). Median time from diagnosis to ART initiation was 20 days. At 24 weeks, no patients had discontinued ART; 99% of patients achieved viral suppression by 24 weeks, with a median time to documented VL suppression of 74 days. Viral suppression was more rapid with integrase inhibitors compared with other regimens (median 41 versus 88.5 days, P