How reliable is an undetectable viral load?
How reliable is an undetectable viral load?
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DOI：
10.1111/j.1468-1293.2009.00714.x
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发表时间：
2009-09-01
期刊：
影响因子：
3
通讯作者：
Hirschel, B.
中科院分区：
文献类型：
--
作者：
Combescure, C.;Vallier, N.;Hirschel, B.
瑞士艾滋病委员会的一篇文章指出，稳定抑制病毒血症的患者[i. e.在6个月或更长时间的高效抗逆转录病毒治疗（HAART）期间，连续几次HIV-1 RNA血浆浓度（病毒载量，VL）低于检测限]不太可能具有传染性。于是产生了一些问题：考虑到各种措施的历史，VL的不可探测性有多可靠？哪些因素决定了可靠性？我们评估了在2003年至2007年期间继续接受HAART的6168例瑞士HIV队列研究患者中，当第n个VL < 50拷贝/mL时，n+1 VL将超过50或1000 HIV-1 RNA拷贝/mL的概率（以下称为可靠性）。结果以50拷贝/mL为临界值，信度为84.5%（n = 1），增加到94.5%（n = 5）。依从性、当前HAART类型和首次接受抗逆转录病毒治疗（ART）（HAART与否）是可靠性的预测因素。当临界值为1000拷贝/mL时，可靠性为97.5%（n = 1），增加至99.1%（n = 4）。图表审查显示，72.2%的患者停止了治疗，承认有依从性方面的重大问题，或正在接受非HAART ART ART。耐药引起的病毒逃逸占5.6%。在22.2%的cases.ConclusionsAfter几个连续的VL在< 50拷贝/mL，可靠性达到约94%的截止值为50拷贝/mL，约99%的截止值为1000拷贝/mL的图表中没有发现任何解释。顺应性是预测可靠性的最重要因素。
ObjectivesAn article by the Swiss AIDS Commission states that patients with stably suppressed viraemia [i. e. several successive HIV-1 RNA plasma concentrations (viral loads, VL) below the limits of detection during 6 months or more of highly active antiretroviral therapy (HAART)] are unlikely to be infectious. Questions then arise: how reliable is the undetectability of the VL, given the history of measures? What factors determine reliability?MethodsWe assessed the probability (henceforth termed reliability) that the n+1 VL would exceed 50 or 1000 HIV-1 RNA copies/mL when the nth one had been < 50 copies/mL in 6168 patients of the Swiss HIV Cohort Study who were continuing to take HAART between 2003 and 2007. General estimating equations were used to analyse potential factors of reliability.ResultsWith a cut-off at 50 copies/mL, reliability was 84.5% (n = 1), increasing to 94.5% (n = 5). Compliance, the current type of HAART and the first antiretroviral therapy (ART) received (HAART or not) were predictive factors of reliability. With a cut-off at 1000 copies/mL, reliability was 97.5% (n = 1), increasing to 99.1% (n = 4). Chart review revealed that patients had stopped their treatment, admitted to major problems with compliance or were taking non-HAART ART in 72.2% of these cases. Viral escape caused by resistance was found in 5.6%. No explanation was found in the charts of 22.2% of cases.ConclusionsAfter several successive VLs at < 50 copies/mL, reliability reaches approximately 94% with a cut-off of 50 copies/mL and approximately 99% with a cut-off at 1000 copies/mL. Compliance is the most important factor predicting reliability.