Effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy in HIV-1-positive subjects: Results from ACTG 384
Effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy in HIV-1-positive subjects: Results from ACTG 384
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DOI：
10.1097/01.qai.0000226789.51992.3f
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发表时间：
2006-08-01
影响因子：
3.6
通讯作者：
Pollard, Richard B.
中科院分区：
文献类型：
--
作者：
Gandhi, Rajesh T.;Spritzler, John;Pollard, Richard B.
目的：评价基线和治疗相关因素对抗逆转录病毒治疗(ART)后免疫功能恢复的影响。方法：将980例抗逆转录病毒初治HIV-1阳性患者随机分为司他夫定/地达宁、齐多夫定/拉米夫定与奈非那韦、伊法韦伦或奈非那韦和伊法韦仑合用。结果：40岁或以下、女性、基线幼稚/记忆性CD4细胞比率较高、基线病毒载量(VL)较高、病毒逻辑抑制(VS)与CD4细胞恢复率相关。大多数保持不可检测的VL的受试者的CD4细胞计数显著增加，但13%的受试者没有增加，即使在VS治疗3年后也是如此。持续的T细胞激活与较低的CD4细胞恢复率有关，即使在获得VS的受试者中也是如此。最初的治疗分配不影响总的CD4细胞恢复、幼稚/记忆的CD4细胞重建，或T细胞活化的下降。结论：在这项大型随机试验中，年龄较小、女性、较高的幼稚/记忆性CD4细胞比率、较高的基线VL和VS与较大的CD4细胞增加有关，而持续的T细胞激活与ART后CD4细胞恢复受损有关。最初的治疗分配不影响CD4细胞的重建。
Objective: To assess the effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy (ART).Methods: Nine hundred eighty antiretroviral-naive HIV-1+ subjects were randomized to start stavudine/didanosine or zidovudine/lamivudine with nelfinavir, efavirenz, or both nelfinavir and efavirenz.Results: Greater CD4 cell recovery was associated with age of 40 years or younger, female sex, higher baseline naive/memory CD4 cell ratio, higher baseline virus load (VL), and virologic suppression (VS). Most subjects who maintained an undetectable VL had a substantial increase in CD4 cell count, but 13% of the subjects did not, even after 3 years of VS. Persistent T-cell activation was associated with lower CD4 cell recovery, even in subjects who achieved VS. Initial treatment assignment did not affect total CD4 cell recovery, naive/memory CD4 cell reconstitution, or decline in T-cell activation. In addition to CD4 cell recovery, B-cell counts rose substantially after ART initiation.Conclusions: In this large randomized trial, younger age, female sex, higher naive/memory CD4 cell ratio, higher baseline VL, and VS were associated with greater CD4 cell increase, whereas per sistent T-cell activation was associated with impaired CD4 cell recovery after ART initiation. Initial treatment assignment did not affect CD4 cell reconstitution.