Duration and predictors of CD4 T-cell gains in patients who continue combination therapy despite detectable plasma viremia
Duration and predictors of CD4 T-cell gains in patients who continue combination therapy despite detectable plasma viremia
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DOI：
10.1097/00002030-200201250-00009
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发表时间：
2002-01-25
期刊：
影响因子：
3.8
通讯作者：
Martin, JN
中科院分区：
文献类型：
--
作者：
Deeks, SG;Barbour, JD;Martin, JN
背景：在基于蛋白酶抑制剂的抗逆转录病毒治疗中，尽管病毒不完全抑制，但CD4细胞计数持续升高通常会发生。目的：确定在蛋白酶抑制剂治疗病毒学失败的患者中CD4细胞计数恢复到治疗前水平的发生率和危险因素。设计：这是一项基于临床的队列研究，研究对象是在蛋白酶抑制剂治疗方案中未能维持持久病毒抑制的hiv感染成人。主要结局指标：病毒学失败定义为持续血浆HIV RNA水平bb0 500拷贝/ml。免疫失败的定义是CD4细胞计数恢复到治疗前的水平。结果：共有291例患者在基于蛋白酶抑制剂的方案中出现病毒学失败，并且在病毒学失败时治疗介导的CD4细胞高于治疗前水平。如果在启动成功的挽救方案时对患者数据进行审查，那么病毒学失败发生后免疫失败的中位时间为3年。如果患者数据在治疗停止时也被删除，那么36.8%的队列在连续3年病毒学失败后经历了免疫失败。与治疗前基线相比，病毒载量的变化，而不是达到的病毒血症的绝对水平，是免疫失败的一个强有力的独立预测因子。停止治疗与独立于病毒载量变化的免疫功能衰竭有关。结论：在以蛋白酶抑制剂为基础的治疗方案中，T CD4+细胞数量的减少最终可能在长期病毒学失败期间发生，并通过低于治疗前“设定点”的病毒学抑制程度来预测。(C) 2002利平科特·威廉姆斯·威尔金斯。
Background: Sustained elevations in CD4 cell counts commonly occur despite incomplete viral suppression with protease inhibitor-based antiretroviral therapy.Objectives: To determine the incidence and risk factors associated with return of CD4 cell count to pre-therapy levels in patients experiencing virologic failure of protease inhibitor therapy.Design: This is a clinic-based cohort study of HIV-infected adults who failed to maintain durable viral suppression on a protease inhibitor-based regimen.Main outcome measures: Virologic failure was defined as persistent plasma HIV RNA level > 500 copies/ml. Immunologic failure was defined as return of CD4 cell count to pre-therapy levels.Results: A total of 291 patients experienced virologic failure on a protease inhibitor-based regimen and had a treatment-mediated CD4 cell increase above pre-therapy levels at the time of virologic failure. If patient data were censored at the time a successful salvage regimen was initiated, then the median time to immunologic failure after the onset of virologic failure was 3 years. If patient data were also censored at the time therapy was discontinued, then 36.8% of the cohort experienced immunologic failure after 3 years of continuous virologic failure. The change in viral load from a pre-treatment baseline, and not the absolute level of viremia achieved, was a strong and independent predictor of immunologic failure. Discontinuing therapy was associated with immunologic failure independent of viral load changes.Conclusion: Reduction in T CD4+ cell numbers may eventually occur during prolonged virologic failure of a protease inhibitor-based regimen and is predicted by the degree of virologic suppression below a pre-therapy 'set-point'. (C) 2002 Lippincott Williams Wilkins.