Immunovirological Response to Triple Nucleotide Reverse-Transcriptase Inhibitors and Ritonavir-Boosted Protease Inhibitors in Treatment-Naive HIV-2-Infected Patients: The ACHIEV2E Collaboration Study Group
Immunovirological Response to Triple Nucleotide Reverse-Transcriptase Inhibitors and Ritonavir-Boosted Protease Inhibitors in Treatment-Naive HIV-2-Infected Patients: The ACHIEV2E Collaboration Study Group
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DOI：
10.1093/cid/cir123
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发表时间：
2011-05-15
影响因子：
11.8
通讯作者：
Matheron, Sophie
中科院分区：
文献类型：
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作者：
Benard, Antoine;van Sighem, Ard;Matheron, Sophie
背景三联核苷逆转录酶抑制剂（NRTI）是世界卫生组织推荐的HIV-2感染初治患者的一线治疗方案。然而，利托那韦加强蛋白酶抑制剂（PI/r）的方案经常规定。在缺乏先前随机试验的情况下，我们回顾性地比较了这些方案的观察队列。纳入了自1998年1月以来开始三联NRTI或PI/r的7个欧洲队列的HIV-2感染患者。使用分段线性模型估计CD 4细胞计数和血浆HIV-2 RNA水平斜率，区分早期阶段（直至第3个月结束）和第二阶段（第4-12个月）。治疗中分析主要治疗调整时的删失数据和第12个月时的系统性数据。44例患者开始三联NRTI治疗，126例开始PI/r治疗。总体而言，在开始联合抗逆转录病毒治疗（cART）时，61%的患者的中位CD 4细胞计数为191个细胞/mm（3），中位血浆HIV-2 RNA水平>= 2.7 log（10）拷贝/ml;首次cART的中位持续时间为20个月，两组之间没有差异。与NRTI方案相比，PI/r方案与更好的CD 4细胞计数和HIV-2 RNA水平结局相关。三重NRTI和PI/r的CD 4细胞计数斜率在早期分别为+6和+12个细胞/mm（3）/月（P = .22），在第二阶段分别为-60个细胞/mm（3）/年和+76个细胞/mm（3）/年（P = .002）。在cART启动时可检测到病毒血症的患者中，第12个月时估计的平均HIV-2 RNA水平分别为4.0和2.2 log（10）拷贝/ml（P = .005）。在这项观察性研究中，作为HIV-2感染患者的一线治疗，含PI/r方案显示出优于三联NRTI方案的上级疗效。
Background. Triple nucleoside reverse-transcriptase inhibitors (NRTIs) are recommended by the World Health Organization as first-line regimen in treatment-naive HIV-2-infected patients. However, ritonavir-boosted protease inhibitor (PI/r)-containing regimens are frequently prescribed. In the absence of previous randomized trials, we retrospectively compared these regimens in observational cohorts.Methods. HIV-2-infected patients from 7 European cohorts who started triple NRTI or PI/r since January 1998 were included. Piecewise linear models were used to estimate CD4 cell count and plasma HIV-2 RNA level slopes, differentiating an early phase (until end of month 3) and a second phase (months 4-12). On-treatment analyses censored data at major treatment modification and systematically at month 12.Results. Forty-four patients started triple NRTI therapy and 126 started PI/r therapy. Overall, the median CD4 cell count was 191 cells/mm(3) and the median plasma HIV-2 RNA level was >= 2.7 log(10) copies/ml in 61% of the patients at combination antiretroviral therapy (cART) initiation; the median duration of the first cART was 20 months, not differing between groups. PI/r regimens were associated with better CD4 cell count and HIV-2 RNA level outcomes, compared with NRTI regimens. Estimated CD4 cell count slopes were +6 and +12 cells/mm(3)/month during the early phase (P = .22), and -60 cells/mm(3)/year versus +76 cells/mm(3)/year during the second phase (P = .002), for triple NRTI and PI/r, respectively. Estimated mean HIV-2 RNA levels at month 12 in patients with detectable viremia at cART initiation were 4.0 and 2.2 log(10) copies/ml, respectively (P = .005).Conclusions. In this observational study, PI/r-containing regimens showed superior efficacy over triple NRTI regimens as first-line therapy in HIV-2-infected patients.