Disease progression, adherence, and response to protease inhibitor therapy for HIV infection in an Urban Veterans Affairs Medical Center.
Disease progression, adherence, and response to protease inhibitor therapy for HIV infection in an Urban Veterans Affairs Medical Center.
复制标题
城市退伍军人事务医疗中心的艾滋病毒感染的蛋白酶抑制剂治疗的疾病进展、依从性和反应。
DOI：
10.1097/00126334-199912010-00006
复制
发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Dickinson,G
中科院分区：
文献类型：
--
作者：
Maher,K;Klimas,N;Fletcher,MA;Cohen,V;Maggio,CM;Triplett,J;Valenzuela,R;Dickinson,G
茚地那韦疗法在临床试验中已显示出治疗HIV-1感染的前景;然而，其在美国退伍军人事务医疗中心的疗效尚不清楚，该中心的治疗通常不受阻碍。从1996年5月开始，对迈阿密队列进行了回顾，以评价茚地那韦加两种核苷类似物的反应。在483名HIV-1阳性患者中（97%为男性，平均年龄46.7 ± 9.7岁），266名患者根据其CD 4计数< 200个细胞/[mu] l或病毒载量> 10，000拷贝/ml接受了茚地那韦治疗。在这些患者中，36%为粘附性，病毒载量显著降低（-93，325 +/-147，911拷贝/ml），CD 4+（111+/-103个细胞/[mu] l）和CD 8+（225+/-338个细胞/[mu] l）T细胞计数升高。基线CD 4计数< 100个细胞/[mu] l的粘附患者后续病毒载量> 10，000拷贝/ml的可能性是CD 4> 200个细胞/[mu] l的患者的4.5倍。CD 4计数< 100个细胞/[mu] l的粘附患者没有显示出免疫”衰竭”的证据，因为他们补充CD 4细胞的能力与CD 4计数> 200个细胞/[mu] l的患者相等。不遵守该方案会导致治疗益处的丧失，并表明增强遵守的策略可能成为治疗的重要组成部分。
Indinavir therapy has demonstrated promise in the treatment of HIV-1 infection in clinical trials; however, its efficacy in a US Veterans Affairs Medical Center, where access to therapy is generally unimpeded, is unknown. A review of the Miami cohort was conducted for the year beginning May 1996 to evaluate response to indinavir plus two nucleoside analogues. Of 483 HIV-1-positive patients (97% male; mean age, 46.7+/-9.7 years), 266 were offered indinavir based on their having CD4 counts< 200 cells/[mu] l or viral loads> 10,000 copies/ml. Of these patients, 36% were adherent and experienced significant reductions in viral loads (-93,325+/-147,911 copies/ml) and elevations in CD4+(111+/-103 cells/[mu] l) and CD8+(225+/-338 cells/[mu] l) T cell counts. Adherent patients with baseline CD4 counts< 100 cells/[mu] l were 4.5 times more likely to have follow-up viral loads> 10,000 copies/ml than those with CD4> 200 cells/[mu] l. Adherent patients with CD4 counts< 100 cells/[mu] l did not show evidence of immune" exhaustion" because they were equal to those with CD4 counts> 200 cells/[mu] l in their capacity to replenish CD4 cells. Nonadherence to the regimen resulted in loss of therapeutic benefit and suggested that strategies to enhance adherence may become an essential component of treatment.