Treatment outcome of HAART-treated patients in a resource-limited setting: The Belgrade Cohort Study
Treatment outcome of HAART-treated patients in a resource-limited setting: The Belgrade Cohort Study
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DOI：
10.1016/j.biopha.2014.01.001
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发表时间：
2014-04-01
影响因子：
7.5
通讯作者：
Djurkovic-Djakovic, Olgica
中科院分区：
文献类型：
--
作者：
Jevtovic, Djordje;Dragovic, Gordana;Djurkovic-Djakovic, Olgica
简介：我们评估了高活性抗逆转录病毒治疗（HAART）在资源有限的setting.Methods的影响：一项横断面研究进行了在艾滋病毒/艾滋病中心，贝尔格莱德，塞尔维亚的HAART患者。如果达到不可检测的HIVRNA血浆病毒载量（pVL < 50拷贝/μ L），并且CD 4 + T细胞计数增加超过350个细胞/μ L，则认为治疗应答是有利的。治疗失败定义为pVL超过1.7 log（10）copies/mL，而不考虑免疫学改善。结果：840例HIV感染者随访8.2 ± 3.4年。在697名可接受随访的患者中，113名（16.2%）患者死亡，44名（6.3%）患者治疗失败，540名（77.5%）患者持续存在无法检测到的病毒血症。419例（60.1%）获得了良好的治疗反应，而121例（14.4%）发生了HAART免疫学和病毒学反应之间的分离。基线CD 4 + T细胞计数高于200个细胞/mL是有利治疗应答的单一独立预测因子（HR = 2，95%CI = 1.69-2.61，P = 0.001），而在治疗开始时接受抗逆转录病毒治疗、HCV合并感染和艾滋病，都是阻止良好反应的因素（HR = 0.27，95%CI = 0.19-0.36，P = 0.001; HR = 0.75，95%CI = 0.56-0.95，P = 0.02; HR = 0.73，95%CI = 0.17-0.95，P = 0.018）。持续的病毒抑制是生存的独立预测因子（HR = 0.2，95% CI 0.07-0.61，P = 0.004）。HAART治疗的HIV感染患者达到并维持不可检测的病毒血症，有80%的可能性生存14年（P = 0.08，对数秩）。如果患有晚期HIV相关免疫缺陷的患者在HAART期间达到并维持最佳病毒抑制，无论免疫恢复水平如何，并且如果他们继续保持这种状态，即使在资源有限的情况下，他们的预后也可能相当好。(C)2014年Elsevier Masson SAS。All rights reserved.
Introduction: We evaluated the effects of highly-active-antiretroviral-therapy (HAART) in a resource-limited settings.Methods: A cross-sectional study was performed in patients who had initiated HAART at the HIV/AIDS-Center, Belgrade, Serbia. Treatment response was considered favorable in case of the achievement of undetectable HIVRNA plasma-viral-load (pVL < 50 copies/mu L), and with the CD4+ T-cell counts increased above 350 cells/mu L. The treatment failure was defined as pVL over 1.7 log(10) copies/mL, regardless of immunological improvement.Results: Eight hundred and forty HIV infected patients were followed-up for 8.2 +/- 3.4 years. Out of 697 patients available for follow-up, 113 (16.2%) patients died, 44 (6.3%) experienced treatment failure, while 540 (77.5%) had sustained undetectable viremia. In 419 (60.1%) favorable treatment response was achieved, while the dissociation between immunological and virological responses to HAART occurred in 121 (14.4%). A baseline CD4+ T-cell counts above 200 cells/mL was the single independent predictor of a favorable treatment response (HR = 2, 95%CI = 1.69-2.61, P = 0.001), while pre-treatment with ART, HCV co-infection and AIDS at the time of treatment initiation, were all factors preventing a favorable response (HR = 0.27, 95% CI = 0.19-0.36, P = 0.001; HR = 0.75, 95% CI = 0.56-0.95, P = 0.02; HR = 0.73, 95% CI = 0.17-0.95, P = 0.018, respectively). A sustained viral suppression was an independent predictor of survival (HR = 0.2, 95% CI 0.07-0.61, P = 0.004). HAART treated HIV-infected patients who reach and maintain undetectable viremia, have an 80% probability of a 14-years survival (P = 0.08, log-rank).Conclusion: If patient with advanced HIV-related immunodeficiency reach and maintain optimal viral suppression during HAART, regardless of the level of immune recovery, and if they continue to maintain this, their prognosis may be fairly good even in the resource-limited settings. (C) 2014 Elsevier Masson SAS. All rights reserved.