Discordant immunologic and virologic responses to highly active antiretroviral therapy are associated with increased mortality and poor adherence to therapy
Discordant immunologic and virologic responses to highly active antiretroviral therapy are associated with increased mortality and poor adherence to therapy
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DOI：
10.1097/01.qai.0000182847.38098.d1
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发表时间：
2005-11-01
影响因子：
3.6
通讯作者：
Montaner, JSG
中科院分区：
文献类型：
--
作者：
Moore, DM;Hogg, RS;Montaner, JSG
目的：为了研究不一致的病毒学和免疫学反应与高活性抗逆转录病毒治疗（HAART）与mortality.Methods的独立关联：一项以人群为基础的研究，1527名首次接受HAART治疗的个体采用考克斯比例风险模型，以确定治疗反应在3至9个月与非意外死亡率的独立关联。结果：病毒载量（VL）（+）/CD 4（-）应答不一致者235例（15.4%），VL-/CD 4（+）应答者179例（11.7%）。在校正的考克斯回归模型中，发现不一致的应答与死亡风险增加独立相关（VL+/CD 4（-）：相对风险[RH] = 1.87，95%置信区间[Cl]：1.15 - 3.04; VL-/CD 4（+）：RH = 2.47，95% Cl：1.54 - 3.95）。VL+/CD 4（-）不一致性与年龄增加、基线HIV RNA载量<100，000拷贝/mL、基线CD 4计数< 50个细胞/μ L、使用拉米夫定（3 TC）/齐多夫定（ZDV）和对治疗依从性差有关。VL-/CD 4（+）不一致性与年龄较轻、注射药物使用、基线HIV RNA载量> 100，000拷贝/mL、基线HIV RNA载量> 10使用3 TC/ZDV，去羟肌苷（ddl）/3 TC，或ddl/司他夫定;和较差的依从性therapeutic.Conclusion：不一致的反应是独立相关的死亡风险增加，反过来，与治疗依从性差。
Objective: To examine the independent association of discordant virologic and immunologic responses to highly active antiretroviral therapy (HAART) with mortality.Methods: A population-based study of 1527 treatment-naive individuals initiating HAART used Cox proportional hazards modeling to determine the independent association of treatment response at 3 to 9 months with nonaccidental mortality. Logistic regression was used to examine associations with discordant responses.Results: Viral load (VL)(+)/CD4(-) discordant responses were seen in 235 (15.4%) of subjects, and VL-/CD4(+) responses were seen in 179 (11.7%) of subjects. In adjusted Cox regression models, discordant responses were found to be independently associated with an increased risk of mortality (VL+/CD4(-): relative hazard [RH] = 1.87, 95% confidence interval [Cl]: 1.15 to 3.04; VL-/CD4(+): RH = 2.47, 95% Cl: 1.54 to 3.95). VL+/CD4(-) discordance was found to be associated with increasing age, baseline HIV RNA load < 100,000 copies/mL, baseline CD4 counts < 50 cells/mu L, the use of lamivudine (3TC)/zidovudine (ZDV), and poor adherence to therapy VL-/CD4(+) discordance was associated with younger age; injection drug use; baseline HIV RNA load > 100,000 copies/mL; the use of 3TC/ZDV, didanosine (ddl)/3TC, or ddl/stavudine; and poor adherence to therapy.Conclusion: Discordant responses are independently associated with an increased risk of mortality and are, in turn, associated with poor adherence to therapy.