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首页> 外文期刊>JAIDS: Journal of acquired immune deficiency syndromes >Is moderate HIV viremia associated with a higher risk of clinical progression in HIV-infected people treated with highly active antiretroviral therapy: evidence from the Italian cohort of antiretroviral-naive patients study.
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Is moderate HIV viremia associated with a higher risk of clinical progression in HIV-infected people treated with highly active antiretroviral therapy: evidence from the Italian cohort of antiretroviral-naive patients study.

机译：中度HIV病毒血症与接受高活性抗逆转录病毒疗法治疗的HIV感染者的临床进展风险较高相关：来自意大利抗逆转录病毒初治患者队列的证据。

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摘要

OBJECTIVE: To assess the risk of clinical progression (CP) according to the duration of time spent without complete viral load (VL) suppression compared with that associated with periods of stably suppressed viremia in HIV-infected people who started highly active antiretroviral therapy (HAART) when previously naive to antiretrovirals. DESIGN: A cohort study of patients having started HAART after enrollment in the Italian Cohort of Antiretroviral-Naive Patients (ICoNA) and being followed for at least 6 months. METHODS: Person-years spent in different categories according to the VL level and the change in VL from the most recent value before the initiation of HAART were calculated. A multivariable Poisson regression model, including potential confounders, was constructed. RESULTS: A total of 3023 patients were studied. The overall rate of CP was 13.4 per 1000 person-years. Evidence for a higher risk of CP was observed for people with a current VL >10,000 copies/mL. For each year longer spent on HAART with a VL >100,000 copies/mL, a 5-fold increased risk was observed (relative risk [RR] = 5.34, 95% confidence interval [CI]: 2.83 to 1.08; P = 0.0001). An increased risk of CP in patients with current suppression <1.5 log10 copies/mL (RR = 2.34, 95% CI: 1.16 to 4.74; P = 0.02) and in those with no suppression or a VL higher than their set point (RR = 2.39, 95% CI: 1.17 to 4.89; P = 0.02) was observed compared with those with suppression of >3 log10 copies/mL, although it was not significant. Longer duration on HAART with a VL suppressed below set point seemed to confer protection against CP. CONCLUSIONS: Virologic failure to antiretroviral drugs is common. The risk of CP may remain low despite a low but detectable level of HIV viremia.
机译：目的：根据开始完全活性抗逆转录病毒疗法（HAART）的HIV感染者，根据未完全抑制病毒（VL）抑制所花费的时间与稳定抑制病毒血症的时间相比，评估临床进展（CP）的风险）以前不懂抗逆转录病毒药物的人。设计：一项针对意大利抗逆转录病毒初治患者队列（ICoNA）入组后已开始HAART并随访至少6个月的患者的队列研究。方法：根据VL水平和从开始HAART之前的最新值算起的VL变化，计算了在不同类别中花费的人年数。构建了包括潜在混杂因素在内的多变量Poisson回归模型。结果：共研究了3023例患者。 CP的总比率为每1000人年13.4。观察到当前VL> 10,000拷贝/ mL的人群发生CP的风险更高。对于VL> 100,000拷贝/ mL的HAART每年花费更长的时间，观察到的风险增加了5倍（相对风险[RR] = 5.34，95％置信区间[CI]：2.83至1.08; P = 0.0001）。电流抑制<1.5 log10拷贝/ mL（RR = 2.34，95％CI：1.16至4.74; P = 0.02）且无抑制或VL高于其设定点的患者发生CP的风险增加（RR =与抑制率> 3 log10拷贝/ mL的那些相比，观察到2.39，95％CI：1.17至4.89; P = 0.02），尽管这并不显着。在VL被抑制在设定点以下的情况下，HAART的持续时间较长似乎可以预防CP。结论：抗逆转录病毒药物的病毒学失败是常见的。尽管HIV病毒血症水平低但可检测，但CP的风险可能仍然很低。

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