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首页> 外文期刊>Current opinion in HIV and AIDS >Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries.
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Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries.

机译：在高收入和中低收入国家中，接受治疗的艾滋病毒感染者的长期免疫结果。

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PURPOSE OF REVIEW: To summarize the recent findings on long-term (at least 3-4 years) immunological responses to combination antiretroviral therapy (cART) and to compare and contrast the findings between cohorts from high-income and low-middle income countries (LMICs). RECENT FINDINGS: Cohort studies from high-income settings suggest that a majority of treated HIV-infected patients who maintain suppressed HIV viremia experience a gradual increase in CD4 cell counts for several years to normal levels. However, those who start cART at CD4 cell counts less than 200 cells/mul (as opposed to CD4 cell counts>200 cells/mul) spend several more years below the safe CD4 cell count threshold of 500 cells/mul. Cohorts from LMICs also report persistent improvements in CD4+ cell counts over first 4-5 years of follow-up. However, low-CD4 cell counts (<200 cells/mul) at the start of cART, high early mortality, and loss to follow-up in LMICs settings suggest that the observed optimistic responses may be affected by survivorship bias and should be cautiously interpreted as the optimal, rather than an average, response in LMICs populations. SUMMARY: LMICs cohorts report similar immunological responses to cART as high-income countries in first 4-5 years of follow-up. Sustaining success in these settings is dependent on timely access to first-line and future cART options, efforts to reduce loss to follow-up, and implementation of treatment guidelines. Cohorts from LMICs are encouraged to continue improving treatment programs and to continue reporting outcomes over the next decade, as surveillance for potential future blunting in responses.
机译：审查目的：总结近期对联合抗逆转录病毒疗法（cART）的长期免疫应答（至少3-4年）的发现，并比较和对比高收入和低收入国家的研究结果（ LMIC）。最近的发现：来自高收入人群的队列研究表明，大多数保持抑制的HIV病毒血症的经治疗的HIV感染患者在几年内CD4细胞计数逐渐增加至正常水平。但是，那些从CD4细胞计数低于200个细胞/ mul（而不是CD4细胞计数> 200个细胞/ mul）开始cART的人花费的时间比安全CD4细胞计数阈值500个细胞/ mul多了几年。来自LMIC的研究小组还报告，在随访的最初4-5年中，CD4 +细胞计数持续改善。但是，cART开始时的CD4细胞计数低（<200个细胞/ mul），早期死亡率高，并且LMIC设置缺乏随访提示，观察到的乐观反应可能会受到生存偏差的影响，应谨慎解释。在低收入和中低收入国家人群中是最佳而不是平均的响应。摘要：在随访的前4-5年中，低收入国家的人群报告了对cART的免疫反应与高收入国家相似。在这些情况下能否获得成功取决于能否及时获得一线和未来的cART方案，为减少随访损失而做出的努力以及实施治疗指南。鼓励中，低收入国家的队列研究者继续改进治疗方案，并在未来十年内继续报告结果，以监测未来潜在的反应迟钝。

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