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Effect of suppressing HIV viremia on the HIV progression of patients undergoing a genotype resistance test after treatment failure.

机译：抑制HIV病毒血症对治疗失败后接受基因型耐药性测试的患者HIV进展的影响。

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BACKGROUND: Treatment guidelines for multi-experienced HIV patients have recently evolved from aiming to preserve immunity to achieving virological success, largely due to the availability of new antiretroviral drugs and drug classes. To assess the role of viral suppression on clinical progression following a genotypic resistance test (GRT), we have examined a database on patients failing to respond to combined antiretroviral therapy (cART). METHODS: Patients undergoing a GRT after failure to respond to cART between January 1999 and May 2006 were followed up to December 2006. Time-to-death or a new AIDS event/death were considered to be analysis end-points. Viral suppression (< 50 copies/ml [c/ml]) after GRT, a time-dependent covariate, was tested as predictor of disease progression. RESULTS: Overall, 1,389 patients were included in this observational study. After the GRT, patients were followed up to 72 months (median 28 months, IQ range 13-51 months). During the follow-up, 124 patients (9%) died, and 86 (6%) experienced a new AIDS event. 774 patients (56%) achieved < 50 c/ml HIV-RNA. The results of an adjusted Cox model showed that undetectable HIV-RNA after the GRT was significantly associated with a lower risk of death (hazard ration [HR] 0.46, 95% confidence interval [CI] 0.27-0.76) and AIDS/death (HR 0.43, 95% CI 0.28-0.65). The adjusted hazard ratios suggested a twofold risk reduction. A threefold risk reduction of death related to achieved undetectable viral load was found in patients with resistance to more than one drug class and with CDC-C diagnosis; a fourfold reduction was found in patients with < 200 CD4+/mm(3). CONCLUSIONS: Maximal viral suppression has a large impact on HIV progression, particularly in heavily pre-treated individuals. Our findings support the latest treatment guidelines, which have rapidly evolved from an initial lack of indication to suggestions, and finally to strong recommendations for achieving the goal of suppressing viremia.
机译：背景：针对多经验的HIV患者的治疗指南最近已从旨在保持免疫力到实现病毒学成功的方向发展，这主要归功于新抗逆转录病毒药物和药物类别的可用性。为了评估基因型耐药性测试（GRT）后病毒抑制在临床进展中的作用，我们检查了有关对联合抗逆转录病毒疗法（cART）无效的患者的数据库。方法：对1999年1月至2006年5月对cART无效的经历了GRT的患者进行随访，直至2006年12月。死亡时间或新的AIDS事件/死亡被认为是分析的终点。测试了GRT（时间依赖性协变量）后的病毒抑制（<50拷贝/ ml [c / ml]）作为疾病进展的预测指标。结果：本研究共纳入1389例患者。 GRT后，随访患者长达72个月（中位28个月，IQ范围13-51个月）。在随访期间，有124名患者（9％）死亡，有86名（6％）经历了新的艾滋病事件。 774名患者（56％）获得的HIV-RNA <50 c / ml。调整后的Cox模型的结果表明，GRT后无法检测到的HIV-RNA与较低的死亡风险（危险比[HR] 0.46、95％置信区间[CI] 0.27-0.76）和AIDS /死亡（HR）显着相关。 0.43，95％CI 0.28-0.65）。调整后的危险比表明降低了两倍的风险。在对一种以上药物具有抗药性且具有CDC-C诊断的患者中，发现与实现无法检测到的病毒载量相关的死亡风险降低了三倍。 ≤200 CD4 + / mm（3）的患者减少了四倍。结论：最大程度的病毒抑制对HIV的进展有很大影响，特别是在经过大量预处理的个体中。我们的发现支持最新的治疗指南，这些指南已从最初的缺乏适应症迅速发展为建议，最后发展为实现抑制病毒血症目标的强有力建议。

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