Background:It is not completely clear whether a very high pre-therapy viral load(≥500000 copies/ml)can impair the virological response.The aim of this study was to examine the influence of very high baseline HIV-RNA ...Background:It is not completely clear whether a very high pre-therapy viral load(≥500000 copies/ml)can impair the virological response.The aim of this study was to examine the influence of very high baseline HIV-RNA levels on long-term virological responses under one type of regimen.Methods:A retrospective study was performed based on data from two multicenter cohorts in China from January to November 2009,and from May 2013 to December 2015.Untreated HIV infected adults between 18 and 65 years old were recruited before receiving non-nucleoside reverse transcriptase inhibitor-based regimen.All patients had baseline HIV-RNA levels over 500 copies/ml,good adherence,and were followed for at least 24 weeks.Virological suppression was defined as the first HIV-RNA<50 copies/ml.Virological failure was defined as any of incomplete viral suppression(HIV-RNA≥200 copies/ml without virological suppression within 24 weeks of treatment)and viral rebound(confirmed HIV-RNA level≥50 copies/ml after virological suppression).Chi-square test,Kaplan–Meier analysis,Cox proportional hazards model and Logistic regression were used to compare virological response between each pretreated viral load stratum.Results:A total of 758 treatment-naïve HIV patients in China were enlisted.Median follow-up time(IQR)was 144(108–276)weeks.By week 48,rates of virological suppression in three groups(<100000,100000–500000 and≥500000 copies/ml)were 94.1,85.0,and 63.8%,respectively(P<0.001).Very high baseline HIV viremia over 500000 copies/ml were found to be associated with delayed virological suppression(≥500000 vs<100000,adjusted relative hazard=0.455,95%CI:0.32–0.65;P<0.001)as well as incomplete viral suppression(≥500000 vs<100000,adjusted odds ratio[aOR]=6.084,95%CI:2.761–13.407;P<0.001)and viral rebound(≥50000 vs<100000,aOR=3.671,95%CI:1.009–13.355,P=0.048).Conclusions:Very high levels of pre-treatment HIV-RNA were related with delayed efficacy of NNRTI-based ART and increased risk of treatment failure.More potent initial regimens should be considered for those with this clinical character.展开更多
文摘目的:观察太芪培元颗粒对气阴两虚肺肾不足型CD4+T淋巴细胞>350个·u L-1的HIV感染者的临床疗效。方法:采用队列研究,将108例HIV感染者根据是否服用太芪培元颗粒分为暴露组及非暴露组。观察6个月,对比两组患者的CD4+T淋巴细胞、HIV-RNA病毒载量、中医症状体征积分、Toll样受体-4(toll like receptor-4,TLR-4)、白介素-10(IL-10)等指标的差异。结果:经过6个月的治疗,暴露组比非暴露组的中医症状体征积分、TLR-4受体指标变化差异有统计学意义(P<0.05)。CD4^+T淋巴细胞、HIV-RNA病毒载量、IL-10等指标差异无统计学意义(P>0.05)。结论:运用太芪培元颗粒治疗气阴两虚肺肾不足型CD4^+T淋巴细胞>350个·u L^(-1)HIV的感染者,可以改善患者临床症状,稳定患者CD4+T淋巴细胞计数,抑制TLR-4受体。太芪培元颗粒可能是通过机体免疫调节的过程发挥作用。
基金The study was supported by the National Key Technologies R&D Program for the 13th Five-Year Plan(Grant No.2017ZX10202101)the National Key Technologies R&D Program for the 12th Five-Year Plan(Grant No.2012ZX10001003–001)+1 种基金the National Key Technologies R&D Program for the 11th Five-Year Plan(Grant No.2008ZX10001006–001)the CAMS Initiative for Innovative Medicine(CAMS-I2M:2017-I2M-1-014).
文摘Background:It is not completely clear whether a very high pre-therapy viral load(≥500000 copies/ml)can impair the virological response.The aim of this study was to examine the influence of very high baseline HIV-RNA levels on long-term virological responses under one type of regimen.Methods:A retrospective study was performed based on data from two multicenter cohorts in China from January to November 2009,and from May 2013 to December 2015.Untreated HIV infected adults between 18 and 65 years old were recruited before receiving non-nucleoside reverse transcriptase inhibitor-based regimen.All patients had baseline HIV-RNA levels over 500 copies/ml,good adherence,and were followed for at least 24 weeks.Virological suppression was defined as the first HIV-RNA<50 copies/ml.Virological failure was defined as any of incomplete viral suppression(HIV-RNA≥200 copies/ml without virological suppression within 24 weeks of treatment)and viral rebound(confirmed HIV-RNA level≥50 copies/ml after virological suppression).Chi-square test,Kaplan–Meier analysis,Cox proportional hazards model and Logistic regression were used to compare virological response between each pretreated viral load stratum.Results:A total of 758 treatment-naïve HIV patients in China were enlisted.Median follow-up time(IQR)was 144(108–276)weeks.By week 48,rates of virological suppression in three groups(<100000,100000–500000 and≥500000 copies/ml)were 94.1,85.0,and 63.8%,respectively(P<0.001).Very high baseline HIV viremia over 500000 copies/ml were found to be associated with delayed virological suppression(≥500000 vs<100000,adjusted relative hazard=0.455,95%CI:0.32–0.65;P<0.001)as well as incomplete viral suppression(≥500000 vs<100000,adjusted odds ratio[aOR]=6.084,95%CI:2.761–13.407;P<0.001)and viral rebound(≥50000 vs<100000,aOR=3.671,95%CI:1.009–13.355,P=0.048).Conclusions:Very high levels of pre-treatment HIV-RNA were related with delayed efficacy of NNRTI-based ART and increased risk of treatment failure.More potent initial regimens should be considered for those with this clinical character.
