Clin Infect Dis:HIV诊断后抗逆转录病毒治疗宜早不宜迟

2019-02-27 王淳 环球医学

2019年1月,中国、美国和加拿大学者在《Clin Infect Dis》发表了抗逆转录病毒治疗(ART)时机的全国队列研究:中国2011~2015年治疗退出和病毒学失败。

2019年1月,中国、美国和加拿大学者在《Clin Infect Dis》发表了抗逆转录病毒治疗(ART)时机的全国队列研究:中国2011~2015年治疗退出和病毒学失败。

背景:携带人类免疫缺陷病毒存活的人(PLWH)仍然诊断延迟,使得早期ART的获益无法实现。因此,研究者旨在评估诊断后立即ART的获益。

方法:在12个月、治疗退出或死亡时(以先发生者为准),审查了2011年1月1日~2014年12月31日中国初始ART且基线CD4计数>200个细胞/μL的全国PLWH队列。测量了治疗退出和病毒学失败(病毒载量≥400个拷贝/mL)。通过Cox和对数二项回归评估决定因素。

结果:队列纳入了123605名PLWH。≤30天组治疗退出率显着较低,为6.72%,而91~365天组为8.91%,>365天组为12.64%。≤30天组也具有显着较低的病毒学失败率,为5.45%(31~90天组:7.39%,91~365天组:9.64%,>365天组:12.67%)。延迟治疗的患者具有较高的治疗退出(91~365天组:调整HR[aHR],1.33;95% 置信区间[CI],1.25~1.42;>365天组:aHR,1.55;CI,1.47~1.54)和病毒学失败(31~90天组:调整RR[aRR],1.35;CI,1.26~1.45;91~365天组:aRR,1.66;CI,1.55~1.78;>365天组:aRR,1.85;CI,1.74~1.97)风险。

结论:HIV诊断后30天内进行ART与治疗失败风险显着降低相关,强调了实施检测和立即治疗政策的需求。

原始出处:

Zhao Y, Wu Z, McGoogan JM, et al.Nationwide Cohort Study of Antiretroviral Therapy Timing: Treatment Dropout and Virological Failure in China, 2011-2015. Clin Infect Dis. 2019 Jan 1;68(1):43-50. doi: 10.1093/cid/ciy400.

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    2019-11-07 hxj0117
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    2019-11-12 mjldent
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