AIM:HIV抗逆转录病毒疗法抑制机体病毒载量

2000年至2008年间，美国部分的HIV感染病人接受了有效的疗法，比如高效抗逆转录病毒疗法（HAART）。“经过治疗的HIV感染者表现出了低的传染性，而且在其死亡后其机体已经产生了健康的免疫系统”，来自约翰霍普金斯大学的研究者这样说。相关研究成果刊登在了国际著名杂志Annals of Internal Medicine上，此项研究归属于北美AIDS合作研究队伍（NA-ACCORD）

这项研究包括了接受HIV临床治疗的45，000位感染者，在研究期间，研究者发现，进行HAART疗法的部分HIV感染病人的比例增加了9%到83%不等。而且研究者观察了进行疗法和不进行此疗法的HIV患者在病毒载量抑制作用的增加效应。病毒载量的抑制可以降低HIV病毒的传染能力，在进行HAART疗法的患者中，病毒载量抑制的患者比例从54%增加到了81%。

研究者Althoff表示，这对于HIV的传染性来说是一个好消息，但是我们还有改进的余地。我们需要继续关注HIV感染者的看护及有效疗法，并不仅仅是个体的健康，而是降低其传染的可能性。

研究分析发现，接受治疗但是最终死亡的HIV病人体内的中等数量的CD4水平发生了明显的升高。中等数量的CD4的增加从每立方毫米60个细胞增加到每立方毫米209个细胞。高等的CD4数量可以等同于健康的免疫系统。后续研究中，研究者试图去研究HIV感染者的死亡动态。

“我们的研究数据揭示了NA-ACCORD可以来检测HIV成年感染者的重要健康指标，浙江对于评估治疗效果非常重要。”研究者Althoff这样说。

编译自：Study finds increase in HIV treatment use in the U.S.

doi:10.1542/peds.2012-0295
PMC:
PMID:

U.S. Trends in Antiretroviral Therapy Use, HIV RNA Plasma Viral Loads, and CD4 T-Lymphocyte Cell Counts Among HIV-Infected Persons, 2000 to 2008

Keri N. Althoff, PhD, MPH; Kate Buchacz, PhD, MPH; H. Irene Hall, PhD, MPH; Jinbing Zhang, MS; David B. Hanna, MS; Peter Rebeiro, ScM; Stephen J. Gange, PhD; Richard D. Moore, MD, MHS; Mari M. Kitahata, MD, MPH; Kelly A. Gebo, MD, MPH; Jeffrey Martin, MD; Amy C. Justice, MD, PhD; Michael A. Horberg, MD; Robert S. Hogg, PhD; Timothy R. Sterling, MD; Angela Cescon, MPH; Marina B. Klein, MD; Jennifer E. Thorne, MD, PhD; Heidi M. Crane, MD, MPH; Michael J. Mugavero, MD; Sonia Napravnik, PhD; Gregory D. Kirk, MD, PhD; Lisa P. Jacobson, ScD; John T. Brooks, MD; and for the North American AIDS Cohort Collaboration on Research and Design

Background: The U.S. National HIV/AIDS Strategy targets for 2015 include “increasing access to care and improving health outcomes for persons living with HIV in the United States” (PLWH-US). Objective: To demonstrate the utility of the NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) for monitoring trends in the HIV epidemic in the United States and to present trends in HIV treatment and related health outcomes. Design: Trends from annual cross-sectional analyses comparing patients from pooled, multicenter, prospective, clinical HIV cohort studies with PLWH-US, as reported to national surveillance systems in 40 states. Setting: U.S. HIV outpatient clinics. Patients: HIV-infected adults with 1 or more HIV RNA plasma viral load (HIV VL) or CD4 T-lymphocyte (CD4) cell count measured in any calendar year from 1 January 2000 to 31 December 2008. Measurements: Annual rates of antiretroviral therapy use, HIV VL, and CD4 cell count at death. Results: 45 529 HIV-infected persons received care in an NA-ACCORD–participating U.S. clinical cohort from 2000 to 2008. In 2008, the 26 030 NA-ACCORD participants in care and the 655 966 PLWH-US had qualitatively similar demographic characteristics. From 2000 to 2008, the proportion of participants prescribed highly active antiretroviral therapy increased by 9 percentage points to 83% (P < 0.001), whereas the proportion with suppressed HIV VL (≤2.7 log10 copies/mL) increased by 26 percentage points to 72% (P < 0.001). Median CD4 cell count at death more than tripled to 0.209 × 109 cells/L (P < 0.001). Limitation: The usual limitations of observational data apply. Conclusion: The NA-ACCORD is the largest cohort of HIV-infected adults in clinical care in the United States that is demographically similar to PLWH-US in 2008. From 2000 to 2008, increases were observed in the percentage of prescribed HAART, the percentage who achieved a suppressed HIV VL, and the median CD4 cell count at death. Primary Funding Source: National Institutes of Health; Centers for Disease Control and Prevention; Canadian Institutes of Health Research; Canadian HIV Trials Network; and the government of British Columbia, Canada.