Virologic outcomes in early antiretroviral treatment: HPTN 052

被引：22

作者：

Eshleman, Susan H. ^{[1
]}

Wilson, Ethan A. ^{[2
]}

Zhang, Xinyi C. ^{[2
]}

Ou, San-San ^{[2
]}

Piwowar-Manning, Estelle ^{[1
]}

Eron, Joseph J. ^{[3
]}

McCauley, Marybeth ^{[4
]}

Gamble, Theresa ^{[5
]}

Gallant, Joel E. ^{[6
]}

Hosseinipour, Mina C. ^{[7
,8
]}

Kumarasamy, Nagalingeswaran ^{[9
]}

Hakim, James G. ^{[10
]}

Kalonga, Ben ^{[11
]}

Pilotto, Jose H. ^{[12
,13
]}

Grinsztejn, Beatriz ^{[14
]}

Godbole, Sheela V. ^{[15
]}

Chotirosniramit, Nuntisa ^{[16
]}

Santos, Breno Riegel ^{[17
]}

Shava, Emily ^{[18
]}

Mills, Lisa A. ^{[19
,20
]}

Panchia, Ravindre ^{[21
]}

Mwelase, Noluthando ^{[22
]}

Mayer, Kenneth H. ^{[23
]}

Chen, Ying Q. ^{[2
]}

Cohen, Myron S. ^{[3
]}

Fogel, Jessica M. ^{[1
]}

机构：

[1] Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD 21205 USA

[2] Fred Hutchinson Canc Res Ctr, Vaccine & Infect Dis Div, 1124 Columbia St, Seattle, WA 98104 USA

[3] Univ North Carolina Chapel Hill, Dept Med, Chapel Hill, NC USA

[4] FHI 360, Sci Facilitat Dept, Washington, DC USA

[5] FHI 360, Sci Facilitat Dept, Durham, NC USA

[6] Southwest CARE Ctr, Santa Fe, NM USA

[7] Univ North Carolina Chapel Hill, Inst Global Hlth & Infect Dis, Chapel Hill, NC USA

[8] UNC Project Malawi, Inst Global Hlth & Infect Dis, Lilongwe, Malawi

[9] VHS, YRGCARE Med Ctr, Madras, Tamil Nadu, India

[10] Univ Zimbabwe, Dept Med, Harare, Zimbabwe

[11] Johns Hopkins Project, Coll Med, Blantyre, Malawi

[12] Hosp Geral Nova Iguacu, Rio De Janeiro, Brazil

[13] Lab AIDS & Imunol Mol IOC Fiocruz, Rio De Janeiro, Brazil

[14] Inst Nacl Infectol Evandro Chagas INI Fiocruz, Rio De Janeiro, Brazil

[15] Natl AIDS Res Inst ICMR, Pune, Maharashtra, India

[16] Chiang Mai Univ, Res Inst Hlth Sci, Chiang Mai, Thailand

[17] Hosp Nossa Senhora Conceicao, Porto Alegre, RS, Brazil

[18] Botswana Harvard AIDS Inst, Gaborone, Botswana

[19] Ctr Dis Control & Prevent, Div HIV AIDS Prevent, Kisumu, Kenya

[20] Kenya Med Res Inst KEMRI, CDC Clin Res Site, Kisumu, Kenya

[21] Univ Witwatersrand, Perinatal HIV Res Unit, Soweto HPTN CRS, Soweto, South Africa

[22] Univ Witwatersrand, Dept Med, Clin HIV Res Unit, Johannesburg, South Africa

[23] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Fenway Hlth Infect Dis Div, Fenway Inst,Dept Med, Boston, MA USA

来源：

HIV CLINICAL TRIALS | 2017年 / 18卷 / 03期

基金：

美国国家卫生研究院;

关键词：

HIV; HPTN; 052; Early ART; Viral suppression; Virologic failure; Virologic outcomes; HIV prevention; INTEGRASE INHIBITOR RALTEGRAVIR; HIV-1 SUBTYPE C; IMMUNOLOGICAL RESPONSE; VIRAL SUPPRESSION; DRUG-RESISTANCE; THERAPY; TRANSMISSION; FAILURE; PREVENTION; INFECTION;

D O I：

10.1080/15284336.2017.1311056

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Introduction: The HIV Prevention Trials Network (HPTN) 052 trial demonstrated that early antiretroviral therapy (ART) prevented 93% of HIV transmission events in serodiscordant couples. Some linked infections were observed shortly after ART initiation or after virologic failure. Objective: To evaluate factors associated with time to viral suppression and virologic failure in participants who initiated ART in HPTN 052. Methods: 1566 participants who had a viral load (VL) > 400 copies/mL at enrollment were included in the analyses. This included 832 in the early ART arm (CD4 350-550 cells/mm(3) at ART initiation) and 734 in the delayed ART arm (204 with a CD4 < 250 cells/mm(3) at ART initiation; 530 with any CD4 at ART initiation). Viral suppression was defined as two consecutive VLs <= 400 copies/mL after ART initiation; virologic failure was defined as two consecutive VLs > 1000 copies/mL > 24 weeks after ART initiation. Results: Overall, 93% of participants achieved viral suppression by 12 months. The annual incidence of virologic failure was 3.6%. Virologic outcomes were similar in the two study arms. Longer time to viral suppression was associated with younger age, higher VL at ART initiation, and region (Africa vs. Asia). Virologic failure was strongly associated with younger age, lower educational level, and lack of suppression by three months; lower VL and higher CD4 at ART initiation were also associated with virologic failure. Conclusions: Several clinical and demographic factors were identified that were associated with longer time to viral suppression and virologic failure. Recognition of these factors may help optimize ART for HIV treatment and prevention.

引用

页码：100 / 109

页数：10

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