Eva M Shelton, Daniel B Reeves, Rachel A Bender Ignacio
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引用次数: 0
Abstract
Antiretroviral therapy (ART) inhibits HIV replication but does not eradicate the latent reservoir. The previous research suggests that earlier ART initiation provides benefit on limiting reservoir size, but timing and extent of this effect remain unclear. Analytic treatment interruption (ATI) may be used to demonstrate HIV remission, but whether early ART also improves likelihood or duration of even temporary virologic remission is unclear. This review seeks to answer both questions. We performed a systematic review and analysis following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and included 21 interventional or observational studies with sufficient HIV reservoir outcomes. We also aggregated reservoir outcomes and transformed data into approximate measurements of total HIV DNA per million peripheral blood mononuclear cells and analyzed the correlation between timing of ART initiation and reservoir size. People living with HIV who initiate ART in primary infection maintain smaller reservoirs on suppressive ART than those who initiate treatment during chronic infection. The reduction of reservoir is most pronounced when ART is started within 2 weeks of HIV acquisition. Across studies, we found a moderately strong association between longer time to ART initiation and reservoir size, which was strongest when measured after 1 year on ART (Pearson's r = 0.69, p = 0.0003). After ATI, larger pre-ATI reservoir size predicts shorter time to viral rebound. Early ART may also facilitate long-term control of viremia. Although achieving sustained HIV remission will require further interventions, initiating ART very early in infection could limit the extent of the reservoir and also lead to post-ATI control in rare cases.
在原发性 HIV 感染期间开始抗逆转录病毒治疗:对潜伏 HIV 储库的影响,包括对分析治疗中断的影响。
抗逆转录病毒疗法(ART)可抑制艾滋病毒的复制,但不能根除潜伏库。以往的研究表明,尽早开始抗逆转录病毒疗法有利于限制潜伏库的规模,但这种影响的时间和程度仍不清楚。分析性治疗中断(ATI)可用于证明艾滋病病毒缓解,但早期抗逆转录病毒疗法是否也能提高即使是暂时性病毒学缓解的可能性或持续时间尚不清楚。本综述试图回答这两个问题。我们按照《系统综述和荟萃分析首选报告项目》指南进行了系统综述和分析,纳入了 21 项具有充分 HIV 储库结果的干预性或观察性研究。我们还汇总了储库结果,并将数据转化为每百万外周血单核细胞中 HIV DNA 总量的近似测量值,并分析了开始抗逆转录病毒疗法的时间与储库规模之间的相关性。与在慢性感染期间开始治疗的艾滋病病毒感染者相比,在初次感染时开始抗逆转录病毒疗法的艾滋病病毒感染者在接受抑制性抗逆转录病毒疗法后,其病毒储库的规模较小。在感染艾滋病病毒两周内开始抗逆转录病毒疗法时,储库的减少最为明显。在所有的研究中,我们发现开始抗逆转录病毒疗法的时间越长,储库规模越大,两者之间的关联性就越强(Pearson's r = 0.69,p = 0.0003)。ATI 后,ATI 前储库规模越大,预测病毒反弹的时间越短。早期抗逆转录病毒疗法还有助于长期控制病毒血症。虽然实现持续的艾滋病毒缓解还需要进一步的干预措施,但在感染初期就开始抗逆转录病毒疗法可以限制病毒库的规模,在极少数情况下还能在 ATI 后实现病毒控制。
期刊介绍:
AIDS Reviews publishes papers reporting original scientific, clinical, epidemiologic and social research which contribute to the overall knowledge of the field of the acquired immunodeficiency syndrome and human retrovirology. Currently, the Journal publishes review articles (usually by invitation, but spontaneous submitted articles will also be considered). Manuscripts submitted to AIDS Reviews will be accepted on the understanding that the authors have not submitted the paper to another journal or published the material elsewhere.