Lymphoid tissue viral burden and duration of viral suppression in plasma
作者:
Esteban Martínez,
Mireia Arnedo,
Vicente Giner,
Cristina Gil,
Miguel Caballero,
Llòcia Alós,
Felipe García,
Christopher Holtzer,
Josep Mallolas,
José Miró,
Tomás Pumarola,
José Gatell,
期刊:
AIDS
(OVID Available online 2001)
卷期:
Volume 15,
issue 12
页码: 1477-1482
ISSN:0269-9370
年代: 2001
出版商: OVID
关键词: HIV-1;RNA;HIV-1 protease inhibitors;nevirapine;nuceloside analogues;viral resistance
数据来源: OVID
摘要:
ObjectivesTo assess virological response in lymphoid tissue and its impact on the durability of response in plasma in HIV-1-infected persons who achieved sustained suppression of plasma viraemia with different antiretroviral regimens.MethodsConsecutive patients on first-line antiretroviral therapy were included if they had a plasma HIV-1 RNA viraemia < 20 copies/ml within the last 6 months and tonsillar tissue accesible for biopsy. First-line therapy contained two nucleoside analogues: alone (2NRTI group, n = 3); plus a HIV-1 protease inhibitor (PI group, n = 11) or plus nevirapine (NVP group; n = 16). Patients were followed until virus was detectable in plasma, they changed therapy or were lost to follow-up.ResultsTonsillar HIV-1 RNA could be detected (> 100 copies/mg) in 10 patients: one in the PI group (9%), six (38%) in the NVP group and in all three patients in the 2NRTI group. Primary resistance mutations could be detected in only 2 of these 10 patients. After a median of 9 months after the biopsies, viral suppression in plasma had failed in 6 of these 10 patients whereas failure had only occurred in 1 out of 20 with initially undetectable viral load in lymphoid tissue (P= 0.01; log rank test).ConclusionsIn patients with sustained viral suppression in plasma, triple therapy including a HIV-1 protease inhibitor was more potent than triple therapy containing nevirapine or dual therapy with nucleoside analogues to reduce viral burden in lymphoid tissue. A worse response in lymphoid tissue could not be explained by local selection of resistance and was associated with a less durable virological response in plasma.
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