Efficacy and safety of antiretroviral therapy in «naive» patients with late stage of HIV infection


DOI: https://dx.doi.org/10.18565/therapy.2022.3.27-34

Veselova E.I., Karamov E.V., Kudlay D.A., Samoilova A.G., Kaminsky G.D.

1) Scientific Medical Research Center of Phthisiopulmonology and Infectious Diseases of the Ministry of Healthcare of Russia, Moscow; 2) State Research Center «Institute of Immunology» of FMBA, Moscow; 3) I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University)
Abstract. In the treatment process of patients with AIDS, antiretroviral therapy (ART) should be of maximal virological efficacy, promote rapid immune restitution, and be metabolically favorable.
The aim of the study is to determine the efficacy and safety of using a three targets-ART scheme in patients with advanced HIV infection.
Material and methods. An open prospective observational study of the efficacy and safety of treatment of 110 previously untreated patients with stage 4B HIV infection (AIDS) using ART schemes that included medicines from three and two classes of antiviral agents for HIV infection treatment was carried out. Observation was performed during 24 weeks from the ART start.
Results. After 24 weeks of ART, by using a scheme, including medicines of 3 classes, the mean viral load (VL) was significantly lower (12 copies/mL vs. 23 copies/mL, p=0,049), and the proportion of patients with undetectable VL was higher (84,6% vs. 66,7%, p=0,028) than with the standard ART scheme (treatment with medicines of two classes). The scheme with medicines from three classes, comparatively with the standard regimen, provided a faster and more intensive increase in CD4 T-lymphocytes: during the first 12 weeks of ART, this figure was 193,3 cells/mcL and 95,5 cells/mcL, respectively. A three-class ART scheme that did not include tenofovir demonstrated a good tolerance, which could be comparable to medicines for the treatment of secondary diseases. The amount of TREC DNA before starting ART determines the increase in the number of CD4 T-lymphocytes after the beginning of treatment.
Conclusion. Use of an ART scheme consisting of three classes of medicines in patients with advanced HIV infection has demonstrated a high efficacy and good safety profile. Use of TREC DNA as an additional marker made it possible to predict the increase in CD4 T-lymphocytes.
Keywords: TREC DNA, increase in CD4 T-lymphocytes, efficacy of antiretroviral therapy, acquired immunodeficiency syndrome, HIV infection
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About the Autors

Elena I. Veselova, researcher at the Scientific Department of infectious pathology, ФГБУ Scientific Medical Research Center of Phthisiopulmonology and Infectious Diseases of the Ministry of Healthcare of Russia. Address: 127473, Moscow, 4/2 Dostoevskogo Str. E-mail: drveselovae@mail.ru. ORCID: http://orcid.org/0000-0003-4339-126X
Eduard V. Karamov, Dr. med. habil., professor, chief researcher at the Scientific Department of infectious pathology, ФГБУ Scientific Medical Research Center of Phthisiopulmonology and Infectious Diseases of the Ministry of Healthcare of Russia. Address: 127473, Moscow, 4/2 Dostoevskogo Str. E-mail: karamov2004@yandex.ru.
ORCID: http://orcid.org/0000-0003-1162-118Х
Dmitry A. Kudlay, Dr. med. habil., professor, chief researcher at the Laboratory of personalized medicine and molecular immunology No. 71, State Research Center «Institute of Immunology» of FMBA, professor of the Department of pharmacology of the Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 115522, Moscow, 24 Kashirskoe Highway. E-mail: D624254@gmail.com. ORCID: http://orcid.org/0000-0003-1878-4467
Anastasia G. Samoilova, Dr. med. habil., first deputy director of Scientific Medical Research Center of Phthisiopulmonology and Infectious Diseases of the Ministry of Healthcare of Russia. Address: 127473, Moscow, 4/2 Dostoevskogo Str. E-mail: a.samoilova.nmrc@mail.ru. ORCID: http://orcid.org/0000-0001-6596-9777
Grigory D. Kaminsky, Dr. med. habil., head the Scientific Department of infectious pathology, ФГБУ Scientific Medical Research Center of Phthisiopulmonology and Infectious Diseases of the Ministry of Healthcare of Russia. Address: 127473, Moscow, 4/2 Dostoevskogo Str. E-mail: gregkaminski.gk@gmail.com.
ORCID: http://orcid.org/0000-0002-3016-6920


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