Aysel KOCAGÜL ÇELİKBAŞ, Nurcan BAYKAM, Selva ÖZMEN, Şebnem EREN, Salim YAPRAKÇI, AYŞE ERBAY, Başak DOKUZOĞUZ

Hıv/aıds olgularında antiretroviral tedaviye virolojik ve immünolojik yanıtın değerlendirilmesi

Bu çalışmada HAART alan HIV/AIDS olgularında başlangıç viral yük (VY) ve CD4 düzeyinin tedavi yanıtı üzerine etkisinin izlenmesi amaçlanmıştır. İlk kez antiretroviral tedavi başlanan ve kontrollerine düzenli gelen 42 hastanın iki yıllık izlem verileri retrospektif olarak değerlendirilmiştir. Hastaların tedavi başlangıcındaki median viral yükü 1.3x105 (1.8x102-7.5x106) kopya/ml ve median CD4 169 (4-1000)/ mm3 bulunmuştur. Olguların toplam % 68’inde tedavinin 6. ayında viral yük negatifliği gelişmiştir. Viral yük negatifliği nonnükleozid revers transkriptaz inhibitörü (NNRTI)-temelli rejim kullananlarda % 74, proteaz inhibitörü (PI) temelli rejim kullananlarda % 55 olarak saptanmıştır (p=0.259). Başlangıç CD4 sayısı 100/mm3 olan hastalarda ise sırasıyla CD4 düzeyleri 362/mm3 , 387/mm3 ve 352/mm3 bulunmuştur. NNRTI ve PI kullanımı arasında CD4 artışı açısından 6. ayda (p=0.399) ve 12. ayda (p=0.401) anlamlı fark saptanmamıştır. Sonuçta NNRTI kullanımında tedavinin 6. ayında % 19 oranında daha fazla viral yük negatifliği elde edilmiştir. CD4 >100/mm3 üzerinde tedavi başlanan olgularda, immünolojik yanıtın daha iyi olduğu ve CD4 için bir eşik değer olan 350/ mm3’ün üzerine çıkmasının sağlandığı sonucuna varılmıştır.

The evaluation of virological and ımmunological response to antiretroviral therapy in hıv/aıds cases

The aim of this study was to evaluate the effect of initial viral load and CD4 count on the response of HAART in HIV/ AIDS cases. The follow up visits and the laboratory data of 42 naive patients that HAART initiated for the first time, were evaluated for two years retrospectively. At the beginning of therapy, median viral load was 1.3x105 (1.8x102 -7.5x106) copy/ml and median CD4 count was 169 (4-1000)/mm3. In the sixth month of the therapy, negative viral load was achieved in 68 % of the cases. Negative viral load was detected in 74 % of patients in nonnucleozid reverse transcriptase inhibitor (NNRTI)-based therapy group and in 55 % of patients in protease inhibitor (PI) based therapy group (p=0.259). In patients with initial CD4 count <100/mm3 (4-92/mm3), the median CD4 count was elevated to 126/mm3 in 6th months, 201/mm3 in 12th months and regressed to 182/mm3 in 24th months. In patients with initial CD4 count >100/mm3 , the median CD4 count was elevated to 362/mm3, 387/mm3 and 352/mm3 respectively. There was no difference in CD4 count elevation between NNRTI ve PI based regimen groups in 6th (p=0.399) and 12th (p=0.401) months of therapy. As a result, the viral load supression was better in NNRTI based regimen with a rate of 19 % compared to PI based regimen in the sixth month of therapy. The immunological response to therapy was better in patients with CD4 count >100/ mm3 at the beginning of treatment with the elevation of CD4 count above 350/mm3 which is a boundary value.

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