Цитата https://academic.oup.com/cid/article-abstract/57/10/1489/288881
Исследование 2013-го года частично на других схемах чем сейчас используются. Без предварительного и последующего генотипирования. Так что неясно, в чем у всех причина неудач. Ну и другие недостатки:
Other factors may also influence the results, such as treatment adherence, being naive to ART, and sociodemographic characteristics. However, our study was not powered to stratify by more categories, and we understand that caution and clinical judgment needs to be used in the generalizability of these results. Another limitation is that we did not have information on adherence or interventions taken to improve adherence, and we did not take into account changes in ART regimen during follow-up. Moreover, we did not analyze the cause of virologic failure or its impact on the risk of developing resistance mutations. Some authors have clearly shown the risk of developing resistance mutations during LLV [11]. For example, Delaugerre et al showed that 11 of 37 patients with an episode of LLV of 500 copies/mL developed at least 1 drug-resistance mutation [11]. Taiwo et al showed that 37% (of 54 patients) developed new resistance mutations during LLV [12]. In patients with an HIV load of 50–400 copies/mL, Nettles et al found that 9 of 21 patients had resistance mutations [13]. McConnell also documented in a cohort of 92 patients that optimizing ART on the basis of genotyping findings during LLV was more successful at achieving an undetectable HIV load than observation and continued receipt of the current regimen [14]. Our cases of virologic failure probably include many situations, including HIV resistance and adherence issues. In 34% of patients (14/41), virologic suppression was achieved between their LLV episode and virologic failure. One possible explanation for this is that a problem with adherence was resolved after an intervention, whereas another is that suppression occurred following an ART-related change/addition, with virologic failure arising because of resistance.
Virologic failure of 1000 copies/mL is known to have clinical consequences, and our analyses showed that any persistent LLV of 50 copies/mL increased the risk of such failures. One of the difficulties when managing LLV is that HIV genotyping is mostly accessible and reliable in patients with an HIV load of 1000 copies/mL but less so at HIV loads of 400–1000 copies/mL [15]. Therefore, in the context of LLV, ART would often need to be adjusted blindly or based on past ART and genotyping history. This is why the option to observe and follow was and remains often considered, with most actions involving adherence counseling. However, the clearly increased risk of virologic failure shown here suggests that, for all persistent LLV of 50 copies/mL, even at a viral load of 200 copies/mL, it might be beneficial to act more aggressively (eg, by providing adherence counseling; measuring plasmatic ART dosage, if available; consider interactions of medications; performing genotyping; and providing closer monitoring).
Россия, Сочи
Блипы до 200 копий не несут рисков резистентности. Скорее всего и выше, только это не проверяли. Ну выскочит у кого-то 150 копий. И?
Есть такая мантра : 50-50-50-копий-копий-копий. А почему 50, а не 63? Или 71? Да потому что когда утверждали такой стандарт, были распространены тест-системы именно с таким порогом. И исследования соответственно проводили на них. Был бы порог в 100 копий, написали бы , что надо имено 100-100-100.
28-03-2021 18:45