摘要目的:观察基线HIV-1 RNA > 50万copies/mL的HIV-1感染者，在高效抗反转录病毒治疗（highly active antiretroviral therapy，HAART）前后外周血totalHIV-1 DNA的变化。方法:从国家十二五科技重大专项课题中选取基线HIV-1 RNA > 50万copies/mL且HAART 96周HIV-1 RNA < 50 copies/mL的初治HIV-1感染者为试验组，年龄性别相当的基线HIV-1 RNA < 50万copies/mL的HIV-1感染者为对照组。检测两组患者基线和HAART 24、48、96周时total HIV-1 DNA水平。结果:基线及HAART 96周，试验组total HIV-1 DNA均高于对照组3.48（3.21~3.80）lg copies/10 6 PBMCsvs 2.90（2.54~3.30）lg copies /10 6 PBMCs（ p<0.001），2.82（2.38~2.96）lgcopies/10 6 PBMCs vs 2.37（1.99~2.65） lg copies /10 6 PBMCs（ p=0.001）。HAART 24周、48周，试验组detal HIV-1 DNA较对照组高0.67（0.41~1.03）lg copies/10 6 PBMCs vs 0.39（0.09~0.73）lg copies/10 6 PBMCs（ P<0.001）, 0.8（0.46~1.16）lg copies/10 6 PBMCs vs 0.43（0.04~0.63）lg copies/10 6 PBMCs（ P<0.001）。且HAART前后total HIV-1 DNA水平均与基线病载正相关。 结论:基线极高病载患者HAART 96周内存在较高total HIV DNA水平，建议选择强效HAART方案来有效降低储存库。

abstractsObjective:To observed the impact of HIV-1 RNA >500 000 copies/mL at baseline on the decay of total HIV-1 DNA in HIV-1 infected patients before and after highly active antiretroviral therapy (HAART).Methods:From the National Key Science and Technology Project of the 12 th Five-year Plan Period, HIV-1 HAART-naive patients with HIV-1 RNA >500 000 copies/mL at baseline were recruited as the study group and HIV-1 HAART-naive patients with matched age and gender, and HIV-1 RNA < 500 000 copies/mL at baseline were selected as controls. Total HIV-1 DNA was quantified with peripheral blood at 0, 24, 48 and 96 weeks after HAART. Results:Compared with the controls, total HIV-1 DNA levels at the baseline and 96 weeks after HAART in the study group were higher, namely, 3.48 (3.21-3.80) lg copies/10 6 PBMCs vs 2.90 (2.54-3.30) lg copies/10 6 PBMCs ( P<0.001), and 2.82 (2.38-2.96) lg copies/10 6 PBMCs vs 2.37 (1.99-2.65) lg copies/10 6 PBMCs ( P=0.001), respectively. Moreover, the detal HIV-1 DNA levels at 24 and 48 weeks after HAART in the study group were higher, namely, 0.67 (0.41-1.03) lg copies/10 6 PBMCs vs 0.39 (0.09-0.73) lg copies/10 6 PBMCs ( P<0.001), 0.8 (0.46-1.16) lg copies/10 6 PBMCs vs 0.43 (0.04-0.63) lg copies/10 6 PBMCs ( P<0.001), respectively. Both the levels of total HIV-1 DNA at baseline and after HAART were positively correlated to the baseline viral loads. Conclusions:HIV-1 infected patients with very high baseline HIV-1 RNA levels presented higher total HIV-1 DNA level within 96 weeks after HAART. More potent initial HAART regimens should be considered to decrease total HIV-1 DNA.