Patients' characteristics and clinical implications of suboptimal CD4 T-cell gains after 1 year of successful antiretroviral therapy
Patients' characteristics and clinical implications of suboptimal CD4 T-cell gains after 1 year of successful antiretroviral therapy
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DOI：
10.2174/157016208783885038
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发表时间：
2008-03-01
影响因子：
1
通讯作者：
del Amo, Julia
中科院分区：
文献类型：
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作者：
Gutierrez, Felix;Padilla, Sergio;del Amo, Julia
描述联合抗逆转录病毒治疗（CART）免疫应答不佳患者的特征和预后。使用来自多中心队列研究的数据，我们选择了启动CART并在治疗1年后显示出次优CD 4-T细胞应答（定义为< 50个细胞/L增加）的患者，尽管持续的病毒学抑制。将这些患者的特征与表现出最佳免疫应答的受试者进行比较。在650例病毒学抑制的患者中，108例（16.6%）显示出次优的CD 4-T细胞应答。次优反应的独立预测因素为既往注射药物使用（OR，1.85; 95% CI，1.12-2.98）和CART开始时的年龄（OR，每年增加1.04; 95% CI，1.01-1.06）。丙型肝炎病毒合并感染与免疫应答受损无关。与免疫应答最佳的患者相比，免疫应答次佳的患者死亡率更高（3.22 vs 0.71/100人年; p= 0.001），但新发艾滋病定义事件的发生率相似。在CART持续病毒学抑制的患者中，既往注射药物使用（而非丙型肝炎病毒合并感染）和开始治疗时年龄较大与次优CD 4 T细胞应答相关。随着时间的推移，反应不佳的患者死亡率较高，主要是由于艾滋病定义事件以外的疾病。
To describe characteristics and prognosis of patients with suboptimal immunological response to combined antiretroviral therapy (CART). Using data from a multicenter cohort study, we selected patients who initiated CART and showed suboptimal CD4-T cell response (defined as < 50 cells/L increase) after 1 year of therapy, despite sustained virological suppression. Characteristics of those patients were compared with subjects who showed optimal immunological response. Of 650 patients with virological suppression, 108 (16.6%) showed suboptimal CD4-T cell response. Independent predictors of suboptimal response were previous injection drug use (OR, 1.85; 95% CI, 1.12-2.98) and age at CART initiation (OR, 1.04 per year increase; 95% CI, 1.01-1.06). Hepatitis C virus coinfection was not associated with impaired inmunological response. As compared with patients with optimal immunological response, those with suboptimal response had a higher mortality rate (3.22 versus 0.71 per 100 person-years; p=.001), but a similar rate of new AIDS-defining events. In patients with sustained virological suppression with CART, previous injection drug use, but not hepatitis C virus coinfection, and older age at initiation of therapy were associated with suboptimal CD4 T-cell responses. Patients with suboptimal response had a higher mortality over time, mainly due to diseases other than AIDS-defining events.