Impact of the highly active antiretroviral therapy era on the epidemiology of primary HIV-associated thrombocytopenia.
Impact of the highly active antiretroviral therapy era on the epidemiology of primary HIV-associated thrombocytopenia.
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DOI：
10.1186/s13104-015-1548-3
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发表时间：
2015-10-23
影响因子：
1.8
通讯作者：
Agan BK
中科院分区：
文献类型：
--
作者：
O'Bryan TA;Okulicz JF;Bradley WP;Ganesan A;Wang X;Agan BK
原发性HIV相关性血小板减少症（PHAT）通常在高效抗逆转录病毒治疗（HAART）后得到改善;然而，病例仍在继续发生。比较HAART前和HAART时代PHAT流行病学的数据有限。我们回顾性研究了1986年至2013年美国军事HIV自然史研究（NHS）中28年的PHAT发病率。受试者血小板计数最低值<100 × 109/l，无其他可识别原因。时间段分为HAART前（1986 - 1995），早期HAART（1996 - 2001）和晚期HAART（2002 - 2013）。比较三个时期的发病率、人口统计学数据和CD4计数。使用广义估计方程模型评估HAART时期诊断病例中血小板计数和HIV病毒载量的任何相关性。218名参与者符合病例定义。86.2%的案件发生在2002年之前。在HAART前、早期和晚期HAART期间，每1000人-年随访的PHAT发生率分别为16.3、4.6和1.9。在血小板减少症发生时，HAART时期的CD4细胞计数显著较高（p <0.001）。在1996年后确诊的患者中，96.4%在血小板最低点前6个月内出现病毒血症，超过一半的患者未经抗逆转录病毒治疗。在HAART治疗期间，病毒载量（每log10拷贝/ml）与血小板计数呈负相关（p <0.0001）。在HAART时代，PHAT的发病率显著下降。然而，病毒血症的个体，包括那些健康的CD4细胞计数，可能处于危险之中。尽早实现病毒抑制可能会进一步降低发病率。
Primary HIV-associated thrombocytopenia (PHAT) typically improves with highly active antiretroviral therapy (HAART); however, cases continue to occur. Data comparing the epidemiology of PHAT between the pre-HAART and HAART eras are limited. We retrospectively examined the incidence of PHAT over 28 years in the US Military HIV Natural History Study (NHS) from 1986 to 2013. Subjects had a nadir platelet count <100 × 109/l with no other identifiable cause. Time periods were categorized as pre-HAART (1986–1995), early HAART (1996–2001), and later HAART (2002–2013). Incidence, demographic data, and CD4 count were compared across the three eras. A generalized estimating equations model was used to assess any association of platelet count and HIV viral load in cases diagnosed during the HAART eras. 218 participants met the case definition. 86.2 % of cases occurred prior to 2002. The incidence of PHAT per 1000 person-years of follow-up was 16.3, 4.6, and 1.9 during pre-HAART, early HAART and later HAART eras respectively. CD4 cell counts were significantly higher in the HAART eras at the time of thrombocytopenia (p < 0.001). Of patients diagnosed after 1996, 96.4 % were viremic within six months preceding the platelet nadir and over half were antiretroviral naïve. Viral load (per log10 copies/ml) inversely correlated with platelet count throughout the HAART eras (p < 0.0001). The incidence of PHAT has markedly decreased in the HAART era. However, viremic individuals, including those with healthy CD4 cell counts, may be at risk. Achieving viral suppression as early as possible may decrease the incidence further.