Changes in the Incidence of Severe Thrombocytopenia and Its Predisposing Conditions in HIV-Infected Patients Since the Introduction of Highly Active Antiretroviral Therapy
Changes in the Incidence of Severe Thrombocytopenia and Its Predisposing Conditions in HIV-Infected Patients Since the Introduction of Highly Active Antiretroviral Therapy
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DOI：
10.1097/qai.0000000000000347
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发表时间：
2014-12-05
影响因子：
3.6
通讯作者：
Ridolfo, Anna L.
中科院分区：
文献类型：
--
作者：
Franzetti, Marco;Adorni, Fulvio;Ridolfo, Anna L.
背景：严重血小板减少症（TCP，血小板，50 × 10(9)/L）在HIV感染期间相对常见，并与出血风险和疾病进展相关。我们调查了hiv阳性受试者队列中严重TCP发病率及其易感条件的变化。方法：对我院1985 - 2012年收治的所有患者的血小板计数50 × 10(9)/L的发生率及预测因素进行调查。在现有抗逆转录病毒治疗方案的基础上考虑了三个不同的时期：P1（1985-1989年）、P2（1990-1996年）和P3（1997-2012年）。发病率采用泊松回归模型评估，预测因子采用Cox回归评估。结果：该研究纳入5137例患者，入组时血小板计数为bbb50 × 10(9)/L。597名受试者发生严重TCP，其发生率随时间而下降。机会性疾病和恶性肿瘤患者的发病率下降，而慢性肝病患者的发病率上升；与HIV感染以外的任何原因无关的TCP保持稳定。多因素分析显示，注射药物使用、艾滋病诊断、低CD4（+）细胞计数、血清丙氨酸转氨酶水平升高和入组年份较早是严重TCP风险增加的预测因素，而使用高效抗逆转录病毒治疗（HAART）与风险降低相关。结论：引入HAART后，发现严重TCP的发生率显著降低，可能是因为它能够限制由不受控制的HIV复制和机会性感染引起的骨髓损伤。相反，HAART对慢性肝病相关TCP的影响可能会降低。
Background: Severe thrombocytopenia (TCP, platelets,50 x 10(9)/L) is relatively frequent during HIV infection and is associated with bleeding risk and disease progression. We investigated the changes in the incidence of severe TCP and its predisposing conditions in a cohort of HIV-positive subjects.Methods: The incidence and predictors of platelet counts,50 x 10(9)/L were investigated in all patients enrolled at our institution between 1985 and 2012. Three different periods were considered on the basis of the available antiretroviral regimens: P1 (1985-1989), P2 (1990-1996), and P3 (1997-2012). Incidence rates were assessed using Poisson regression models and the predictors by means of Cox regression.Results: The study involved 5137 patients with platelet counts >50 x 10(9)/L at enrollment. Severe TCP occurred in 597 subjects, and its incidence decreased over time. The incidence decreased in patients with opportunistic diseases and malignancies but increased in patients with chronic liver disease; TCP unrelated to any cause other than HIV infection remained stable. Multivariate analysis showed that injected drug use, a diagnosis of AIDS, low CD4(+) cell counts, increased serum alanine aminotransferase levels, and an earlier year of enrollment were predictors of an increased risk of severe TCP, whereas the use of highly active antiretroviral therapy (HAART) was associated with a reduced risk.Conclusions: A considerable reduction in the incidence of severe TCP after the introduction of HAART was found, probably because of its ability to limit bone marrow damage induced by uncontrolled HIV replication and opportunistic infections. On the contrary, HAART may have a reduced impact on TCP related to chronic liver disease.