Immunologic risk factors for early mortality after starting antiretroviral therapy in HIV-infected Zambian children.
Immunologic risk factors for early mortality after starting antiretroviral therapy in HIV-infected Zambian children.
复制标题
感染艾滋病毒的赞比亚儿童开始抗逆转录病毒治疗后早期死亡的免疫学危险因素。
DOI：
10.1089/aid.2012.0246
复制
发表时间：
2013
影响因子：
1.5
通讯作者：
Moss,WilliamJ
中科院分区：
文献类型：
--
作者：
Rainwater-Lovett,Kaitlin;Nkamba,HopeC;Mubiana-Mbewe,Mwangelwa;Moore,CarolynBolton;Moss,WilliamJ
To explore immunologic risk factors for death within 90 days of highly active antiretroviral therapy (HAART) initiation, CD4+and CD8+T cell subsets were measured by flow cytometry and characterized by logistic regression in 149 Zambian children between 9 months and 10 years of age enrolled in a prospective, observational study of the impact of HAART on measles immunity. Of 21 children who died during follow-up, 17 (81%) had known dates of death and 16 (76%) died within 90 days of initiating HAART. Young age and low weight-for-agez-scores were associated with increased risks of mortality within 90 days of starting HAART, whereas CD4+T cell percentage was not associated with mortality. After adjusting for these factors, each 10% increase in CD8+effector T cells increased the odds of overall mortality [OR=1.43 (95% CI: 1.08, 1.90)] and was marginally associated with early mortality [OR=1.29 (95% CI: 0.97, 1.72)]. Conversely, each 10% increase in CD4+central memory T cells decreased the odds of overall [OR=0.06 (95% CI: 0.01, 0.59)] and early mortality [OR=0.09 (95% CI: 0.01, 0.97)]. Logistic regression prediction models demonstrated areas under the receiver-operator characteristic curves of ≥85% for early and overall mortality, with bootstrapped sensitivities of 82–85% upon validation, supporting the predictive accuracy of the models. CD4+and CD8+T cell subsets may be more accurate predictors of early mortality than CD4+T cell percentages and could be used to identify children who would benefit from more frequent clinical monitoring after initiating HAART.
