RATE OF CD4 CELL DECLINE AND PREDICTION OF SURVIVAL IN ZIDOVUDINE-TREATED PATIENTS
RATE OF CD4 CELL DECLINE AND PREDICTION OF SURVIVAL IN ZIDOVUDINE-TREATED PATIENTS
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DOI：
10.1097/00002030-199307000-00009
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发表时间：
1993-07-01
期刊：
影响因子：
3.8
通讯作者：
GAZZARD, B
中科院分区：
文献类型：
--
作者：
EASTERBROOK, PJ;EMAMI, J;GAZZARD, B
目的：调查齐多夫定 (ZDV) 治疗开始前和治疗后第一年生存率与 CD4 细胞下降率之间的关系。设计：回顾性观察研究。背景：伦敦河滨区卫生局内的医院 HIV 诊所。患者：艾滋病患者 (n = 476)、有症状 (n = 687) 或无症状 (n = 194) 患者（总共 1415 名） HIV-1 感染或临床状态未知 (n = 58)，在 1986 年 6 月至 1991 年 10 月期间首次接受 ZDV。 干预：大多数患者接受 ZDV 的初始剂量为每 6 小时 200 mg 或每天两次 250 mg。接受 ZDV 后的中位随访时间为 17 个月（范围为 2-54 个月）。主要测量：ZDV 开始之前和之后的 CD4 细胞计数； ZDV 治疗前和治疗第一年期间对数转换 CD4 细胞计数的下降率；结果：截至1991年12月31日，已有432名患者死亡。与之前 CD4 计数没有下降或增加的患者相比，在开始 ZDV 之前（每月小于或等于 -0.06 个对数细胞）以及在 ZDV 治疗第一年（每月小于或等于 -0.08 个对数细胞）中 log CD4 下降率最高的患者自 ZDV 开始后的 3 年生存率要差得多（分别为 23% 和 40.5%）。 (39.0%) 或 ZDV 治疗后 (72.3%)。在一系列多变量分析中，在调整 ZDV 开始时的年龄和临床状态以及最近的 CD4 计数后，ZDV 治疗第一年的 log CD4 下降率较高（每月小于或等于 -0.08 log 个细胞）预示着生存率较差。相比之下，ZDV之前的CD4下降率、初始CD4升高的存在以及ZDV之后CD4下降率的变化幅度不再与结果显着相关。结论：在这项回顾性研究中，ZDV治疗第一年的CD4下降率，而不是初始CD4升高的发生率可以预测生存，这表明早期CD4反应可能是衡量ZDV影响的不良指标。尽管接受 ZDV 治疗，CD4 下降率仍较高的患者代表了预后不良的患者亚组，这些患者可能会受益于替代或联合抗逆转录病毒疗法。
Objective: To investigate the relationship between survival and the rate of CD4 cell decline before and in the first year following initiation of zidovudine (ZDV) therapy.Design: Retrospective observational study.Setting: Hospital-based HIV clinics within the Riverside District Health Authority in London.Patients: Patients (total, 1415) with AIDS (n = 476), symptomatic (n = 687) or asymptomatic (n = 194) HIV-1 infection, or of unknown clinical status (n = 58), who first received ZDV between June 1986 and October 1991.Intervention: The majority of patients received ZDV at an initial dose of 200 mg every 6 h or 250 mg twice daily. The median duration of follow-up after receipt of ZDV was 17 months (range, 2-54 months).Main measurements: CD4 cell counts prior to and following initiation of ZDV; rate of decline of log-transformed CD4 cell count before ZDV therapy and during the first year of therapy; survival.Results: As of 31 December 1991, 432 patients had died. Patients with the highest rate of log CD4 decline before initiation of ZDV (less-than-or-equal-to -0.06 log cells per month) as well as in the first year of ZDV therapy (less-than-or-equal-to -0.08 log cells per month) had a much poorer 3-year survival from initiation of ZDV (23 and 40.5%, respectively) compared with patients with no decline or an increase in their CD4 count before (39.0%) or after (72.3%) ZDV therapy. In a series of multivariate analyses, a high rate of log CD4 decline in the first year of ZDV therapy (less-than-or-equal-to -0.08 log cells per month) was predictive of poor survival, after adjustment for age and clinical status at initiation of ZDV and most recent CD4 count. In contrast, rate of CD4 decline before ZDV, presence of an initial CD4 rise and the magnitude of change in the rate of CD4 decline following ZDV were no longer significantly associated with outcome.Conclusions: In this retrospective study, the rate of CD4 decline in the first year of ZDV therapy, but not the occurrence of an initial CD4 rise was predictive of survival, suggesting that the early CD4 response may be a poor measure of the impact of ZDV. Patients with a high rate of CD4 decline despite ZDV therapy represent a subgroup of patients with a poor prognosis who might benefit from alternative or combination antiretroviral therapies.