Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy
Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy
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DOI：
10.1001/jama.286.20.2568
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发表时间：
2001-11-28
影响因子：
120.7
通讯作者：
Montaner, JSG
中科院分区：
文献类型：
--
作者：
Hogg, RS;Yip, B;Montaner, JSG
背景目前对感染人类免疫缺陷病毒1型（HIV）的患者开始抗逆转录病毒治疗的建议是基于CD 4 T淋巴细胞计数和血浆HIV RNA水平。每个标志物的相对预后价值开始治疗后尚未得到充分的characteristic.Objective描述率的疾病进展死亡和艾滋病或死亡的患者开始三种药物的抗逆转录病毒治疗，分层的基线CD 4细胞计数和HIV RNA水平。对不列颠哥伦比亚省1219名18岁或以上未经抗逆转录病毒治疗的艾滋病毒阳性男性和女性进行基于人群的分析，这些男性和女性在8月1日至12月30日期间开始接受三联药物治疗。1996年和1999年9月30日。主要结果测量从三联药物抗逆转录病毒治疗开始到2000年9月30日的累积死亡率，使用各种CD 4细胞和血浆HIV RNA阈值确定。12个月时累积死亡率的乘积限估计值（SE）为2.9%（0.5%）。在单变量分析中，既往诊断为获得性免疫缺陷综合征（AIDS）、CD 4细胞计数、蛋白酶抑制剂的使用和HIV RNA水平与死亡率相关。不同年龄和性别的死亡率没有差异，只有CD 4细胞计数在多变量分析中保持统计学显著性。在控制AIDS、蛋白酶抑制剂使用和基线血浆HIV RNA水平后，CD 4细胞计数低于50/穆尔的患者为6.67（95%置信区间[CI]，3.61-12.34）倍，计数为50/穆尔至199/穆尔的患者为3.41（95%CI，1.93-6.03）倍的可能性死亡比那些计数至少200/穆尔。结论我们的数据表明，在开始抗逆转录病毒治疗的患者中，CD 4细胞计数至少200/穆尔的疾病进展至死亡和AIDS或死亡的比率一致较低。在我们的研究中，疾病进展至死亡和AIDS或死亡聚集在开始治疗时CD 4细胞计数低于200/穆尔的患者中。
Context Current recommendations for initiation of antiretroviral therapy in patients infected with human immunodeficiency virus type 1 (HIV) are based on CD4 T-lymphocyte cell counts and plasma HIV RNA levels. The relative prognostic value of each marker following initiation of therapy has not been fully characterized.Objective To describe rates of disease progression to death and AIDS or death among patients starting triple-drug antiretroviral therapy, stratified by baseline CD4 cell count and HIV RNA levels.Design, Setting, and Participants Population-based analysis of 1219 antiretroviral therapy-naive HIV-positive men and women aged 18 years or older in British Columbia who initiated triple-drug therapy between August 1, 1996, and September 30, 1999.Main Outcome Measure Cumulative mortality rates from the initiation of triple-drug antiretroviral therapy to September 30, 2000, determined using various CD4 cell and plasma HIV RNA thresholds.Results As of September 30, 2000, 82 patients had died of AIDS-related causes, for a crude AIDS-related mortality rate of 6.7%. The product limit estimate (SE) of the cumulative mortality rate at 12 months was 2.9% (0.5%), In univariate analyses, a prior diagnosis of acquired immunodeficiency syndrome (AIDS), CD4 cell count, use of protease inhibitors, and HIV RNA level were associated with mortality. There was no difference in mortality by age or sex, Only CD4 cell count remained statistically significant in the multivariate analysis. After controlling for AIDS, protease inhibitor use, and plasma HIV RNA level at baseline, patients with CD4 cell counts of less than 50/muL were 6.67 (95% confidence interval [CI], 3.61-12.34) times and those with counts of 50/muL to 199/muL were 3.41 (95% CI, 1.93-6.03) times more likely to die than those with counts of at least 200/muL.Conclusion Our data demonstrate uniformly low rates of disease progression to death and AIDS or death among patients starting antiretroviral therapy with CD4 cell counts of at least 200/muL. In our study, disease progression to death and AIDS or death was clustered among patients starting therapy with CD4 cell counts less than 200/muL.