CD4 Decline Is Associated With Increased Risk of Cardiovascular Disease, Cancer, and Death in Virally Suppressed Patients With HIV
CD4 Decline Is Associated With Increased Risk of Cardiovascular Disease, Cancer, and Death in Virally Suppressed Patients With HIV
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DOI：
10.1093/cid/cit232
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发表时间：
2013-07-15
影响因子：
11.8
通讯作者：
Gerstoft, Jan
中科院分区：
文献类型：
--
作者：
Helleberg, Marie;Kronborg, Gitte;Gerstoft, Jan
背景。尽管抗逆转录病毒治疗和病毒抑制，CD4显著下降的临床意义尚不清楚。我们的目的是验证CD4显著下降可能是心血管疾病或未确诊癌症的标志这一假设。1995-2010年期间，在丹麦全国范围内以人群为基础的队列研究中，对人类免疫缺陷病毒（HIV）患者进行了随访，每季度测量CD4。使用泊松回归分析CD4下降>= 30%与心血管疾病、癌症和死亡之间的关系，并将CD4下降日期作为时间更新变量。我们对2584例病毒抑制的HIV患者进行了13369人年的随访（PY；中位观察时间为4.7年）。56例患者出现CD4下降（发生率4.2/1000 PY[95%可信区间{CI}， 3.2 ~ 5.4]）。CD4细胞计数中位数从492个/ μ L下降到240个/ μ L， CD8、CD3和总淋巴细胞计数也随之下降。除了用二腺苷治疗外，没有hiv相关因素与CD4下降相关。患心血管疾病、癌症和死亡的风险显著增加
Background. The clinical implications of a considerable CD4 decline despite antiretroviral treatment and viral suppression are unknown. We aimed to test the hypothesis that a major CD4 decline could be a marker of cardiovascular disease or undiagnosed cancer.Methods. Patients with human immunodeficiency virus (HIV) were followed in the Danish nationwide, population-based cohort study in the period 1995-2010 with quarterly CD4 measurements. Associations between a CD4 decline of >= 30% and cardiovascular disease, cancer, and death were analyzed using Poisson regression with date of CD4 decline as a time-updated variable.Results. We followed 2584 virally suppressed HIV patients for 13 369 person-years (PY; median observation time, 4.7 years). Fifty-six patients developed CD4 decline (incidence rate, 4.2/1000 PY [95% confidence interval {CI}, 3.2-5.4]). CD4 counts dropped from a median of 492 cells/mu L to 240 cells/mu L. CD8, CD3, and total lymphocyte counts dropped concomitantly. No HIV-related factors, apart from treatment with didanosine, were associated with CD4 decline. The risk of cardiovascular disease, cancer, and death increased markedly