Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per microL in Europe and North America: a pooled cohort observational study.
Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per microL in Europe and North America: a pooled cohort observational study.
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DOI：
10.1016/s0140-6736(10)60932-4
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发表时间：
2010-07-31
期刊：
影响因子：
168.9
通讯作者：
Phillips, Andrew N.
中科院分区：
文献类型：
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作者：
Lodwick, Rebecca K.;Sabin, Caroline A.;Porter, Kholoud;Ledergerber, Bruno;van Sighem, Ard;Cozzi-Lepri, Alessandro;Khaykin, Pavel;Mocroft, Amanda;Jacobson, Lisa;De Wit, Stephane;Obel, Niels;Castagna, Antonella;Wasmuth, Jan-Christian;Gill, John;Klein, Manna B.;Gange, Stephen;Riera, Melchor;Mussini, Cristina;Gutierrez, Felix;Touloumi, Giota;Carrieri, Patrizia;Guest, Jodie L.;Brockmeyer, Norbert H.;Phillips, Andrew N.
目前尚不清楚与普通人群相比，抗逆转录病毒(ART)幼稚HIV阳性、高CD4计数的人是否有更高的死亡风险，但这与考虑更早开始抗逆转录病毒治疗有关。我们汇集了来自欧洲和北美23个队列的数据，计算了国家、年龄、性别和年份标准化死亡率(SMR)，并按风险组分层。纳入的患者在抗逆转录病毒治疗前至少有一次CD4计数超过350个/mm3。使用Poisson回归方法评估CD4计数和死亡率之间的关系。在40,830名患者中，在80,682人年的随访中，CD4计数超过350个/mm~3的患者中，419人(1.0%)死亡。男同性恋者的SMR(95%可信区间)为1.30(1.06~1.58)，异性恋者和IDU危险人群的SMR分别为2.94(2.28~3.73)和9.37(8.13~10.75)。CD4计数大于500个/mm~3与死亡率低于350~499个/mm~3有关：500~699个/mm~3和700个/mm~3以上的调整比率(95%可信区间)分别为0.77(0.61~0.95)和0.66(0.52~0.85)。与普通人群相比，在HIV感染、CD4计数高的幼稚患者中，死亡率更高。在男同性恋者中，这是适度的，这表明在其他群体中，风险增加的一部分是由于其他因素的混淆造成的。即使在如此高的CD_4计数范围内，CD_4计数较低也与死亡率升高有关。
It is unclear whether antiretroviral (ART) naive HIV-positive individuals with high CD4 counts have a raised mortality risk compared with the general population, but this is relevant for considering earlier initiation of antiretroviral therapy. Pooling data from 23 European and North American cohorts, we calculated country-, age-, sex-, and year-standardised mortality ratios (SMRs), stratifying by risk group. Included patients had at least one pre-ART CD4 count above 350 cells/mm3. The association between CD4 count and death rate was evaluated using Poisson regression methods. Of 40,830 patients contributing 80,682 person-years of follow up with CD4 count above 350 cells/mm3, 419 (1.0%) died. The SMRs (95% confidence interval) were 1.30 (1.06-1.58) in homosexual men, and 2.94 (2.28-3.73) and 9.37 (8.13-10.75) in the heterosexual and IDU risk groups respectively. CD4 count above 500 cells/mm3 was associated with a lower death rate than 350-499 cells/mm3: adjusted rate ratios (95% confidence intervals) for 500-699 cells/mm3 and above 700 cells/mm3 were 0.77 (0.61-0.95) and 0.66 (0.52-0.85) respectively. In HIV-infected ART-naive patients with high CD4 counts, death rates were raised compared with the general population. In homosexual men this was modest, suggesting that a proportion of the increased risk in other groups is due to confounding by other factors. Even in this high CD4 count range, lower CD4 count was associated with raised mortality.