CD4-PERCENT IS THE BEST PREDICTOR OF DEVELOPMENT OF AIDS IN A COHORT OF HIV-INFECTED HOMOSEXUAL MEN
CD4-PERCENT IS THE BEST PREDICTOR OF DEVELOPMENT OF AIDS IN A COHORT OF HIV-INFECTED HOMOSEXUAL MEN
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DOI：
10.1097/00002030-199104000-00002
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发表时间：
1991-04-01
期刊：
影响因子：
3.8
通讯作者：
PENNY, R
中科院分区：
文献类型：
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作者：
BURCHAM, J;MARMOR, M;PENNY, R
为了确定个体的基线T细胞亚群、其随时间的变化率和无艾滋病生存时间之间的关系，以6个月的间隔从379名艾滋病毒血清阳性的同性恋悉尼男子中收集数据，其中31人在3年的观察期内发展为艾滋病。CD4%及其变化率对判断无艾滋病生存期有重要意义。与CD4%保持稳定的受试者相比，CD4%在一年内下降7%或以上的受试者发生AIDS的相对危险度为35.1（95%可信区间= 11.7-105.6，P < 0.001）。增加CD4%具有显著的保护作用，降低了患艾滋病的风险。CD4%、CD 4细胞计数和CD 4：CD 8比值在后来被诊断为艾滋病的受试者中的下降幅度大于未被诊断为艾滋病的受试者。尽管感染持续时间存在不确定的差异，但无艾滋病血清转换者和血清阳性者的免疫学变化率相似。多因素考克斯回归分析显示，基线CD4%、CD4%变化率、基线淋巴细胞计数与无艾滋病生存期相关。基线CD4%的预后价值大于基线CD 4细胞计数。在该分析中，基线CD8%、基线CD 8计数、其变化率及其均方误差均不具有独立显著性。这些发现对于临床医生监测个体中的HIV感染以及临床试验中的进入标准和监测程序都很重要。它们也对资源贫乏的环境有影响;基于CD4%的预后可以用流式细胞仪进行，而无需全血细胞计数。在齐多夫定上市之前收集的数据反映了HIV感染的自然史。
To determine the relationships between individuals' baseline T-cell subsets, their rates of change with time, and AIDS-free survival time, data were collected at 6-monthly intervals from 379 HIV-seropositive homosexual Sydney men, of whom 31 developed AIDS during the 3-year observation period. Both CD4% and rate of change of CD4% in an individual had significant prognostic value in determinign AIDS-free survival time. Compared with subjects whose CD4% remained stable, subjects whose CD4% dropped by 7% or more in a year had a relative hazard of 35.1 (95% confidence interval = 11.7-105.6, P < 0.001) of developing AIDS. Increasing CD4% had a significant protective effect, reducing the risk of developing AIDS. CD4%, CD4 cell count and CD4:CD8 ratios showed steeper declines in subjects who were later diagnosed with AIDS than in those who remained AIDS-free. The rates of immunological change in AIDS-free seroconverters and seropositives were similar, despite indeterminate differences in durations of infections. In the multivariate Cox regression analysis, baseline CD4%, the rate of change of CD4%, and baseline lymphocyte count were associated with AIDS-free survival time. Baseline CD4% had greater prognostic value than baseline CD4 cell count. Baseline CD8%, baseline CD8 count, their rates of change and their mean square errors were not independently significant in this analysis. These findings are important for clinicians monitoring HIV infection in an individual and for entry criteria and monitoring procedures in clinical trials. They also have implications for resource-poor settings; prognosis based on CD4% can be made with a flow cytometer without a full blood count. Data were collected before zidovudine was available and thus reflect the natural history of HIV infection.