Combining CD4 recovery and CD4: CD8 ratio restoration as an indicator for evaluating the outcome of continued antiretroviral therapy: an observational cohort study.
Combining CD4 recovery and CD4: CD8 ratio restoration as an indicator for evaluating the outcome of continued antiretroviral therapy: an observational cohort study.
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DOI：
10.1136/bmjopen-2017-016886
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发表时间：
2017-09-15
期刊：
影响因子：
2.9
通讯作者：
Chan KCW
中科院分区：
文献类型：
--
作者：
Lee SS;Wong NS;Wong BCK;Wong KH;Chan KCW
高效抗逆转录病毒治疗（HAART）后的免疫恢复通常仅通过CD 4重建的程度来评估。在这项研究中，我们的目的是通过结合CD 4计数和CD 4：CD 8比率来评估免疫恢复。观察性队列研究访问了参加香港最大的HIV服务并接受HAART ≥4年的中国HIV阳性患者的临床数据。最佳免疫结果定义为CD 4计数≥500/μL且CD 4：CD 8比率≥0.8。共纳入718例患者进行分析（6353人-年）。第4年结束时，715例患者中有318例达到CD 4 ≥500/μL，其中仅33%（105/318）同时达到CD 4：CD 8比值≥0.8。HAART前CD 8 ≤800/μL的患者（704例中的428例）更有可能是CD 4 ≥500/μL和CD 4：CD 8比值≥0.8的最佳免疫结局获得者，调整HAART前CD 4计数后，两者的相关性更强。在多变量logistic模型中，最佳免疫结局与男性、HAART前年龄较小和HAART前CD 4计数较高、HAART持续时间较长和HAART前CD 8 ≤800/μL呈正相关。治疗方案和累积病毒载量在免疫恢复模式中没有显着作用。在单独监测CD 4计数的基础上，CD 4计数和CD 4：CD 8比值的组合可能是描述治疗结果随时间变化的有用方法。
Immune recovery following highly active antiretroviral therapy (HAART) is commonly assessed by the degree of CD4 reconstitution alone. In this study, we aimed to assess immune recovery by incorporating both CD4 count and CD4:CD8 ratio. Observational cohort study Clinical data from Chinese HIV-positive patients attending the largest HIV service in Hong Kong and who had been on HAART for ≥4 years were accessed. Optimal immune outcome was defined as a combination of a CD4 count ≥500/μL and a CD4:CD8 ratio ≥0.8. A total of 718 patients were included for analysis (6353 person-years). At the end of year 4, 318 out of 715 patients achieved CD4 ≥500/μL, of which only 33% (105 out of 318) concurrently achieved CD4:CD8 ratio ≥0.8. Patients with a pre-HAART CD8 ≤800/μL (428 out of 704) were more likely to be optimal immune outcome achievers with CD4 ≥500/μL and CD4:CD8 ratio ≥0.8, the association of which was stronger after adjusting for pre-HAART CD4 counts. In a multivariable logistic model, optimal immune outcome was positively associated with male gender, younger pre-HAART age and higher pre-HAART CD4 count, longer duration of HAART and pre-HAART CD8 ≤800/μL. Treatment regimen and cumulative viral loads played no significant role in the pattern of immune recovery. A combination of CD4 count and CD4:CD8 ratio could be a useful approach for the characterisation of treatment outcome over time, on top of monitoring CD4 count alone.
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