HIV-associated thrombotic microangiopathy in the era of highly active antiretroviral therapy: An observational study
HIV-associated thrombotic microangiopathy in the era of highly active antiretroviral therapy: An observational study
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DOI：
10.1086/422363
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发表时间：
2004-11-01
影响因子：
11.8
通讯作者：
Feinberg, J
中科院分区：
文献类型：
--
作者：
Becker, S;Fusco, G;Feinberg, J
在人类免疫缺陷病毒（HIV）结局研究/美国队列合作项目中，对高活性抗逆转录病毒治疗（HAART）时代血栓性微血管病（TMA）的患病率和易感因素进行了评估。6022例患者中，17例（0.3%）患有TMA，未经调整的TMA发病率为每100人年0.079例，血栓性血小板减少性紫癜为0.009例，溶血性尿毒症综合征为0.069例。与没有TMA的患者相比，TMA患者的平均CD4（+）细胞计数较低（197 vs. 439细胞/mm）；P = .0009)和更高的平均对数（10）HIV-1 RNA水平（4.6 vs. 3.3拷贝/mL， P = .0001），获得性免疫缺陷综合征（82.4% vs. 55.3%, P = .025）、鸟分枝杆菌复合体感染（17.6% vs. 3.3%, P = .018）、丙型肝炎（29.4% vs. 11.3%, P = .001）和死亡（41.2% vs. 7.4%, P < .0001）的发生率显著增加。TMA患者的疱疹患病率和抗疱疹药的使用略高，但未经调整的分布无统计学意义。在引入HAART后调查的队列中，TMA很少见，并且与晚期HIV疾病有关。
The prevalence and predisposing factors of thrombotic microangiopathy (TMA) in the era of highly active antiretroviral therapy ( HAART) were evaluated among patients in the Collaborations in Human Immunodeficiency Virus (HIV) Outcomes Research/US cohort. Of 6022 patients, 17 (0.3%) had TMA, with unadjusted incidences per 100 person-years of 0.079 for TMA, 0.009 for thrombotic thrombocytopenic purpura, and 0.069 for hemolytic-uremic syndrome. Compared with patients without TMA, patients with TMA had lower mean CD4(+) cell counts (197 vs. 439 cells/mm(3); P = .0009) and higher mean log(10) HIV-1 RNA levels (4.6 vs. 3.3 copies/mL; P = .0001) at last follow-up and a significantly greater incidence of acquired immune deficiency syndrome (82.4% vs. 55.3%; P = .025), Mycobacterium avium complex infection (17.6% vs. 3.3%; P = .018), hepatitis C (29.4% vs. 11.3%; P = .001), and death (41.2% vs. 7.4%; P < .0001). The prevalence of herpes and use of antiherpetics were slightly higher for patients with TMA, but unadjusted distributions were not statistically significant. TMA in a cohort surveyed after the introduction of HAART was rare and was associated with advanced HIV disease.