The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian-European collaborative retrospective cohort study.
The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian-European collaborative retrospective cohort study.
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DOI：
10.9778/cmajo.20140017
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发表时间：
2014-10-01
期刊：
影响因子：
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通讯作者：
Smaill, Fiona
中科院分区：
文献类型：
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作者：
Klein, Marina B;Young, Jim;Smaill, Fiona
背景：种族差异可能会混淆 HIV-1 亚型与免疫进展之间的关联。我们比较了最流行的 HIV-1 亚型在未经治疗的感染期间 CD4 细胞计数的下降情况，重点是区分病毒亚型和种族的影响。方法：我们结合了 4 个欧洲和 6 个加拿大队列的数据，选择处于未经治疗的 HIV 感染慢性稳定期的成年人。我们使用混合模型估计了亚型和种族的 CD4 细胞计数平方根随时间的变化，并调整了因对初始 CD4 细胞计数或其下降的潜在影响而选择的协变量。 结果：分析了 9772 名患者的数据，提供了 79175 次 CD4 细胞计数测量值和 24157 人年的随访。总体而言，与病毒 B 亚型相比，病毒 A、CRF01_AE、CRF02_AG、C 和 G 亚型的 CD4 细胞计数下降没有明显差异；而非洲血统患者的 CD4 细胞计数下降速度明显慢于其他种族患者。当单独研究种族时，有证据表明，与病毒 B 亚型相比，非洲血统患者中病毒 C 亚型（可能还有 A 和 G）的 CD4 细胞计数下降较慢，但其他种族患者中则不然，这表明亚型和种族之间存在相互作用。解释：种族是 CD4 细胞计数下降的主要决定因素；病毒亚型差异可能存在，但与种族的影响相比很小，并且在非洲血统的患者中最为明显。在发展中国家，非洲人后裔中 CD4 细胞计数下降较慢可能会导致无症状期更长，并增加艾滋病毒传播的机会。
BACKGROUND: Ethnic differences have the potential to confound associations between HIV-1 subtype and immunologic progression. We compared declines in CD4 cell counts during untreated infection for the most prevalent HIV-1 subtypes, focusing on distinguishing between the effects of viral subtype and ethnicity.METHODS: We combined data from 4 European and 6 Canadian cohorts, selecting adults in the stable chronic phase of untreated HIV infection. We estimated the change in square root CD4 cell count over time for subtypes and ethnicities using mixed models, adjusting for covariates selected for their potential effect on initial CD4 cell count or its decline.RESULTS: Data from 9772 patients were analyzed, contributing 79175 measurements of CD4 cell count and 24157 person-years of follow-up. Overall, there were no appreciable differences in CD4 cell count decline for viral subtypes A, CRF01_AE, CRF02_AG, C and G compared with viral subtype B; whereas the decline in CD4 cell count in patients of African ancestry was considerably slower than in patients of other ethnicity. When ethnic groups were studied separately, there was evidence for slower declines in CD4 cell count in viral subtypes C, and possibly A and G, compared with viral subtype B in patients of African ancestry but not among patients of other ethnicities, suggesting an interaction between subtype and ethnicity.INTERPRETATION: Ethnicity is a major determinant of CD4 cell count decline; viral subtype differences may have existed but were small compared with the effect of ethnicity and were most apparent in patients of African ancestry. In developing countries, slower CD4 cell count declines among individuals of African descent may translate to a longer asymptomatic phase and increase the opportunity for HIV transmission.