The association of CD4+ T-cell counts and cardiovascular risk in treated HIV disease.
The association of CD4+ T-cell counts and cardiovascular risk in treated HIV disease.
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DOI：
10.1097/qad.0b013e328352ce54
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发表时间：
2012-06-01
期刊：
影响因子：
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通讯作者：
Hsue PY
中科院分区：
文献类型：
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作者：
Ho JE;Scherzer R;Hecht FM;Maka K;Selby V;Martin JN;Ganz P;Deeks SG;Hsue PY
目的：HIV感染者是心血管疾病的高危人群。早期启动HIV治疗在较高的CD 4+细胞计数是否有任何影响，对心血管疾病的风险评估内皮function.Design：横断面研究74抗逆转录病毒治疗的男性与不可检测的血浆HIV RNA levels.Methods：参与者进行了非侵入性评估内皮功能使用肱动脉血流介导的扩张（FMD）。结果：中位年龄为47岁[四分位距（IQR）42-55]，中位当前CD 4 + T细胞计数为659个/μl（IQR 542-845），最低CD 4细胞计数为314个/μl（IQR 150-490）。28%患有高血压，32%患有高脂血症。在年龄调整和种族调整分析中，CD 4 + T细胞计数最低值低于350个细胞/μl与FMD较低相关，在调整心血管危险因素（高血压、糖尿病、吸烟、高脂血症）和HIV相关特征（HIV持续时间、HAART持续时间）后，仍是FMD的独立预测因素。多变量校正后，CD 4 + T细胞计数最低值低于350个细胞/μl的个体FMD比T细胞计数较高的个体低1.22%[95%置信区间（CI）-2.20至0.19，P= 0.02]。结论：在接受治疗的HIV感染者中，CD 4 + T细胞计数最低值低于350个/μl与FMD降低独立相关，提示延迟治疗会导致内皮功能的持续损害。我们的数据支持未来的前瞻性研究，评价在较高的CD 4+细胞计数下开始HAART的心血管效应。
Objective:HIV-infected individuals are at high risk of developing cardiovascular disease. Whether earlier initiation of HIV therapy at higher CD4+ cell counts has any effect on cardiovascular risk as assessed by endothelial function is unknown.Design:Cross-sectional study of 74 antiretroviral-treated men with undetectable plasma HIV RNA levels.Methods:Participants underwent noninvasive assessment of endothelial function using brachial artery flow-mediated dilation (FMD). The association of nadir and current CD4+ T-cell count with FMD was assessed using multivariable linear regression.Results:The median age was 47 years [interquartile range (IQR) 42–55], median current CD4+ T-cell count was 659 cells/μl (IQR 542–845), and nadir CD4 cell count was 314 cells/μl (IQR 150–490). Twenty-eight percent had hypertension, and 32% hyperlipidemia. Nadir CD4+ T-cell count less than 350 cells/μl was associated with lower FMD in age-adjusted and race-adjusted analyses and remained an independent predictor of FMD after adjustment for cardiovascular risk factors (hypertension, diabetes, smoking, hyperlipidemia) and HIV-related characteristics (HIV duration, HAART duration). After multivariable adjustment, individuals with nadir CD4+ T-cell count less than 350 cells/μl had a 1.22% lower FMD compared with those with higher T-cell counts [95% confidence interval (CI)− 2.20 to− 0.19, P= 0.02]. Proximal CD4+ T-cell count showed little association with FMD.Conclusion:Among treated HIV-infected individuals, nadir CD4+ T-cell count less than 350 cells/μl is independently associated with lower FMD, suggesting that delayed therapy results in sustained harm to endothelial function. Our data support future prospective studies evaluating cardiovascular effects of HAART initiation at higher CD4+ cell counts.