Relations among CD4 lymphocyte count nadir, antiretroviral therapy, and HIV-1 disease progression: Results from the EuroSIDA study
Relations among CD4 lymphocyte count nadir, antiretroviral therapy, and HIV-1 disease progression: Results from the EuroSIDA study
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DOI：
10.7326/0003-4819-130-7-199904060-00005
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发表时间：
1999-04-06
影响因子：
39.2
通讯作者：
Lundgren, JD
中科院分区：
文献类型：
--
作者：
Miller, V;Mocroft, A;Lundgren, JD
背景资料：尚未研究既往CD 4细胞计数最低值对CD 4细胞计数升高患者临床进展的影响。目的：评估CD 4计数至少为200个细胞/mm的患者中HIV疾病进展的风险（3）（按既往最低CD 4计数分层），并比较CD 4计数低于50个细胞/ mm的患者的进展率（3）与CD 4计数从低于50个细胞/mm（3）反弹到至少200个细胞/mm（3）的患者相比，差异有统计学意义。设计：前瞻性、观察性多中心研究，设置：欧洲52个HIV门诊。CD 4计数至少为200个细胞/mm（3）（A组）和CD 4计数小于50个细胞/mm（3）（B组）。A组根据之前的最低CD 4计数进行分层：至少150个细胞/mm（3）（第1层），100至149个细胞/mm（3）（第2层），50至99个细胞/mm（3）（层3）和1至50个细胞/ mm（3）（层4）.测量：对患者进行随访，直至发生进展事件（首次AIDS定义事件、新发AIDS定义事件或死亡）或直至CD 4计数降至低于200个细胞/mm（3）（A组）或增至高于50个细胞/mm（3）（B组）。发病率基于患者-年分析，并报告为每100患者-年随访的事件;进展的相对风险基于考克斯比例风险模型。A组的总体疾病进展率为3.9/100患者-年（95% CI，3.5 - 4.3/100患者-年），而B组更高（72.9/100患者-年[CI，69.0 - 76.8/100患者-年]）。在A组中，既往CD 4细胞计数最低值较低的患者的发生率增加，导致进展的相对风险显著增加。第2、3和4层的相对危险度分别为2.29（CI，1.30 ~ 4.03）、3.65（CI，1.94 ~ 6.85）和2.94（CI，1.44 ~ 6.00）。结论：CD 4计数从极低水平增加到至少200个细胞/mm 3与疾病进展率显著降低相关。然而，在CD 4细胞计数至少为200个细胞/mm的患者中，先前较低的CD 4细胞计数最低点仍然与疾病进展的中度较高风险相关（3）。
Background: The effect of previous CD4 cell count nadir on clinical progression in patients with increases in CD4 cell counts has not been investigated.Objective: To assess risk for progression of HIV disease in patients with CD4 counts of at least 200 cells/mm(3) (stratified by the lowest previous CD4 count) and compare the rate of progression in patients with CD4 counts less than 50 cells/ mm(3) with that in patients whose CD4 counts rebounded from less than 50 cells/mm(3) to at least 200 cells/mm(3)Design: Prospective, observational multicenter study,Setting: 52 HIV outpatient clinics in Europe.Patients: Two groups were identified: those with CD4 counts of at least 200 cells/mm(3) (group A) and those with CD4 counts less than 50 cells/mm(3) (group B). Group A was stratified according to the lowest previous CD4 count: at least 150 cells/mm(3) (stratum 1), 100 to 149 cells/mm(3) (stratum 2), 50 to 99 cells/mm(3) (stratum 3), and 1 to 50 cells/ mm(3) (stratum 4).Measurements: Patients were followed until a progression event occurred (first AIDS-defining event, new AIDS-defining event, or death) or until the CD4 count decreased to less than 200 cells/mm(3) (group A) or increased to more than 50 cells/mm(3) (group B). Incidence rates were based on a patient-years analysis and reported as events per 100 patient-years of follow-up; the relative hazards for progression were based on Cox proportional hazards models.Results: The overall rate of disease progression in group A was 3.9 per 100 patient-years (95% CI, 3.5 to 4.3 per 100 patient-years), whereas in group B it was much higher (72.9 per 100 patient-years [CI, 69.0 to 76.8 per 100 patient-years]). in group A, the rate increased in patients with previous low CD4 cell count nadirs, resulting in a significant increase in the relative hazard for progression. The relative hazards for strata 2, 3, and 4 were 2.29 (CI, 1.30 to 4.03), 3.65 (CI, 1.94 to 6.85), and 2.94 (CI, 1.44 to 6.00), respectively.Conclusions: Increases in CD4 counts from very low levels to at least 200 cells/mm(3) are associated with a much reduced rate of disease progression. However, a previously low CD4 cell count nadir remains associated with a moderately higher risk for disease progression among patients with CD4 counts of at least 200 cells/mm(3).