CD4+ lymphocyte level and rate of decline as predictors of AIDS in intravenous drug users with HIV infection.
CD4+ lymphocyte level and rate of decline as predictors of AIDS in intravenous drug users with HIV infection.
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CD4 淋巴细胞水平和下降率是感染 HIV 的静脉吸毒者中 AIDS 的预测因子。
DOI：
10.1097/00002030-199304000-00010
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发表时间：
1993
期刊：
影响因子：
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通讯作者：
Klein,RS
中科院分区：
文献类型：
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作者：
Alcabes,P;Schoenbaum,EE;Klein,RS
目的：探讨纽约布朗克斯区参加美沙酮计划的静脉注射吸毒者(IVDU)外周血中CD4+T淋巴细胞缺失率与艾滋病发病风险的关系。设计：对190例HIV抗体阳性受试者在确诊前每隔约6个月记录一次外周血中CD4+T淋巴细胞的百分率(CD4%)。方法：采用嵌套式病例对照研究，将所有患艾滋病的受试者与未患艾滋病的受试者进行比较。结果：使用单一基线的CD4%测量来调整CD4+淋巴细胞计数的分析表明，低下降率(每学期1~5CD4%)和高下降率(≥5CD4%/学期)可能与艾滋病风险有关：相对危险度分别为1.83和1.44，尽管95%可信区间(CI)分别为1.0。调整目前的CD4%水平消除了CD4%低下降率与艾滋病风险之间的关联，但不消除高下降率与艾滋病风险之间的关联(调整后的相对风险为1.80；95%可信区间为0.57-5.70)。系列观察显示，在控制已达到的CD4%水平后，每学期CD4%≥5的下降率是艾滋病风险的显著预测因素(调整后的相对风险为3.5 8；95%可信区间为1.0 7~11.95)。结论：静脉注射吸毒者发生艾滋病的CD4细胞损失率高于无艾滋病者。与CD4+淋巴细胞水平相比，在HIV感染的IVDU中，较低的CD4+淋巴细胞耗尽率并不是立即发生艾滋病的重要预测指标，但较高的CD4+衰减率可以是一个重要的预测指标。
Objective: To examine the relationship between rate of loss of CD4+ T lymphocytes and risk of AIDS in HIV-infected intravenous drug users (IVDU) enrolled in a methadone program in the Bronx, New York.Design: Serial CD4 percentages (CD4%) among lymphocytes before AIDS diagnosis were recorded at approximately 6-month intervals for 190 HIV-antibody-positive subjects.Methods: A nested case-control study was performed, in which all subjects who developed AIDS were compared with those who remained AIDS-free. The relationship between CD4% decline and AIDS risk was evaluated using proportional-hazards regression.Results: Analyses that used a single baseline CD4% measurement to adjust for CD4+ lymphocyte count suggested that both low (1–5 CD4% per semester) and high (≥ 5 CD4% per semester) rates of decline might be related to AIDS risk: relative risks were 1.83 and 1.44, although the 95% confidence intervals (CI) included 1.0 in each case. Adjustment for current level of CD4% eliminated the association between low rates of CD4% decline and AIDS risk, but not that between high rates of decline and AIDS risk (adjusted relative risk, 1.80; 95% CI, 0.57–5.70). Serial observations showed that a rate of decline of CD4%≥ 5 per semester was a significant predictor of AIDS risk after controlling for level of CD4% achieved (adjusted relative risk, 3.58; 95% CI, 1.07–11.95).Conclusions: IVDU who develop AIDS have a greater rate of CD4 cell loss than subjects who remain AIDS-free. A low rate of CD4+ lymphocyte depletion is not an important predictor of the immediate onset of AIDS in HIV-infected IVDU, compared with CD4+ lymphocyte level, but a high rate of CD4+ decline can be.