目标:晚期人类免疫缺陷病毒(HIV)感染,尽管通过高效抗逆转录病毒疗法(HAART)持续抑制病毒,是免疫恢复不良的危险因素。然而,一些晚期感染患者确实表现出免疫恢复。在这项研究中,在表现出持续病毒抑制的晚期HIV患者中分析了免疫学恢复的预测因素.
方法:在HIV-1RNA<50拷贝/mL的HIV感染成年患者中进行了病例对照研究,并维持了4年或更长时间并正在接受HAART。晚期HIV感染定义为基线CD4T细胞计数<200/mm(3)。免疫应答者定义为显示免疫恢复的患者(使用HAART治疗4年时CD4T细胞计数≥500/mm(3))。为了分析CD4T细胞动力学,使用CD4T细胞计数与自HAART开始后的时间之间的线性回归估计每位患者的CD4斜率(CD4T细胞计数的每月变化).
结果:在102名符合条件的患者中,73人患有晚期艾滋病毒,33例(45.2%)显示免疫恢复。73例晚期患者在HAART的0至6个月和0至12个月期间的中位CD4斜率(细胞/mm(3)/月)显着高于无反应者(0至6个月,38.6vs.22.8;0至12个月,24.5vs.13.5).多因素分析显示HAART开始时的机会性感染(调整后的比值比[OR],0.28),在HAART的0至12个月期间CD4斜率≥20(调整后的OR,10.10)与免疫学恢复独立相关。
结论:CD4斜率可作为晚期HIV患者长期免疫恢复的早期预测指标。
OBJECTIVE: Advanced human immunodeficiency virus (HIV) infection, despite sustained viral suppression by highly active antiretroviral therapy (HAART), is a risk factor for poor immunologic recovery. However, some patients with advanced infection do show immunologic recovery. In this study, predictive factors of immunologic recovery were analyzed in advanced HIV patients showing sustained viral suppression.
METHODS: A
case-control study was conducted in HIV-infected adult patients with HIV-1 RNA < 50 copies/mL maintained for 4 years or longer and who were receiving HAART. Advanced HIV infection was defined as a baseline CD4 T cell count < 200/mm(3). Immunologic responders were defined as patients showing immunologic recovery (CD4 T cell counts ≥ 500/mm(3) at 4 years with HAART). To analyze the CD4 T cell kinetics, the CD4 slope (monthly changes in the CD4 T cell count) was estimated for each patient using a linear regression between the CD4 T cell count and the time since HAART initiation.
RESULTS: Of 102 eligible patients, 73 had advanced HIV, and 33 (45.2%) showed immunologic recovery. The median CD4 slopes (cells/mm(3) per month) during 0 to 6 and 0 to 12 months of HAART in the 73 advanced patients were significantly higher in responders than in non-responders (0 to 6 months, 38.6 vs. 22.8; 0 to 12 months, 24.5 vs. 13.5). Multivariate analyses showed opportunistic infections at the start of HAART (adjusted odds ratio [OR], 0.28) and a CD4 slope ≥ 20 during 0 to 12 months of HAART (adjusted OR, 10.10) were independently associated with immunologic recovery.
CONCLUSIONS: The CD4 slope can be an early predictor of long-term immunologic recovery in advanced HIV patients.