Hogg R S, Yip B, Chan K J, Wood E, Craib K J, O'Shaughnessy M V, Montaner J S
Director, AIDS Research Programme, St Paul's Hospital/University of British Columbia, 667-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada.
JAMA. 2001 Nov 28;286(20):2568-77. doi: 10.1001/jama.286.20.2568.
Current recommendations for initiation of antiretroviral therapy in patients infected with human immunodeficiency virus type 1 (HIV) are based on CD4 T-lymphocyte cell counts and plasma HIV RNA levels. The relative prognostic value of each marker following initiation of therapy has not been fully characterized.
To describe rates of disease progression to death and AIDS or death among patients starting triple-drug antiretroviral therapy, stratified by baseline CD4 cell count and HIV RNA levels.
DESIGN, SETTING, AND PARTICIPANTS: Population-based analysis of 1219 antiretroviral therapy-naive HIV-positive men and women aged 18 years or older in British Columbia who initiated triple-drug therapy between August 1, 1996, and September 30, 1999.
Cumulative mortality rates from the initiation of triple-drug antiretroviral therapy to September 30, 2000, determined using various CD4 cell and plasma HIV RNA thresholds.
As of September 30, 2000, 82 patients had died of AIDS-related causes, for a crude AIDS-related mortality rate of 6.7%. The product limit estimate (SE) of the cumulative mortality rate at 12 months was 2.9% (0.5%). In univariate analyses, a prior diagnosis of acquired immunodeficiency syndrome (AIDS), CD4 cell count, use of protease inhibitors, and HIV RNA level were associated with mortality. There was no difference in mortality by age or sex. Only CD4 cell count remained statistically significant in the multivariate analysis. After controlling for AIDS, protease inhibitor use, and plasma HIV RNA level at baseline, patients with CD4 cell counts of less than 50/microL were 6.67 (95% confidence interval [CI], 3.61-12.34) times and those with counts of 50/microL to 199/microL were 3.41 (95% CI, 1.93-6.03) times more likely to die than those with counts of at least 200/microL.
Our data demonstrate uniformly low rates of disease progression to death and AIDS or death among patients starting antiretroviral therapy with CD4 cell counts of at least 200/microL. In our study, disease progression to death and AIDS or death was clustered among patients starting therapy with CD4 cell counts less than 200/microL.
目前针对感染1型人类免疫缺陷病毒（HIV）患者启动抗逆转录病毒治疗的建议是基于CD4 T淋巴细胞计数和血浆HIV RNA水平。治疗开始后每个标志物的相对预后价值尚未完全明确。
描述开始三联抗逆转录病毒治疗的患者中疾病进展至死亡、患艾滋病或死亡的发生率，并按基线CD4细胞计数和HIV RNA水平进行分层。
设计、地点和参与者：对1996年8月1日至1999年9月30日期间在不列颠哥伦比亚省开始三联药物治疗的1219名未接受过抗逆转录病毒治疗、年龄在18岁及以上的HIV阳性男性和女性进行基于人群的分析。
使用各种CD4细胞和血浆HIV RNA阈值确定从开始三联抗逆转录病毒治疗至2000年9月30日的累积死亡率。
截至2000年9月30日，82例患者死于艾滋病相关原因，艾滋病相关粗死亡率为6.7%。12个月时累积死亡率的乘积限估计值（SE）为2.9%（0.5%）。在单变量分析中，既往获得性免疫缺陷综合征（AIDS）诊断、CD4细胞计数、蛋白酶抑制剂的使用和HIV RNA水平与死亡率相关。年龄和性别对死亡率无差异。在多变量分析中，只有CD4细胞计数仍具有统计学意义。在控制了艾滋病、蛋白酶抑制剂的使用和基线血浆HIV RNA水平后，CD4细胞计数低于50/μL的患者死亡可能性是CD4细胞计数至少为200/μL患者的6.67倍（95%置信区间[CI]，3.61 - 12.34），CD4细胞计数为50/μL至199/μL的患者死亡可能性是其3.41倍（95%CI，1.93 - 6.03）。
我们的数据表明，开始抗逆转录病毒治疗时CD4细胞计数至少为200/μL的患者中，疾病进展至死亡、患艾滋病或死亡的发生率普遍较低。在我们的研究中，疾病进展至死亡、患艾滋病或死亡集中在开始治疗时CD4细胞计数低于200/μL的患者中。
