高效抗逆转录病毒疗法的病毒学、免疫学及临床反应：再探性别问题
Virologic, immunologic, and clinical response to highly active antiretroviral therapy: the gender issue revisited.
作者信息
Moore Antonia L, Kirk Ole, Johnson Anne M, Katlama Christine, Blaxhult Anders, Dietrich Manfred, Colebunders Robert, Chiesi Antonio, Lungren Jens D, Phillips Andrew N
机构信息
Department of Primary Care and Population Sciences, Royal free and University College School fo Medicine, Hampstead, London, UK.
出版信息
J Acquir Immune Defic Syndr. 2003 Apr 1;32(4):452-61. doi: 10.1097/00126334-200304010-00017.
BACKGROUND
Highly active antiretroviral therapy (HAART) has dramatically improved the prognosis for patients with HIV. There is ongoing debate over a potential gender effect on patient outcome after HAART.
METHODS
Individuals were from the EuroSIDA cohort, naive to protease inhibitors and nonnucleoside reverse transcriptase inhibitors, and had at least one viral load and CD4 measurement prior to starting HAART. Endpoints were virologic (time to <500 copies/mL, time to rebound [first of two consecutive viral loads >500 copies/mL]), immunologic (time to a 100/mm cell rise in CD4 count) and clinical (time to new AIDS and death). Hazard ratios (HR), derived using Cox regression models, compared female to male rates of achieving endpoints.
RESULTS
Of 2547 patients, 20% (511) were female. Significantly more females than males were nonwhite (24% vs. 10%, p <.001). Males were older (median age 39 vs. 35 years, p <.0001), had lower CD4 counts (211 vs. 240/mm, p =.03), higher viral loads (4.6 vs. 4.4 log copies/mL, p <.0001), were more likely to have a history of AIDS (26% vs. 18%, p <.001) and were more likely to be treatment-naive (34% vs. 29%, p =.03). Adjusted HR for association between gender (comparing females with males) and the outcomes studied were as follows: for reaching <500 copies/mL 0.91 (0.81-1.03, p =.17), rebound 1.17 (0.95-1.44, p =.15), for 100 cell CD4 count rise 1.02 (0.88-1.14, p =.99), for progression to new AIDS 1.12 (0.73-1.71, p =.59) and for time to death 1.15 (0.69-1.92, p =.57).
CONCLUSIONS
We found no significant evidence of a gender difference in virologic, immunologic, or clinical outcomes after starting HAART.
背景
高效抗逆转录病毒疗法（HAART）显著改善了HIV患者的预后。关于HAART后患者预后是否存在潜在性别差异的争论仍在继续。
方法
研究对象来自欧洲SIDA队列，未使用过蛋白酶抑制剂和非核苷类逆转录酶抑制剂，且在开始HAART之前至少有一次病毒载量和CD4细胞计数测量值。观察终点包括病毒学指标（病毒载量降至<500拷贝/毫升的时间、病毒反弹时间[连续两次病毒载量>500拷贝/毫升中的第一次]）、免疫学指标（CD4细胞计数升高100/立方毫米的时间）和临床指标（出现新的艾滋病相关症状和死亡的时间）。使用Cox回归模型得出的风险比（HR），比较了女性和男性达到观察终点的比率。
结果
在2547例患者中，20%（511例）为女性。非白人女性显著多于男性（24%对10%，p<.001）。男性年龄更大（中位年龄39岁对35岁，p<.0001），CD4细胞计数更低（211/立方毫米对240/立方毫米，p =.03），病毒载量更高（4.6对4.4 log拷贝/毫升，p<.0001），更有可能有艾滋病病史（26%对18%，p<.001），且更有可能未接受过治疗（34%对29%，p =.03）。性别（女性与男性比较）与所研究结局之间关联的校正后HR如下：病毒载量降至<500拷贝/毫升为0.91（0.81 - 1.03，p =.17），病毒反弹为1.17（0.95 - 1.44，p =.15），CD4细胞计数升高100为1.02（0.88 - 1.14，p =.99），进展为新的艾滋病相关症状为1.12（0.73 - 1.71，p =.59），死亡时间为1.15（0.69 - 1.92，p =.57）。
结论
我们发现开始HAART后，在病毒学、免疫学或临床结局方面没有显著的性别差异证据。
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