Núñez Marina, Asencio Román, Valencia M Eulalia, Leal Manuel, González-Lahoz Juan, Soriano Vincent
Service of Infectious Diseases, Instituto de Salud Carlos III, 28035 Madrid, Spain.
AIDS Res Hum Retroviruses. 2003 May;19(5):363-8. doi: 10.1089/088922203765551719.
Of patients attending HIV clinics, neither the proportion with CD4(+) cell counts below 200 cells/microl, and therefore at risk for developing opportunistic infections (OIs), nor the reasons for the persistence of low CD4(+) cell counts are well known in the era of highly active antiretroviral therapy (HAART). In an effort to gather data concerning this issue, the charts of all outpatients who attended two reference HIV clinics in Spain throughout the year 2001 were retrospectively reviewed. Of 1897 subjects, 213 (11%) had at least one CD4(+) cell count determination below 200 cells/microl during 2001. The main reasons for presenting with low CD4(+) cell counts were as follows: (1) poor treatment adherence, 64 (30%); (2) poor immune recovery despite complete virus suppression for longer than 1 year on HAART, 47 (22%); (3) virologic failure under HAART, 33 (15%); (4) no antiretroviral therapy, 23 (11%); (5) initiation of HAART within the current year in subjects with very low CD4(+) cell counts, 17 (8%); (6) impediment in using HAART due to toxicity, 17 (8%); and (7) drug-induced myelotoxicity, 12 (6%). During the period under review, one or more OIs developed in 52 of the 213 (24%) patients with low CD4(+) cell counts. They occurred more frequently in subjects who were naive for antiretroviral drugs or who initiated therapy recently (RR, 6.45; 95% CI, 2.43-17.12; p < 0.001), and conversely tended to be less frequent among subjects with poor immune reconstitution despite complete virologic suppression while on HAART (RR 0.86; 95% CI, 0.28-2.62; p = 0.79). A lower lifetime CD4(+) cell count nadir was associated with a greater risk of developing an OI (RR, 0.98; 95% CI, 0.97-0.99; p < 0.001). We conclude that, despite the availability of HAART, more than 10% of patients currently attending HIV clinics have CD4(+) cell counts <200 cells/microl, and continue to be at risk for developing OIs. Poor treatment adherence and lack of immune recovery despite complete virus suppression while on HAART account for more than half of cases.
在接受艾滋病病毒治疗的患者中,在高效抗逆转录病毒治疗(HAART)时代,CD4(+)细胞计数低于200个/微升因而有发生机会性感染(OI)风险的患者比例,以及CD4(+)细胞计数持续偏低的原因都尚不明确。为了收集有关此问题的数据,我们对2001年全年在西班牙两家艾滋病病毒参考诊所就诊的所有门诊患者的病历进行了回顾性研究。在1897名受试者中,有213名(11%)在2001年期间至少有一次CD4(+)细胞计数测定低于200个/微升。CD4(+)细胞计数偏低的主要原因如下:(1)治疗依从性差,64例(30%);(2)尽管在HAART治疗下病毒完全抑制超过1年,但免疫恢复不佳,47例(22%);(3)HAART治疗下病毒学失败,33例(15%);(4)未接受抗逆转录病毒治疗,23例(11%);(5)在CD4(+)细胞计数极低的受试者中于当年开始HAART治疗,17例(8%);(6)因毒性而妨碍使用HAART治疗,17例(8%);(7)药物性骨髓毒性,12例(6%)。在研究期间,213例CD4(+)细胞计数偏低的患者中有52例(24%)发生了一种或多种机会性感染。这些感染在未接受过抗逆转录病毒药物治疗或近期开始治疗的受试者中更频繁发生(相对危险度,6.45;95%置信区间,2.43 - 17.12;P < 0.001),相反,在接受HAART治疗时尽管病毒完全抑制但免疫重建不佳的受试者中感染往往较少发生(相对危险度0.86;95%置信区间,0.28 - 2.62;P = 0.79)。较低的终身CD4(+)细胞计数最低点与发生机会性感染的风险增加相关(相对危险度,0.98;95%置信区间,0.97 - 0.99;P < 0.001)。我们得出结论,尽管有HAART治疗,但目前在艾滋病病毒诊所就诊的患者中超过10%的患者CD4(+)细胞计数<200个/微升,并且仍然有发生机会性感染的风险。治疗依从性差以及在接受HAART治疗时尽管病毒完全抑制但缺乏免疫恢复占病例的一半以上。