Anastos Kathryn, Barrón Yolanda, Cohen Mardge H, Greenblatt Ruth M, Minkoff Howard, Levine Alexandra, Young Mary, Gange Stephen J
Montefiore Medical Center, Bronx, New York, USA.
Ann Intern Med. 2004 Feb 17;140(4):256-64. doi: 10.7326/0003-4819-140-4-200402170-00007.
The prognostic value of CD4+ cell counts and HIV-1 RNA levels attained after the initiation of highly active antiretroviral therapy (HAART) compared with before the initiation of HAART has not been well defined.
To determine the prognostic value for clinical outcomes of CD4+ cell counts and HIV-1 RNA levels attained after initiating therapy.
Prospective cohort study.
Women's Interagency HIV Study.
1132 participants in the Women's Interagency HIV Study.
HIV-1 RNA level, CD+ cell counts, AIDS-defining illness, and death.
In multivariate analyses with a median follow-up of 3.9 years, women with CD4+ cell counts of less than 0.200 x 10(9) cells/L compared with women with CD4+ cell counts of greater than 0.350 x 10(9) cells/L after HAART initiation had a relative hazard of death from all causes of 2.66 (95% CI, 1.42 to 4.99) and a relative hazard of death from AIDS of 47.61 (CI, 5.69 to 398.40). The relative hazard of all-cause death was 3.44 (CI, 1.67 to 7.09) in women with RNA levels of more than 10 000 copies/mL compared with women with attained RNA levels of less than 80 copies/mL. The relative hazard of AIDS-related or all-cause death did not increase for women with post-HAART CD4+ cell counts between 0.200 and 0.350 x 10(9) cells/L compared with women with CD4+ cell counts of greater than 0.350 x 10(9) cells/L. Also, the relative hazard did not increase in women with post-HAART HIV-1 RNA levels between 80 and 10 000 copies/mL compared with women with post-HAART HIV-1 RNA levels of less than 80 copies/mL. Of the laboratory markers, only the post-HAART CD4+ cell count and HIV-1 RNA level were predictive of new AIDS-defining illness.
Post-HAART laboratory markers predicted death and new AIDS-defining illness. Pre-HAART CD4+ cell count and HIV-1 RNA level were not predictive of clinical outcomes if adjusted for values attained after HAART initiation, suggesting that even advanced immune suppression can be overcome with HAART that results in CD4+ cell counts of greater than 0.200 x 10(9) cells/L and RNA levels of less than 10 000 copies/mL.
与高效抗逆转录病毒治疗（HAART）开始前相比，HAART开始后获得的CD4+细胞计数和HIV-1 RNA水平的预后价值尚未明确界定。
确定治疗开始后获得的CD4+细胞计数和HIV-1 RNA水平对临床结局的预后价值。
前瞻性队列研究。
妇女机构间HIV研究。
1132名妇女机构间HIV研究的参与者。
HIV-1 RNA水平、CD4+细胞计数、艾滋病界定疾病和死亡。
在中位随访3.9年的多变量分析中，HAART开始后CD4+细胞计数低于0.200×10⁹个细胞/L的女性与CD4+细胞计数高于0.350×10⁹个细胞/L的女性相比，各种原因导致的死亡相对风险为2.66（95%CI，1.42至4.99），艾滋病导致的死亡相对风险为47.61（CI，5.69至398.40）。RNA水平高于10000拷贝/mL的女性与RNA水平低于80拷贝/mL的女性相比，各种原因导致的死亡相对风险为3.44（CI，1.67至7.09）。与CD4+细胞计数高于0.350×10⁹个细胞/L的女性相比，HAART后CD4+细胞计数在0.200至0.350×10⁹个细胞/L之间女性的艾滋病相关或各种原因导致的死亡相对风险并未增加。同样，与HAART后HIV-1 RNA水平低于80拷贝/mL的女性相比，HAART后HIV-1 RNA水平在80至10000拷贝/mL之间女性的相对风险也未增加。在实验室指标中，只有HAART后的CD4+细胞计数和HIV-1 RNA水平可预测新的艾滋病界定疾病。
HAART后的实验室指标可预测死亡和新的艾滋病界定疾病。如果根据HAART开始后获得的值进行调整，HAART前的CD4+细胞计数和HIV-1 RNA水平不能预测临床结局，这表明即使是晚期免疫抑制也可通过HAART得到克服，使CD4+细胞计数高于0.200×10⁹个细胞/L且RNA水平低于10000拷贝/mL。
