Lau Bryan, Gange Stephen J, Phair John P, Riddler Sharon A, Detels Roger, Margolick Joseph B
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA.
J Acquir Immune Defic Syndr. 2005 Aug 15;39(5):620-5.
Prognostic markers for HIV monitoring are needed for resource-limited regions. Prior research has demonstrated rapid declines in total lymphocyte count (TLC) and hemoglobin levels before AIDS, but the prognostic accuracy of these declines has not been examined prospectively.
Longitudinal TLC and hemoglobin data from men in the Multicenter AIDS Cohort Study (MACS) before the introduction of potent HIV therapy were used to identify the first time when the TLC was <or=1200 cells/mm, TLC declined by >33% per year, and hemoglobin declined by >11.6% per year. The prognostic value of these declines for AIDS was evaluated by Cox regression models and Kaplan-Meier survival curves.
Rapid declines in TLC or hemoglobin were associated with progression to AIDS (relative hazard [RH]=4.70, 95% confidence interval [CI]: 3.23-6.86 for TLC; RH=5.55, 95% CI: 3.69-8.36 for hemoglobin). The World Health Organization criterion for initiating therapy, a TLC<or=1200 cells/mm, was also predictive of progression to AIDS (RH=6.14, 95% CI: 4.33-8.71). Even among those with a TLC>1200 cells/mm, a rapid decline in TLC or hemoglobin was strongly associated with progression to AIDS (RH=2.53, 95% CI: 1.56-4.10 for TLC; RH=5.28, 95% CI: 3.11-8.97 for hemoglobin).
In the MACS, rapid declines in TLC or hemoglobin concentration indicated an increased likelihood of progression of HIV infection to AIDS. These results support the potential utility of these markers for monitoring HIV-infected people in resource-limited regions, but critical levels and rates of decline of markers for such regions remain to be defined.
资源有限地区需要用于HIV监测的预后标志物。先前的研究已证明在艾滋病发生之前总淋巴细胞计数（TLC）和血红蛋白水平会迅速下降，但这些下降的预后准确性尚未进行前瞻性研究。
在强效HIV治疗引入之前，来自多中心艾滋病队列研究（MACS）中男性的纵向TLC和血红蛋白数据被用于确定TLC首次≤1200个细胞/mm³、TLC每年下降超过33%以及血红蛋白每年下降超过11.6%的时间。通过Cox回归模型和Kaplan-Meier生存曲线评估这些下降对艾滋病的预后价值。
TLC或血红蛋白的快速下降与进展至艾滋病相关（相对风险[RH]=4.70，95%置信区间[CI]：TLC为3.23 - 6.86；血红蛋白为RH=5.55，95% CI：3.69 - 8.36）。世界卫生组织启动治疗的标准，即TLC≤1200个细胞/mm³，也可预测进展至艾滋病（RH=6.14，95% CI：4.33 - 8.71）。即使在TLC>1200个细胞/mm³的人群中，TLC或血红蛋白的快速下降也与进展至艾滋病密切相关（TLC的RH=2.53，95% CI：1.56 - 4.10；血红蛋白的RH=5.28，95% CI：3.11 - 8.97）。
在MACS中，TLC或血红蛋白浓度的快速下降表明HIV感染进展至艾滋病的可能性增加。这些结果支持了这些标志物在资源有限地区监测HIV感染者的潜在效用，但此类地区标志物的临界水平和下降率仍有待确定。
