MacArthur Rodger D, Perez George, Walmsley Sharon, Baxter John D, Mullin Christopher M, Neaton James D
Wayne State University, University Health Center, Detroit, Michigan 48201, USA.
HIV Clin Trials. 2005 May-Jun;6(3):127-35. doi: 10.1310/A9B9-RQD7-U8KA-503U.
The comparative prognostic importance of latest plasma HIV RNA levels (viral loads) and CD4+ cell counts among patients prescribed highly active antiretroviral therapy (HAART) has not been well characterized.
We assessed the prognostic value of latest CD4+ cell counts and latest viral loads for progression to AIDS or death and explored their interaction among 432 HIV-infected persons with advanced HIV who were prescribed a protease inhibitor (PI) as their first HAART regimen.
Pre-HAART median CD4+ cell count and viral load were 41 cells/mm3 and 126,331 copies/mL, respectively. After 12 months of HAART, the median CD4+ cell count was 154 cells/mm3; 39% of patients had a viral load of 400 copies/mL or lower. Over a median follow-up of 33 months, 109 (25%) of the 432 patients experienced an AIDS event or died. The hazard ratio for AIDS or death for those with latest CD4+ cell count <50 cells/mm3 versus > or =200 cells/mm3 was 13.9 (95% CI 6.5 to 29.7) without adjustment for latest viral load measurements and 9.5 (95% CI 4.0 to 22.5) after adjustment for latest viral load. In contrast, the hazard ratio for AIDS or death for those with viral load > or =100,000 versus <400 copies/mL was 4.2 (95% CI 2.3 to 7.7) without adjustment for latest CD4+ level and 1.2 (95% CI 0.6 to 2.4) with adjustment for latest CD4+ cell count.
We conclude that when latest CD4+ cell count and viral load are considered separately, both are significantly related to AIDS or death; when these markers are jointly considered, the association of viral load with AIDS or death is substantially diminished. Latest CD4+ levels are more strongly related to AIDS or death than latest viral load levels in patients on HAART.
在接受高效抗逆转录病毒治疗（HAART）的患者中，最新血浆HIV RNA水平（病毒载量）和CD4 +细胞计数的比较预后重要性尚未得到充分描述。
我们评估了最新CD4 +细胞计数和最新病毒载量对进展为艾滋病或死亡的预后价值，并在432例接受蛋白酶抑制剂（PI）作为首个HAART方案的晚期HIV感染者中探讨了它们之间的相互作用。
HAART治疗前CD4 +细胞计数中位数和病毒载量分别为41个细胞/mm³和126,331拷贝/mL。HAART治疗12个月后，CD4 +细胞计数中位数为154个细胞/mm³；39%的患者病毒载量为400拷贝/mL或更低。在中位随访33个月期间，432例患者中有109例（25%）发生艾滋病事件或死亡。最新CD4 +细胞计数<50个细胞/mm³与≥200个细胞/mm³的患者发生艾滋病或死亡的风险比在未调整最新病毒载量测量时为13.9（95%CI 6.5至29.7），调整最新病毒载量后为9.5（95%CI 4.0至22.5）。相比之下，病毒载量≥100,000与<400拷贝/mL的患者发生艾滋病或死亡的风险比在未调整最新CD4 +水平时为4.2（95%CI 2.3至7.7），调整最新CD4 +细胞计数后为1.2（95%CI 0.6至2.4）。
我们得出结论，当分别考虑最新CD4 +细胞计数和病毒载量时，两者均与艾滋病或死亡显著相关；当联合考虑这些指标时，病毒载量与艾滋病或死亡的关联大幅减弱。在接受HAART治疗的患者中，最新CD4 +水平与艾滋病或死亡的相关性比最新病毒载量水平更强。
