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一组墨西哥HIV感染患者中,口腔念珠菌病和毛状白斑发病前CD4 +淋巴细胞与病毒载量的同步动力学。

Synchronous kinetics of CD4+ lymphocytes and viral load before the onset of oral candidosis and hairy leukoplakia in a cohort of Mexican HIV-infected patients.

作者信息

Ramírez-Amador Velia, Ponce-De-León Sergio, Sierra-Madero Juan, Soto-Ramírez Luis, Esquivel-Pedraza Lilly, Anaya-Saavedra Gabriela

机构信息

Universidad Autónoma Metropolitana-Xochimilco, México D.F.

出版信息

AIDS Res Hum Retroviruses. 2005 Dec;21(12):981-90. doi: 10.1089/aid.2005.21.981.

Abstract

An observational, prospective, longitudinal cohort study was performed at the AIDS Clinic of a tertiary care institution in Mexico City to determine the association of viral load (VL) and CD4+ lymphocyte kinetics with the development of oral candidosis (OC) and hairy leukoplakia (HL). Participants were HIV-infected adult subjects, without a history of or current OC or HL, not receiving HAART. Oral examinations were performed at baseline and every month for evidence of OC or HL; CD4+ and VL determinations were done at baseline, at 6-month intervals, when oral lesions were detected, and 2 months later. Affected subjects (OL group) by OC or HL had clinical intervals defined before (antecedent), during (concurrent), and after their development. In the nonaffected individuals (NA group), 6-month intervals were determined. Differences (changes) along the clinical and study intervals were calculated for CD4+ and VL. The median study time was 178 (range: 31-924) days; 99 patients were included. The 2-year cumulative incidence of either oral lesion was 54% (49.5% for OC and 33.2% for HL). In the OL group (31 patients) a progressive and continuous decrease of CD4+ was found in the antecedent interval followed by a significant increase in VL in the concurrent period. The NA group showed a significant fall in CD4+ by semester 3, without a significant rise of VL in the following semester. The effect of CD4+ remained significant in a multivariate analysis. This study has shown that the onset of OC and/or HL is heralded by the sequence of a sustained reduction of CD4+, followed by a sharp increase of VL. In the multivariate analysis, the decrease in CD4+ lymphocytes appeared to be the predominant factor predicting the appearance of these oral lesions. Their potential use as markers of a recent change in the immunologic and virologic status of HIV-infected individuals is emphasized.

摘要

在墨西哥城一家三级医疗机构的艾滋病诊所开展了一项观察性、前瞻性、纵向队列研究,以确定病毒载量(VL)和CD4+淋巴细胞动力学与口腔念珠菌病(OC)和毛状白斑(HL)发生之间的关联。研究对象为感染HIV的成年受试者,无OC或HL病史及现患情况,未接受高效抗逆转录病毒治疗(HAART)。在基线期及之后每月进行口腔检查,以寻找OC或HL的证据;在基线期、每间隔6个月、发现口腔病变时以及2个月后测定CD4+和VL。受OC或HL影响的受试者(OL组)在病变出现前(前驱期)、出现期间(并发期)和出现后有临床分期。在未受影响的个体(NA组)中,确定6个月的间隔期。计算CD4+和VL在临床和研究期间的差异(变化)。研究中位时间为178天(范围:31 - 924天);纳入99例患者。两种口腔病变的2年累积发病率为54%(OC为49.5%,HL为33.2%)。在OL组(31例患者)中,前驱期CD4+呈进行性持续下降,随后并发期VL显著升高。NA组在第3学期时CD4+显著下降,随后学期VL无显著升高。在多变量分析中,CD4+的影响仍然显著。本研究表明,OC和/或HL的发病先有CD4+持续降低,随后VL急剧升高。在多变量分析中,CD4+淋巴细胞减少似乎是预测这些口腔病变出现的主要因素。强调了它们作为HIV感染个体免疫和病毒学状态近期变化标志物的潜在用途。

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