Levine Alexandra M, Karim Roksana, Mack Wendy, Gravink D Jay, Anastos Katherine, Young Mary, Cohen Mardge, Newman Meg, Augenbraun Michael, Gange Stephen, Watts D Heather
Department of Medicine, Division of Hematology, University of Southern California, Los Angeles, CA 90033, USA.
Arch Intern Med. 2006 Feb 27;166(4):405-10. doi: 10.1001/archinte.166.4.405.
Neutropenia is well described in individuals infected with human immunodeficiency virus (HIV) and occurs in approximately 10% to 50% of cases. Neither the effect of highly active antiretroviral therapy (HAART) on neutrophil counts nor the significance of neutropenia in terms of survival has previously been evaluated.
The prevalence of neutropenia among 1729 HIV-infected women, followed up as part of the Women's Interagency HIV Study, was evaluated. The CD4 lymphocyte counts, HIV-1 RNA levels, and complete blood cell counts, including absolute neutrophil counts, were obtained at 6-month intervals.
Neutropenia was common among HIV-infected women; at baseline, 44% had neutrophil counts less than 2000/microL, whereas 7% had counts less than 1000/microL. During 7.5 years of follow-up, neutrophil counts less than 2000/microL occurred on at least 1 occasion in 79%, whereas absolute neutrophil counts less than 1000/microL were documented in 31%. Worsening HIV disease parameters, such as lower CD4 cell counts (P<.001) and higher HIV-1 RNA levels (P<.001), were associated with development of neutropenia. Resolution of neutropenia was associated with higher CD4 cell counts (P<.001) and use of HAART (P=.007). We found that HAART, without zidovudine, was associated with protection against development of neutropenia. On multivariate analysis, neutropenia was not found to be associated with decreased survival among HIV-infected women.
Worsening HIV disease parameters are associated with neutropenia in HIV-infected women. Treatment with HAART, without zidovudine in the regimen, protects against development of neutropenia, whereas HAART use and higher CD4 cell counts are associated with resolution of neutropenia. Neutropenia is not associated with decreased survival in HIV-infected women.
中性粒细胞减少症在感染人类免疫缺陷病毒（HIV）的个体中已有充分描述，约10%至50%的病例会出现该症状。此前尚未评估高效抗逆转录病毒疗法（HAART）对中性粒细胞计数的影响，也未评估中性粒细胞减少症对生存的意义。
对作为女性机构间HIV研究一部分进行随访的1729名感染HIV的女性中性粒细胞减少症的患病率进行评估。每6个月获取一次CD4淋巴细胞计数、HIV-1 RNA水平以及全血细胞计数，包括绝对中性粒细胞计数。
中性粒细胞减少症在感染HIV的女性中很常见；基线时，44%的女性中性粒细胞计数低于2000/微升，而7%的女性计数低于1000/微升。在7.5年的随访期间，79%的女性至少有一次中性粒细胞计数低于2000/微升，而31%的女性记录到绝对中性粒细胞计数低于1000/微升。HIV疾病参数恶化，如较低的CD4细胞计数（P<0.001）和较高的HIV-1 RNA水平（P<0.001），与中性粒细胞减少症的发生有关。中性粒细胞减少症的缓解与较高的CD4细胞计数（P<0.001）和使用HAART（P=0.007）有关。我们发现，不含齐多夫定的HAART与预防中性粒细胞减少症的发生有关。多因素分析显示，中性粒细胞减少症与感染HIV的女性生存率降低无关。
HIV疾病参数恶化与感染HIV的女性中性粒细胞减少症有关。不含齐多夫定的HAART治疗可预防中性粒细胞减少症的发生，而使用HAART和较高的CD4细胞计数与中性粒细胞减少症的缓解有关。中性粒细胞减少症与感染HIV的女性生存率降低无关。
