Yarchoan R, Venzon D J, Pluda J M, Lietzau J, Wyvill K M, Tsiatis A A, Steinberg S M, Broder S
National Cancer Institute, Bethesda, Maryland.
Ann Intern Med. 1991 Aug 1;115(3):184-9. doi: 10.7326/0003-4819-115-3-184.
To investigate the relation between CD4 count and the immediate hazard of dying in patients receiving zidovudine (azidothymidine [AZT])-based antiretroviral therapy.
A research hospital that recruits patients from the entire United States.
Retrospective analysis of a cohort of patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex participating in long-term zidovudine-based antiretroviral protocols.
Fifty-five patients with human immunodeficiency virus (HIV) infection and either AIDS or severe AIDS-related complex who were followed for as many as 4 years while they received antiretroviral therapy.
CD4 counts were measured.
Ten patients are known to be alive and 1 was lost to follow-up. Of the 44 patients who are known to have died, the CD4 range was known within 6 months of death in 41. All but 1 of these 41 assessable deaths occurred in patients whose CD4 counts were known to have fallen below 50 CD4 cells/mm3 (P less than 10(-10)). The hazard of dying in the cohort ranged from 0 deaths/patient-month (95% CI, 0 to 0.008 deaths/patient-month) in patients with 200 or more CD4 cells/mm3 to 0.07 deaths/patient-month (CI, 0.050 to 0.094 deaths/patient-month) in patients with fewer than 50 CD4 cells/mm3. For the patients who died and whose cases were assessable, the mean of the last three CD4 counts obtained before death was 7.7 CD4 cells/mm3 (CI, 0.9 to 63.3 cells/mm3). The median survival of patients once their CD4 counts fell below 50 CD4 cells/mm3 was 12.1 months (CI, 7.2 to 19.4 months).
In a carefully followed cohort treated with zidovudine-based antiretroviral therapy, nearly all deaths occurred in patients with fewer than 50 CD4 cells/mm3. These findings may have implications in the monitoring of patients with AIDS and in the use of CD4 count as a clinical trials end point for the antiretroviral therapy of HIV infection.
探讨接受以齐多夫定（叠氮胸苷[AZT]）为基础的抗逆转录病毒治疗的患者的CD4细胞计数与近期死亡风险之间的关系。
一家从美国全境招募患者的研究医院。
对一组参与长期以齐多夫定为基础的抗逆转录病毒方案的获得性免疫缺陷综合征（AIDS）或AIDS相关综合征患者进行回顾性分析。
55例人类免疫缺陷病毒（HIV）感染患者，患有AIDS或严重AIDS相关综合征，在接受抗逆转录病毒治疗期间接受了长达4年的随访。
测量CD4细胞计数。
已知10例患者存活，1例失访。在已知死亡的44例患者中，41例在死亡前6个月内有CD4细胞计数范围数据。这41例可评估死亡患者中，除1例之外，均发生在已知CD4细胞计数降至50个/mm³以下的患者中（P<10⁻¹⁰）。该队列中的死亡风险范围为：CD4细胞计数为200个/mm³或更多的患者为0例死亡/患者月（95%CI，0至0.008例死亡/患者月），而CD4细胞计数少于50个/mm³的患者为0.07例死亡/患者月（CI，0.050至0.094例死亡/患者月）。对于死亡且病例可评估的患者，死亡前最后三次获得的CD4细胞计数的平均值为7.7个/mm³（CI，0.9至63.3个/mm³）。CD4细胞计数降至50个/mm³以下的患者的中位生存期为12.1个月（CI，7.2至19.4个月）。
在接受以齐多夫定为基础的抗逆转录病毒治疗且经过仔细随访的队列中，几乎所有死亡均发生在CD4细胞计数少于50个/mm³的患者中。这些发现可能对AIDS患者监测以及将CD4细胞计数用作HIV感染抗逆转录病毒治疗临床试验终点具有启示意义。
