Guiguet Marguerite, Porter Kholoud, Phillips Andrew, Costagliola Dominique, Babiker Abdel
INSERM U720, Paris, France.
Open AIDS J. 2008;2:3-9. doi: 10.2174/1874613600802010003. Epub 2008 Feb 12.
Rates of AIDS defining event (ADE), serious ADE and death by CD4 and HIV RNA categories before and after combination antiretroviral therapy (cART) initiation are lacking for high CD4 counts.
Event rates were estimated within CD4 cell strata using a Poisson regression model adjusting for sex, exposure category, age, and current HIV RNA (<4, 4-4.99, > or =5 log copies/ml), and including an interaction term between the CD4 cell count and cART indicator.
7317 and 6376 persons contributed to "naïve " and "cART " groups respectively, of whom 3911 contributed to both. At the same CD4 level, the risk of ADE was nearly 2 fold higher during naive follow-up compared to cART for CD4 <500 cells/mm(3). However, after adjustment for current HIV RNA, the risk of ADE became similar for both groups except for CD4 count <200 cells/mm(3) when it is 35% (6-72%) higher for naives. The same results were observed for the risk of serious ADE. There was no evidence of a difference in risk of death between naive and cART follow-up at specific CD4 categories even after adjustment for HIV RNA.
Within CD4 cell strata above 200 cells/mm(3), the risk of ADE before ART initiation is higher than it is following cART initiation.
对于高CD4计数患者，在开始联合抗逆转录病毒治疗（cART）之前和之后，缺乏按CD4和HIV RNA类别划分的艾滋病定义事件（ADE）、严重ADE及死亡发生率。
使用泊松回归模型在CD4细胞分层内估计事件发生率，该模型对性别、暴露类别、年龄和当前HIV RNA（<4、4 - 4.99、≥5 log拷贝/ml）进行了调整，并纳入了CD4细胞计数与cART指标之间的交互项。
分别有7317人和6376人纳入“初治”组和“cART”组，其中3911人同时纳入两组。在相同的CD4水平下，对于CD4<500细胞/mm³的患者，初治随访期间ADE的风险比cART期间高出近2倍。然而，在对当前HIV RNA进行调整后，除了CD4计数<200细胞/mm³时初治组高出35%（6 - 72%）外，两组ADE的风险变得相似。严重ADE的风险也观察到相同结果。即使在对HIV RNA进行调整后，在特定CD4类别中，初治随访和cART随访之间的死亡风险也没有差异的证据。
在CD4细胞计数高于200细胞/mm³的分层中，ART启动前ADE的风险高于启动cART后。
