Moore David M, Awor Anna, Downing Robert, Kaplan Jonathan, Montaner Julio S G, Hancock John, Were Willy, Mermin Jonathan
Global AIDS Program, US Centers for Disease Control and Prevention, Entebbe, Uganda.
J Acquir Immune Defic Syndr. 2008 Dec 15;49(5):477-84. doi: 10.1097/QAI.0b013e318186eb18.
CD4 T-lymphocyte (CD4) counts are widely used to monitor response to antiretroviral therapy (ART) in resource-limited settings. However, the utility of such monitoring in terms of predicting virologic response to therapy has been little studied.
We studied participants aged 18 years and older who initiated ART in Tororo, Uganda. CD4 counts, CD4 percentages, and viral load (VL) were examined at 6-monthly intervals. Various definitions of immunologic failure were examined to identify individuals with VLs>or=50, >or=500, >or=1000, or >or=5000 copies per milliliter at 6, 12, and 18 months after treatment initiation.
One thousand sixty-three ART-naive persons initiated ART. The proportion of individuals with virologic failure ranged between 1.5% and 16.4% for each time point. The proportion with no increase in CD4 count from baseline did not differ between those with suppressed or unsuppressed VLs at 6, 18, and 24 months after ART initiation. No increase in CD4 cell counts at 6 months had a sensitivity of 0.04 [95% confidence interval (CI) 0.00 to 0.10] and a positive predictive value of 0.03 (95% CI 0.00 to 0.09) for identifying individuals with VL>or=500 copies per milliliter at 6 months. The best measure identified was an absolute CD4 cell count<125 cells per microliter at 21 months for predicting VL>or=500 copies per milliliter at 18 months which had a sensitivity of 0.13 (95% CI 0.01 to 0.21) and a positive predictive value of 0.29 (95% CI 0.10 to 0.44).
CD4 cell count monitoring does not accurately identify individuals with virologic failure among patients taking ART.
在资源有限的环境中，CD4 T淋巴细胞（CD4）计数被广泛用于监测抗逆转录病毒疗法（ART）的疗效。然而，这种监测在预测治疗的病毒学反应方面的效用鲜有研究。
我们研究了在乌干达托罗罗开始接受ART治疗的18岁及以上参与者。每6个月检测一次CD4计数、CD4百分比和病毒载量（VL）。研究了各种免疫失败的定义，以确定在开始治疗后6、12和18个月时病毒载量≥50、≥500、≥1000或≥5000拷贝/毫升的个体。
1063名未接受过ART治疗的人开始接受ART治疗。每个时间点病毒学失败个体的比例在1.5%至16.4%之间。在开始ART治疗后6、18和24个月，病毒载量被抑制或未被抑制的个体中，CD4计数未从基线增加的比例没有差异。在开始治疗6个月时，CD4细胞计数未增加对识别6个月时病毒载量≥500拷贝/毫升个体的敏感性为0.04[95%置信区间（CI）0.00至0.10]，阳性预测值为0.03（95%CI 0.00至0.09）。确定的最佳指标是在21个月时绝对CD4细胞计数<125个/微升，用于预测18个月时病毒载量≥500拷贝/毫升，其敏感性为0.13（95%CI 0.01至0.21），阳性预测值为0.29（95%CI 0.10至0.44）。
在接受ART治疗的患者中，CD4细胞计数监测不能准确识别病毒学失败的个体。
