Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
HIV Med. 2009 Nov;10(10):657-60. doi: 10.1111/j.1468-1293.2009.00739.x. Epub 2009 Jul 9.
The clinical implications of a failure to achieve high CD4 cell counts while receiving virally suppressive highly active antiretroviral therapy (HAART) are uncertain.
We analysed data from HIV-infected men participating in the Multicenter AIDS Cohort Study (MACS) to elucidate associations between CD4 cell counts achieved during virally suppressive HAART and risks of AIDS or death. Inclusion criteria were: CD4 cell count <200 cells/microL before HAART initiation; >or=2 viral load (VL) determinations after HAART initiation; and sustained viral suppression, defined as all VL <50 HIV-1 RNA copies/mL, but allowing a single VL of 50-1000 copies/mL.
One hundred and twenty-one men were included; median age was 42 years. After first VL <50 copies/mL, six participants had a new AIDS diagnosis and seven died. The median CD4 cell count change/year (cells/microL) after first VL <50 copies/mL was zero among patients who either developed AIDS or died vs. 39 among those who did not meet either endpoint (P=0.119). After controlling for time from HAART initiation to first VL <50 copies/mL, age at first VL <50 copies/mL, history of AIDS and antiretroviral therapy (ART) experience before HAART, the hazard ratio for AIDS or death at CD4 cell count of <or=200 vs. >350 cells/microL was 10.7 (P=0.013), and at CD4 cell count of 201-350 vs. >350 cells/microL was 8.54 (P=0.014).
In this cohort, lower CD4 cell count at the time of viral suppression was associated with increased risk of AIDS or death.
在接受病毒抑制性高效抗逆转录病毒治疗（HAART）时未能达到高 CD4 细胞计数的临床意义尚不确定。
我们分析了参与多中心艾滋病队列研究（MACS）的 HIV 感染者的数据，以阐明在病毒抑制性 HAART 期间达到的 CD4 细胞计数与艾滋病或死亡风险之间的关联。纳入标准为：HAART 起始前 CD4 细胞计数<200 个/μL；HAART 起始后有>或=2 次病毒载量（VL）测定；并持续病毒抑制，定义为所有 VL <50 HIV-1 RNA 拷贝/ml，但允许单次 VL 为 50-1000 拷贝/ml。
共纳入 121 名男性；中位年龄为 42 岁。首次 VL <50 拷贝/ml 后，6 名参与者新诊断为艾滋病，7 名参与者死亡。首次 VL <50 拷贝/ml 后，中位 CD4 细胞计数变化/年（个/μL）在发生 AIDS 或死亡的患者中为零，而在未达到任何终点的患者中为 39 个（P=0.119）。在控制 HAART 起始至首次 VL <50 拷贝/ml 的时间、首次 VL <50 拷贝/ml 时的年龄、艾滋病史和 HAART 治疗（ART）前史后，CD4 细胞计数<200 与>350 个/μL 相比，发生 AIDS 或死亡的风险比为 10.7（P=0.013），CD4 细胞计数 201-350 与>350 个/μL 相比，风险比为 8.54（P=0.014）。
在本队列中，病毒抑制时较低的 CD4 细胞计数与 AIDS 或死亡风险增加相关。
