Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
AIDS. 2010 Aug 24;24(13):2117-21. doi: 10.1097/QAD.0b013e32833b784a.
To evaluate the relationship between early CD4(+) lymphocyte recovery on antiretroviral therapy (ART) and subsequent survival among low body mass index (BMI) HIV-1-infected adults.
Retrospective analysis of a large programmatic cohort in Lusaka, Zambia.
We evaluated ART-treated adults enrolled in care for more than 6 months. We stratified this study population according to World Health Organization (WHO) malnutrition criteria: normal (BMI >or=18.5 kg/m(2)), mild (17.00-18.49), moderate (16.00-16.99), and severe (<16.0). We used Cox proportional hazards regression to estimate the subsequent risk of death associated with absolute CD4(+) cell count change over the first 6 months on ART. To account for effect modification associated with baseline CD4(+) cell count, a weighted summary measure was calculated.
From May 2004 to February 2009, 56,612 patients initiated ART at Lusaka district clinics; of these, 33 097 (58%) were included in this analysis. The median change in 0-6 month CD4(+) cell count in each baseline BMI strata varied from 127 to 131 cells/microl. There was a statistically significant, inverse association between baseline BMI and the post 6-month hazard for mortality only among those patients with less than 100 cells/microl increase in the first 6 months of ART. A CD4(+) cell count increase of at least 100 cells/microl over the first 6 months of ART was not associated with a higher hazard for mortality, regardless of baseline BMI.
Low baseline BMI and attenuated CD4(+) cell count response at 6 months had a compounding, negative impact on post 6-month survival. Specific guidelines for monitoring ART response using immunologic criteria may be warranted for low BMI patients.
评估抗逆转录病毒治疗(ART)早期 CD4(+)淋巴细胞恢复与低体重指数(BMI)HIV-1 感染成人后续生存之间的关系。
赞比亚卢萨卡一个大型规划队列的回顾性分析。
我们评估了接受治疗并接受护理超过 6 个月的成年 ART 患者。我们根据世界卫生组织(WHO)营养不良标准对该研究人群进行分层:正常(BMI≥18.5kg/m2)、轻度(17.00-18.49)、中度(16.00-16.99)和重度(<16.0)。我们使用 Cox 比例风险回归来估计 ART 治疗最初 6 个月内绝对 CD4(+)细胞计数变化与随后死亡风险之间的关系。为了说明与基线 CD4(+)细胞计数相关的效应修饰,计算了加权综合指标。
2004 年 5 月至 2009 年 2 月,卢萨卡区诊所开始接受 56612 名患者进行 ART;其中 33097 名(58%)纳入本分析。每个基线 BMI 分层中 0-6 个月 CD4(+)细胞计数的中位数变化范围从 127 到 131 个细胞/μl。仅在基线 CD4(+)细胞计数<100 个细胞/μl 的患者中,基线 BMI 与 ART 治疗最初 6 个月后死亡的 6 个月后危险之间存在显著的反比关系。在 ART 治疗最初 6 个月内 CD4(+)细胞计数至少增加 100 个细胞/μl 与更高的死亡率无关,而与基线 BMI 无关。
低基线 BMI 和 6 个月时 CD4(+)细胞计数反应减弱对 6 个月后生存有复合负面影响。可能需要为低 BMI 患者制定使用免疫学标准监测 ART 反应的具体指南。