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赞比亚城市中接受抗逆转录病毒疗法的营养不良成年人的早期免疫反应和随后的生存情况。

Early immunologic response and subsequent survival among malnourished adults receiving antiretroviral therapy in Urban Zambia.

机构信息

Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.

出版信息

AIDS. 2010 Aug 24;24(13):2117-21. doi: 10.1097/QAD.0b013e32833b784a.

Abstract

OBJECTIVE

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.

DESIGN

Retrospective analysis of a large programmatic cohort in Lusaka, Zambia.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

目的

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。

设计

赞比亚卢萨卡一个大型规划队列的回顾性分析。

方法

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。

结果

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。

结论

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。

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本文引用的文献

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2
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