荷兰1型艾滋病毒感染移民接受联合抗逆转录病毒治疗后的免疫恢复及新的艾滋病界定事件的发生情况

Immune restoration and onset of new AIDS-defining events with combination antiretroviral therapy in HIV type-1-infected immigrants in the Netherlands.

作者信息

Kesselring Anouk M, Gras Luuk, Wit Ferdinand W, Smit Colette, Geerlings Suzanne E, Mulder Jan W, Schreij Gerrit, Sprenger Herman G, Reiss Peter, de Wolf Frank

机构信息

HIV Monitoring Foundation, Amsterdam, the Netherlands.

出版信息

Antivir Ther. 2010;15(6):871-9. doi: 10.3851/IMP1638.

DOI:10.3851/IMP1638

PMID:20834099

Abstract

BACKGROUND

We investigated differences in immune restoration and onset of new AIDS-defining events on combination antiretroviral therapy (cART) among HIV type-1 (HIV-1)-infected patients of different regional origin now living in the Netherlands.

METHODS

Treatment-naive adults reaching plasma viral load (pVL)<400 copies/ml within 9 months of starting cART were selected from the Netherlands ATHENA cohort. CD4(+) T-cell response on cART was determined over 7 years using mixed models. CD4(+) T-cell counts were excluded from the analyses at the first of two consecutive measurements of pVL≥400 copies/ml following prior suppression to <400 copies/ml. Multivariate analyses included gender, age, CD4(+) T-cell count and pVL prior to cART, hepatitis coinfection, HIV-1 transmission and region of origin (Western Europe/North America [WN], sub-Saharan Africa [SSA], Southeast Asia [SEA], Latin America/Caribbean [LAC] or other).

RESULTS

For 6,057 selected patients (WN 3,947, SSA 989, SEA 237, LAC 695 and other 189), median follow-up was 3.2 years (WN 3.3, SSA 2.9, SEA 3.2, LAC 2.7 and other 2.7). CD4(+) T-cell increase in the first 6 months of cART was lower in males than females (-26 cells/mm(3); P<0.0001) and in patients from SSA compared with WN (-36 cells/mm(3); P<0.0001). Because men from SSA started with lower CD4(+) T-cell counts than men from WN, they continued to lag behind and had lower absolute CD4(+) T-cell counts after 7 years of cART. Furthermore, cumulative tuberculosis incidence after 7 years of cART was higher in SSA compared with WN (4.5% versus 0.5%, hazard ratio 5.08, 95% confidence interval 2.22-11.60).

CONCLUSIONS

HIV-1-infected immigrants from SSA have blunted immune restoration on fully suppressive cART and should be identified at an earlier disease stage. Our results call for more intensive screening for both latent and active tuberculosis in these patients.

摘要

背景

我们调查了现居住在荷兰的不同地区来源的1型人类免疫缺陷病毒（HIV-1）感染患者在接受联合抗逆转录病毒疗法（cART）时免疫恢复情况及新的艾滋病定义事件的发生差异。

方法

从荷兰ATHENA队列中选取开始cART治疗9个月内血浆病毒载量（pVL）降至<400拷贝/ml的初治成人。使用混合模型在7年时间内确定cART治疗时CD4(+) T细胞反应。在先前pVL抑制至<400拷贝/ml后连续两次测量中首次出现pVL≥400拷贝/ml时，将CD4(+) T细胞计数排除在分析之外。多变量分析包括性别、年龄、cART治疗前的CD4(+) T细胞计数和pVL、合并感染肝炎、HIV-1传播途径以及来源地区（西欧/北美[WN]、撒哈拉以南非洲[SSA]、东南亚[SEA]、拉丁美洲/加勒比地区[LAC]或其他）。

结果

对于6057名被选患者（WN组3947人、SSA组989人、SEA组237人、LAC组695人以及其他组189人），中位随访时间为3.2年（WN组3.3年、SSA组2.9年、SEA组3.2年、LAC组2.7年以及其他组2.7年）。cART治疗前6个月CD4(+) T细胞增加量男性低于女性（-26个细胞/mm³；P<0.0001），SSA地区患者低于WN地区患者（-36个细胞/mm³；P<0.0001）。由于SSA地区男性开始治疗时CD4(+) T细胞计数低于WN地区男性，他们在cART治疗7年后仍持续落后且绝对CD4(+) T细胞计数更低。此外，cART治疗7年后SSA地区累积结核病发病率高于WN地区（4.5%对0.5%，风险比5.08，95%置信区间2.22 - 11.60）。