MRC Clinical Trials Unit, University College London, UK.
Clin Infect Dis. 2011 Oct;53(8):817-25. doi: 10.1093/cid/cir494.
Recent updates of human immunodeficiency virus (HIV) treatment guidelines have raised the CD4+ cell count thresholds for antiretroviral therapy initiation from 350 to 500 cells/mm(3) in the United States and from 200 to 350 cells/mm³ in mid- and low-income countries. Robust data of time from HIV seroconversion to CD4+ cell counts of 200, 350, and 500 cells/mm³ are lacking but are needed to inform health care planners of the likely impact and cost effectiveness of these and possible future changes in CD4+ cell count initiation threshold.
Using Concerted Action on Seroconversion to AIDS and Death in Europe data from individuals with well-estimated dates of HIV seroconversion, we fitted mixed models on the square root of CD4+ cell counts measured before combined antiretroviral therapy (cART) initiation. Restricting analyses to adults (age >16 years), we predicted time between seroconversion and CD4+ cell count <200, <350, and <500 cells/mm³ as well as CD4+ cell count distribution and proportions reaching these thresholds at 1, 2, and 5 years after seroconversion.
Median (interquartile range [IQR]) follow-up for the 18495 eligible individuals from seroconversion while cART-free was 3.7 years (1.5, 7). Most of the subjects were male (78%), had a median age at seroconversion of 30 years (IQR, 25-37 years), and were infected through sex between men (55%). Estimated median times (95% confidence interval [CI]) from seroconversion to CD4+ cell count <500, <350, and <200 cells/mm(3) were 1.19 (95% CI, 1.12-1.26), 4.19 (95% CI, 4.09-4.28), and 7.93 (95% CI, 7.76-8.09) years, respectively. Almost half of infected individuals would require treatment within 1 year of seroconversion for guidelines recommending its initiation at 500 cells/mm³, compared with 26% and 9% for guidelines recommending initiation at 350 and 200 cells/mm³, respectively.
These data suggest substantial increases in the number of individuals who require treatment and call for early HIV testing.
最近，人类免疫缺陷病毒（HIV）治疗指南的更新将抗逆转录病毒治疗启动的 CD4+ 细胞计数阈值从美国的 350 个提高到 500 个/mm³，从中等和低收入国家的 200 个提高到 350 个/mm³。缺乏从 HIV 血清转换到 CD4+ 细胞计数为 200、350 和 500 个/mm³的时间的有力数据，但这些数据对于告知卫生保健规划者这些和可能未来的 CD4+ 细胞计数启动阈值变化的可能影响和成本效益是必要的。
利用欧洲艾滋病和死亡血清转换联合行动的数据，根据 HIV 血清转换日期估计较好的个体，我们对接受联合抗逆转录病毒治疗（cART）前 CD4+ 细胞计数的平方根进行了混合模型拟合。将分析限制在成年人（年龄>16 岁），我们预测了从血清转换到 CD4+ 细胞计数<200、<350 和<500 个/mm³的时间，以及在血清转换后 1、2 和 5 年达到这些阈值的 CD4+ 细胞计数分布和比例。
在 cART 无治疗的情况下，18495 名符合条件的个体从血清转换到中位（四分位距[IQR]）随访时间为 3.7 年（1.5，7）。大多数研究对象为男性（78%），血清转换时的中位年龄为 30 岁（IQR，25-37 岁），且通过男男性行为感染（55%）。从血清转换到 CD4+ 细胞计数<500、<350 和<200 个/mm³的估计中位时间（95%置信区间[CI]）分别为 1.19（95% CI，1.12-1.26）、4.19（95% CI，4.09-4.28）和 7.93（95% CI，7.76-8.09）年。几乎一半的感染者将需要在血清转换后 1 年内接受治疗，因为指南建议在 CD4+ 细胞计数为 500 个/mm³时开始治疗，而建议在 CD4+ 细胞计数为 350 和 200 个/mm³时开始治疗的比例分别为 26%和 9%。
这些数据表明，需要治疗的人数将大幅增加，并呼吁进行早期 HIV 检测。
