Institute of Tropical Medicine, Antwerp, Belgium.
Trans R Soc Trop Med Hyg. 2011 Dec;105(12):694-703. doi: 10.1016/j.trstmh.2011.08.007. Epub 2011 Oct 2.
The objectives of this study were to examine the association of the on-treatment CD4 cell count with late mortality (after >6 months of antiretroviral treatment [ART]) and to identify the determinants of the long-term CD4 cell count evolution after treatment initiation. We conducted a retrospective analysis including all antiretroviral (ARV)-naïve adults initiating ART in a tertiary hospital in Phnom Penh, Cambodia from 2003-2010. We used Cox proportional hazards modelling (mortality analysis), including time-updated CD4 counts, and mixed-effects modelling (CD4 response over time). Overall, 2840 patients were included (47% male, median age: 34 years, median baseline CD4 count: 78 cells/μL). The median time on ART was 2.5 years (IQR 1.1-4.3); 71 patients died after >6 months of ART. The baseline CD4 count was the main determinant of the on-treatment CD4 cell count. Time-updated CD4 cell counts was the strongest determinant of late mortality with a HR of 0.32 (95% CI 0.16-0.63) and 0.29 (95% CI 0.11-0.71) for CD4 values of 200-350 cells/μL and 350-500 cells/μL respectively. We conclude that baseline CD4 counts strongly determine the long-term immune recovery, which critically affects late mortality. This calls for increased efforts for early ART initiation and availability of CD4 count testing in low-income countries.
本研究旨在探讨治疗中 CD4 细胞计数与晚期死亡率（抗逆转录病毒治疗 [ART] 后 >6 个月）之间的关联，并确定治疗启动后长期 CD4 细胞计数演变的决定因素。我们进行了一项回顾性分析，纳入了 2003-2010 年在柬埔寨金边一家三级医院接受首次抗逆转录病毒治疗的所有抗逆转录病毒（ARV）初治成年人。我们使用 Cox 比例风险模型（死亡率分析），包括时间更新的 CD4 计数，以及混合效应模型（CD4 随时间的反应）。总体而言，共纳入 2840 例患者（47%为男性，中位年龄为 34 岁，中位基线 CD4 计数为 78 个/μL）。ART 的中位时间为 2.5 年（IQR 1.1-4.3）；71 例患者在 ART 后 >6 个月死亡。基线 CD4 计数是治疗中 CD4 细胞计数的主要决定因素。时间更新的 CD4 细胞计数是晚期死亡率的最强决定因素，CD4 值为 200-350 个/μL 和 350-500 个/μL 时，风险比分别为 0.32（95%CI 0.16-0.63）和 0.29（95%CI 0.11-0.71）。我们得出结论，基线 CD4 计数强烈决定了长期免疫恢复，这对晚期死亡率有重大影响。这呼吁在低收入国家加大早期 ART 启动和 CD4 计数检测的力度。
