Epicentre, 8 rue saint Sabin, Paris, France.
AIDS. 2012 Jul 17;26(11):1393-8. doi: 10.1097/QAD.0b013e328352d054.
We investigated the association between immune response and mortality in four HIV African programs supported by Médecins Sans Frontières.
Multicentric retrospective cohort study.
All antiretroviral therapy (ART) naive adults (>15 years) who initiated therapy between March 2001 and November 2010 and receiving therapy for 9 months or more were included. We described the evolution of mortality over time. Mixed Poisson models were used to assess the effect of updated CD4 cell counts and other potential risk factors on mortality.
A total of 24 037 patients, of which 68% were women, contributed 69 516.2 person-years of follow-up. At ART initiation, 5718 patients (23.7%) were classified as WHO clinical stage 4, 1587 (6.6%) had a BMI below 16 kg/m and 2568 (10.7%) had CD4 cell count below 50 cells/μl. A total of 568 (2.4%) deaths were recorded during the study period. In the CD4 response categories 500 cells/μl or more, 350-499, 200-349, 50-199 cells/μl and less than 50 cells/μl, unadjusted mortality rates were 0.36; 0.58; 0.88; 1.91 and 7.43 per 100 person-years, respectively. In multivariate analysis, higher mortality was observed in patients with CD4 response levels 350-499 cells/μl [adjusted hazard ratio (aHR) 1.70, 95% confidence interval (CI) 1.26-2.30] and for those between 200-349 (aHR 2.56; 95% CI 1.93-3.38), compared to those with 500 cells/μl or more.
The observed higher survival of patients with a CD4 response to ART higher than 500 cells/μl supports the need of further research to evaluate the individual benefit of initiating ART at higher CD4 levels in sub-Saharan Africa.
我们调查了在无国界医生组织支持的四个非洲艾滋病毒项目中，免疫反应与死亡率之间的关系。
多中心回顾性队列研究。
纳入 2001 年 3 月至 2010 年 11 月期间开始接受治疗且接受治疗 9 个月或以上的所有抗逆转录病毒治疗（ART）初治成年人（>15 岁）。我们描述了死亡率随时间的变化。使用混合泊松模型评估更新后的 CD4 细胞计数和其他潜在风险因素对死亡率的影响。
共有 24037 名患者（其中 68%为女性），共随访 69516.2 人年。在开始接受 ART 时，5718 名患者（23.7%）为世界卫生组织临床分期 4 期，1587 名（6.6%）体重指数低于 16kg/m2，2568 名（10.7%）CD4 细胞计数低于 50 个/μl。研究期间共记录了 568 例（2.4%）死亡。在 CD4 反应类别中，>=500 个/μl、350-499 个/μl、200-349 个/μl、50-199 个/μl 和 <50 个/μl 的未调整死亡率分别为 0.36、0.58、0.88、1.91 和 7.43/100 人年。多变量分析显示，CD4 反应水平为 350-499 个/μl 的患者死亡率较高[调整后的危险比（aHR）1.70，95%置信区间（CI）1.26-2.30]，200-349 个/μl 的患者死亡率也较高（aHR 2.56，95%CI 1.93-3.38），与 CD4 水平>=500 个/μl 的患者相比。
观察到 CD4 对 ART 的反应高于 500 个/μl 的患者的生存率更高，这支持进一步研究评估在撒哈拉以南非洲以更高 CD4 水平启动 ART 的个体获益的必要性。
