Serrano-Villar Sergio, Pérez-Elías María Jesús, Dronda Fernando, Casado José Luis, Moreno Ana, Royuela Ana, Pérez-Molina José Antonio, Sainz Talia, Navas Enrique, Hermida José Manuel, Quereda Carmen, Moreno Santiago
Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain.
CIBER, Epidemiología y Salud Pública, Clinical Biostatistics Unit, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
PLoS One. 2014 Jan 30;9(1):e85798. doi: 10.1371/journal.pone.0085798. eCollection 2014.
A low CD4/CD8 ratio has been identified in the general population as a hallmark of inmmunosenescence and a surrogate of all-cause mortality. We aimed to investigate in treated HIV-infected individuals the relationship between the CD4/CD8 ratio and serious non-AIDS events.
Case-control study within a prospective hospital-based cohort of HIV-infected subjects during at least one year of ART-mediated viral suppression. Cases were patients with serious non-AIDS events (non-AIDS malignancies, cardiovascular disease, and end-stage kidney disease), and controls individuals who did not developed non-AIDS events during follow-up. Data were analyzed using ROC analysis and multivariate logistic regression. Conditional logistic regression was performed in 200 cases/controls matched by age, sex, nadir CD4 and proximal CD4 counts.
We analyzed 407 subjects (109 cases, 298 controls). The CD4/CD8 ratio was lower in cases (0.44 vs. 0.70, P<0.0001), with higher discriminatory ability for the detection of non-AIDS events than the CD4 count, CD8 count and nadir CD4. Multivariate analyses (adjusted for age, sex, nadir CD4, proximal CD4 count, year of ART initiation and ART duration) confirmed the independent association of a low CD4/CD8 ratio with the risk of non-AIDS morbidity (per CD4/CD8 ratio quartile decrease, OR, 2.9; 95% CI, 1.3-6.2) and non-AIDS mortality (OR, 2.8; 95% CI, 1.5-5.3).
The CD4/CD8 ratio provides additional information to the CD4 counts and nadir CD4 in treated HIV-infected individuals, since it is independently associated with the risk of non-AIDS-related morbidity and mortality. This association is robust and maintained within different subgroups of patients.
在普通人群中，低CD4/CD8比值已被确定为免疫衰老的衰老的标志和全因死亡率的替代指标。我们旨在研究接受治疗的HIV感染者中CD4/CD8比值与严重非艾滋病事件之间的关系。
在一个基于医院的前瞻性队列中，对至少接受一年抗逆转录病毒治疗（ART）且病毒得到抑制的HIV感染者进行病例对照研究。病例为发生严重非艾滋病事件（非艾滋病恶性肿瘤、心血管疾病和终末期肾病）的患者，对照为随访期间未发生非艾滋病事件的个体。使用ROC分析和多因素逻辑回归分析数据。对200对按年龄、性别、最低CD4细胞计数和最近CD4细胞计数匹配的病例/对照进行条件逻辑回归分析。
我们分析了407名受试者（109例病例，298名对照）。病例组的CD4/CD8比值较低（0.44对0.70，P<0.0001），与CD4细胞计数、CD8细胞计数和最低CD4细胞计数相比，对检测非艾滋病事件具有更高的辨别能力。多因素分析（校正年龄、性别、最低CD4细胞计数、最近CD4细胞计数、开始抗逆转录病毒治疗的年份和抗逆转录病毒治疗持续时间）证实，低CD4/CD8比值与非艾滋病发病风险（每降低一个CD4/CD8比值四分位数，比值比[OR]为2.9；95%置信区间[CI]为1.3 - 6.2）和非艾滋病死亡风险（OR为2.8；95%CI为1.5 - 5.3）独立相关。
在接受治疗的HIV感染者中，CD4/CD8比值比CD4细胞计数和最低CD4细胞计数能提供更多信息，因为它与非艾滋病相关发病和死亡风险独立相关。这种关联是稳健且在不同患者亚组中持续存在。
