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HIV-1亚型和种族对初治抗逆转录病毒治疗患者CD4细胞计数下降率的影响:一项加拿大-欧洲合作的回顾性队列研究。

The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian-European collaborative retrospective cohort study.

作者信息

Klein Marina B, Young Jim, Dunn David, Ledergerber Bruno, Sabin Caroline, Cozzi-Lepri Alessandro, Dabis Francois, Harrigan Richard, Tan Darrell H, Walmsley Sharon, Gill John, Cooper Curtis, Scherrer Alexandra U, Mocroft Amanda, Hogg Robert S, Smaill Fiona

机构信息

Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Royal Victoria Hospital, McGill University Health Centre, Montréal, Que.

Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Royal Victoria Hospital, McGill University Health Centre, Montréal, Que. ; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.

出版信息

CMAJ Open. 2014 Oct 1;2(4):E318-29. doi: 10.9778/cmajo.20140017. eCollection 2014 Oct.

Abstract

BACKGROUND

Ethnic differences have the potential to confound associations between HIV-1 subtype and immunologic progression. We compared declines in CD4 cell counts during untreated infection for the most prevalent HIV-1 subtypes, focusing on distinguishing between the effects of viral subtype and ethnicity.

METHODS

We combined data from 4 European and 6 Canadian cohorts, selecting adults in the stable chronic phase of untreated HIV infection. We estimated the change in square root CD4 cell count over time for subtypes and ethnicities using mixed models, adjusting for covariates selected for their potential effect on initial CD4 cell count or its decline.

RESULTS

Data from 9772 patients were analyzed, contributing 79 175 measurements of CD4 cell count and 24 157 person-years of follow-up. Overall, there were no appreciable differences in CD4 cell count decline for viral subtypes A, CRF01_AE, CRF02_AG, C and G compared with viral subtype B; whereas the decline in CD4 cell count in patients of African ancestry was considerably slower than in patients of other ethnicity. When ethnic groups were studied separately, there was evidence for slower declines in CD4 cell count in viral subtypes C, and possibly A and G, compared with viral subtype B in patients of African ancestry but not among patients of other ethnicities, suggesting an interaction between subtype and ethnicity.

INTERPRETATION

Ethnicity is a major determinant of CD4 cell count decline; viral subtype differences may have existed but were small compared with the effect of ethnicity and were most apparent in patients of African ancestry. In developing countries, slower CD4 cell count declines among individuals of African descent may translate to a longer asymptomatic phase and increase the opportunity for HIV transmission.

摘要

背景

种族差异可能会混淆HIV-1亚型与免疫进展之间的关联。我们比较了未经治疗的感染期间最常见的HIV-1亚型的CD4细胞计数下降情况,重点是区分病毒亚型和种族的影响。

方法

我们合并了来自4个欧洲队列和6个加拿大队列的数据,选择处于未经治疗的HIV感染稳定慢性期的成年人。我们使用混合模型估计了各亚型和种族的平方根CD4细胞计数随时间的变化,并针对因其对初始CD4细胞计数或其下降可能产生的影响而选择的协变量进行了调整。

结果

分析了9772名患者的数据,提供了79175次CD4细胞计数测量值和24157人年的随访数据。总体而言,与病毒B亚型相比,病毒A、CRF01_AE、CRF02_AG、C和G亚型的CD4细胞计数下降没有明显差异;而非洲裔患者的CD4细胞计数下降明显慢于其他种族的患者。当分别研究种族群体时,有证据表明,在非洲裔患者中,与病毒B亚型相比,病毒C亚型以及可能的A和G亚型的CD4细胞计数下降较慢,但在其他种族的患者中并非如此,这表明亚型和种族之间存在相互作用。

解读

种族是CD4细胞计数下降的主要决定因素;病毒亚型差异可能存在,但与种族的影响相比很小,并且在非洲裔患者中最为明显。在发展中国家,非洲裔个体中较慢的CD4细胞计数下降可能意味着无症状期更长,并增加了HIV传播的机会。

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