资源匮乏地区艾滋病毒/艾滋病感染者中巨细胞病毒所致终末器官疾病的分布及决定因素：来自印度的观察
Distribution and determinants of cytomegalovirus induced end organ disease/s among people living with HIV/AIDS in a poor resource setting: observation from India.
作者信息
Chakraborty Avirup, Mahapatra Tanmay, Mahapatra Sanchita, Ansari Sabbir, Siddhanta Sattik, Banerjee Siwalik, Banerjee Dipanjan, Sarkar Rathindra Nath, Guha Subhashish Kamal, Chakraborty Nilanjan
机构信息
ICMR Virus Unit, Kolkata, ID & BG Hospital, GB4, 57 Dr. SC Banerjee Road Beliaghata, Kolkata 700 010, India.
Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
出版信息
PLoS One. 2015 Feb 13;10(2):e0117466. doi: 10.1371/journal.pone.0117466. eCollection 2015.
BACKGROUND
In India, despite well-established anti-retroviral treatment programs, Cytomegalovirus (CMV) infection-related end-organ diseases (EODs) still remain a major concern resulting in exacerbation of morbidity and mortality among HIV/AIDS patients. A prospective study was designed to understand the distribution and prognosis of CMV associated EODs and to determine a standardized cut-off value for serum CMV viral load associated with the development of EODs amongst HIV/AIDS subjects.
METHODS
In a cohort of 400 late-diagnosed HAART naïve HIV/AIDS subjects attending anti-retroviral centers of Kolkata during 2008-2014, the median duration of follow-up was 560 days, and at least 3 visits subsequent to the baseline were mandatory for eligibility. HIV-1 and CMV viral load were estimated by performing Real-Time Polymerase Chain Reactions (PCR).
RESULTS
Among subjects, 40.5% (162/400) had CMV EODs which were more common at lower CD4 counts. Poor prognosis and higher death rate were associated with a low CD4 count and increased HIV-1 and CMV viral loads. Subjects having higher CD4 count responded better to therapy [for CD4 = 60-100: Risk Ratio:RR = 1.48 (95% Confidence Interval: 95%CI = 1.18-1.82) and for CD4 = 30-59: RR = 1.64 (95%CI = 1.18-2.27)]. The cut off value of the serum CMV viral load (expressed as log10DNA/ml serum) associated with the development of EODs and disseminated CMV EODs was determined as 5.4 (p<0.0001) and 6.4 (p<0.0001) respectively. These cut offs were found to have satisfactorily high sensitivity, specificity, positive and negative predictive values.
CONCLUSION
Prognosis of CMV EOD was poor as indicated by higher death rates among subjects with lower CD4 count, and specific cut-off values were found to have useful potential for identification and treatment of CMV infected HIV/AIDS patients in due time to avoid CMV EODs among HIV/AIDS subjects. Targeted intervention programs seemed to be required urgently to make these cut-offs operational in order to minimize the burden of CMV EOD in this vulnerable population.
背景
在印度，尽管抗逆转录病毒治疗项目已成熟，但巨细胞病毒（CMV）感染相关的终末器官疾病（EODs）仍是一个主要问题，会导致艾滋病毒/艾滋病患者的发病率和死亡率加剧。一项前瞻性研究旨在了解CMV相关EODs的分布和预后，并确定与艾滋病毒/艾滋病患者中EODs发生相关的血清CMV病毒载量的标准化临界值。
方法
在2008年至2014年期间，对400名在加尔各答抗逆转录病毒中心初治的晚期诊断艾滋病毒/艾滋病患者进行队列研究，随访的中位时间为560天，基线后至少进行3次随访才有资格入选。通过实时聚合酶链反应（PCR）检测HIV-1和CMV病毒载量。
结果
在这些受试者中，40.5%（162/400）患有CMV EODs，在较低的CD4细胞计数时更常见。预后不良和较高的死亡率与低CD4细胞计数以及HIV-1和CMV病毒载量增加有关。CD4细胞计数较高的受试者对治疗反应更好[CD4 = 60 - 100时：风险比：RR = 1.48（95%置信区间：95%CI = 1.18 - 1.82）；CD4 = 30 - 59时：RR = 1.64（95%CI = 1.18 - 2.27）]。与EODs发生和播散性CMV EODs相关的血清CMV病毒载量（以log10DNA/ml血清表示）的临界值分别确定为5.4（p<0.0001）和6.4（p<0.0001）。发现这些临界值具有令人满意的高敏感性、特异性、阳性和阴性预测值。
结论
如CD4细胞计数较低的受试者死亡率较高所示，CMV EOD的预后较差，并且发现特定的临界值对于及时识别和治疗CMV感染的艾滋病毒/艾滋病患者具有有用的潜力，以避免艾滋病毒/艾滋病患者中出现CMV EODs。似乎迫切需要有针对性的干预项目以使这些临界值能够发挥作用，从而将这一脆弱人群中CMV EOD的负担降至最低。
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