Jarrin Inma, Pantazis Nikos, Dalmau Judith, Phillips Andrew N, Olson Ashley, Mussini Cristina, Boufassa Faroudy, Costagliola Dominique, Porter Kholoud, Blanco Juliá, Del Amo Julia, Martinez-Picado Javier
aInstituto de Salud Carlos III, Madrid, Spain bAthens University Medical School, Athens, Greece cAIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain dResearch Department of Infection and Population Health eMedical Research Council Clinical Trials Unit, University College London, London, UK fInstitute of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy gInserm, CESP Centre for Research in Epidemiology and Population Health, Epidemiology of HIV and STI Team, Le Kremlin Bicetre hUniv Paris-Sud, Le Kremlim Bicetre iUPMC Univ Paris 06 jINSERM, Paris, France kUniversitat de Vic-Central de Catalunya, UVIC-UCC, Vic lInstitució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain. *Julia Del Amo and Javier Martinez-Picado are senior coauthors of this work.
AIDS. 2015 Nov;29(17):2323-33. doi: 10.1097/QAD.0000000000000805.
This article compares trends in CD4 T-cell recovery and proportions achieving optimal restoration (≥500 cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors.
We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 less than 200 cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration.
Of 4024 individuals, 294 (7.3%) were classified as rapid progressors. At the same CD4 T-cell count at cART start (baseline), rapid progressors experienced faster CD4 T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1.82 (1.61; 2.04)], which reversed to slightly slower increases in months 1-18 [-0.05 (-0.06; -0.03)] and no significant differences in 18-60 months [-0.003 (-0.01; 0.01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29.2 vs. 62.5%) and 36 (47.1 vs. 72.4%) but not at month 60 (70.4 vs. 71.8%). These differences disappeared after adjusting for baseline CD4 T-cell count: odds ratio (95% confidence interval) 0.86 (0.61; 1.20), 0.90 (0.38; 2.17) and 1.56 (0.55; 4.46) at months 12, 36 and 60, respectively.
Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4 T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4 T-cell counts at cART initiation.
本文比较了快速进展者和非快速进展者在开始联合抗逆转录病毒治疗（cART）后病毒抑制情况下CD4 T细胞恢复趋势以及达到最佳恢复（≥500个细胞/微升）的比例。
我们纳入了在cART开始后6个月内实现病毒抑制的HIV-1血清转化者。快速进展者是指在cART前血清转化后12个月内至少有一次CD4细胞计数低于200个细胞/微升的个体。我们使用分段线性混合模型和逻辑回归分析来评估最佳恢复情况。
在4024名个体中，294名（7.3%）被归类为快速进展者。在cART开始时（基线）相同的CD4 T细胞计数水平下，快速进展者在第一个月的CD4 T细胞增加速度比非快速进展者快[平均每月增加量（平方根尺度）的差异（95%置信区间）：1.82（1.61；2.04）]，但在第1 - 18个月转为略慢的增加速度[-0.05（-0.06；-0.03）]，在18 - 60个月无显著差异[-0.003（-0.01；0.01）]。在第12个月（29.2%对62.5%）和第36个月（47.1%对72.4%），快速进展者达到最佳恢复的百分比显著低于非快速进展者，但在第60个月（70.4%对71.8%）无显著差异。在调整基线CD4 T细胞计数后，这些差异消失：在第12个月、36个月和60个月的优势比（95%置信区间）分别为0.86（0.61；1.20）、0.90（0.38；2.17）和1.56（0.55；4.46）。
在接受抑制性抗逆转录病毒治疗的人群中，快速进展者的CD4 T细胞计数初始增加速度比非快速进展者快，但在cART后的前36个月内达到最佳恢复的可能性较小，主要原因是cART开始时CD4 T细胞计数较低。
