Di Biagio Antonio, Ameri Marta, Sirello Davide, Cenderello Giovanni, Di Bella Enrico, Taramasso Lucia, Giannini Barbara, Giacomini Mauro, Viscoli Claudio, Cassola Giovanni, Montefiori Marcello
Infectious Disease Clinic, IRCCS San Martino - IST Hospital, Genoa, Italy.
Department of Economics, University of Genoa, Via Vivaldi 5, 16126, Genoa, Italy.
BMC Infect Dis. 2017 Feb 6;17(1):127. doi: 10.1186/s12879-017-2199-x.
In the last 20 years routine T CD4+ lymphocyte (CD4+) cell count has proved to be a key factor to determine the stage of HIV infection and start or discontinue of prophylaxis for opportunistic infections. However, several studies recently showed that in stable patients on cART a quarterly CD4+ cell count monitoring results in limited (or null) clinical relevance. The research is intended to investigate whether performing quarterly CD4+ cell counts in stable HIV-1 patients is still recommendable and to provide a forecast of the cost saving that could be achieved by reducing CD4+ monitoring in such a category of patients.
The study is based on data referring to all HIV-infected patients > 18 years of age being treated at two large infectious diseases units located in the metropolitan area of Genoa, Italy. The probability of CD4+ cell counts dropping below a threshold value set at 350 cells/mm is assessed using confidence intervals and Kaplan-Meier survival estimates, whereas multivariate Cox analysis and logistic regression are implemented in order to identify factors associated with CD4+ cell count falls below 350 cells/mm.
Statistical analysis reveals that among stable patients the probability of maintaining CD4+ >350 cell/mm is more than 98%. Econometric models indicate that HCV co-infection and HIV-RNA values >50 copies/mL in previous examinations are associated with CD4+ falls below 350 cells/mm. Moreover, results suggest that the cost saving that could be obtained by reducing CD4+ examinations ranges from 33 to 67%.
Empirical findings shows that patients defined as stable at enrollment are highly unlikely to experience a CD4+ value <350 cell/mm in the space/arc of a year. The research supports a recommendation for annual CD4+ monitoring in stable HIV-1 patients.
在过去20年中，常规T CD4 +淋巴细胞（CD4 +）细胞计数已被证明是确定HIV感染阶段以及开始或停止机会性感染预防的关键因素。然而，最近的几项研究表明，对于接受抗逆转录病毒治疗（cART）的稳定患者，每季度进行一次CD4 +细胞计数监测的临床相关性有限（或为零）。本研究旨在调查在稳定的HIV-1患者中每季度进行CD4 +细胞计数是否仍然值得推荐，并预测通过减少此类患者的CD4 +监测可实现的成本节约。
该研究基于意大利热那亚大都市地区两个大型传染病科治疗的所有年龄大于18岁的HIV感染患者的数据。使用置信区间和Kaplan-Meier生存估计评估CD +细胞计数降至设定阈值350个细胞/mm以下的概率，同时进行多变量Cox分析和逻辑回归，以确定与CD4 +细胞计数低于350个细胞/mm相关的因素。
统计分析表明，在稳定患者中，CD4 +维持> 350细胞/mm的概率超过98%。计量经济学模型表明，丙型肝炎病毒（HCV）合并感染和先前检查中HIV-RNA值> 50拷贝/mL与CD4 +低于350个细胞/mm相关。此外，结果表明，通过减少CD4 +检查可节省的成本范围为33%至67%。
实证研究结果表明，入组时被定义为稳定的患者在一年的时间内极不可能出现CD4 +值<350细胞/mm。该研究支持对稳定的HIV-1患者进行每年一次CD4 +监测的建议。
