Lee Sulggi, Byakwaga Helen, Boum Yap, Burdo Tricia H, Williams Kenneth C, Lederman Michael M, Huang Yong, Tracy Russell P, Cao Huyen, Haberer Jessica E, Kembabazi Annet, Bangsberg David R, Martin Jeffrey N, Hunt Peter W
University of California, San Francisco, USA
Mbarara University of Science and Technology, Uganda.
J Infect Dis. 2017 Apr 15;215(8):1270-1274. doi: 10.1093/infdis/jix113.
The plasma kynurenine/tryptophan (KT) ratio, a marker of adaptive immune defects, strongly predicts mortality during treated human immunodeficiency virus (HIV) disease in Ugandans as compared to US-based populations. Here, the KT ratio and T-cell and plasma biomarkers of immune activation were measured among 535 HIV-infected Ugandans prior to ART initiation and at month 6 of viral suppression. The month 6 KT ratio (adjusted hazard ratio [aHR], 2.74), soluble CD14 level (aHR, 2.32), interleukin 6 level (aHR, 2.34), and D-dimer level (aHR, 1.95) were associated with mortality occurring ≥6 months after ART initiation. The KT ratio remained significantly predictive of mortality even after adjustment for the additional biomarkers, suggesting an independent contribution to clinical outcomes in resource-limited settings.
作为适应性免疫缺陷标志物的血浆犬尿氨酸/色氨酸（KT）比值，与美国人群相比，能更有力地预测乌干达接受治疗的人类免疫缺陷病毒（HIV）感染者的死亡率。在此，对535名感染HIV的乌干达人在开始抗逆转录病毒治疗（ART）前及病毒抑制6个月时的KT比值以及免疫激活的T细胞和血浆生物标志物进行了测量。ART开始后≥6个月发生的死亡与6个月时的KT比值（调整后风险比[aHR]，2.74）、可溶性CD14水平（aHR，2.32）、白细胞介素6水平（aHR，2.34）和D-二聚体水平（aHR，1.95）相关。即使在对其他生物标志物进行调整后，KT比值仍能显著预测死亡率，这表明在资源有限的环境中，其对临床结局有独立的影响。
