Wong Ngai Sze, Chan Kenny Chi Wai, Cheung Edward Ka Hin, Wong Ka Hing, Lee Shui Shan
Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, China.
Medicine (Baltimore). 2017 Jul;96(28):e7493. doi: 10.1097/MD.0000000000007493.
In HIV-infected persons, age is negatively associated with optimal CD4 recovery following antiretroviral therapy. Our understanding of the situation in older adults, especially the middle-aged is, however, limited. We undertook to examine the latter's pattern of CD4/CD8 recovery following antiretroviral therapy.Retrospective clinical cohort data of HIV patients diagnosed between 1985 and 2014 in Hong Kong were collected. They were categorized by age at treatment initiation, viz., young adults (age 18-49), middle-aged (age 50-64), and elderly (≥65 years' old). Predictors of immune recovery (CD4 count, CD8 count, CD4/CD8 ratio) over time were examined using multivariable linear generalized estimating equations.A total of 2754 patients (aged ≥18) have been on antiretroviral therapy, with baseline characteristics similar between middle-aged and the elderly. Late diagnosis, defined as progression to AIDS within 3 months of HIV diagnosis, was less common in middle-aged (odds ratio = 0.58, 95% confidence interval = 0.37-0.91). Among Chinese patients who have been on treatment for ≥4 years (n = 913), 80.6%, 14.6%, and 4.8% were young adults, middle-aged, and elderly respectively. Late treatment initiation, defined as AIDS diagnosis or CD4 count ≤100 cells/μL before treatment, was common in middle-aged and elderly, the former however had faster CD4 recovery (3.95 vs. 3.36 cells/μL/month), but slower CD8 decline (-1.76 vs. -4.34 cells/μL/month) and CD4/CD8 normalization (0.009 vs. 0.0101/month).As a transitional age group, the immune recovery of middle-aged patients lagged behind young adults largely because of late treatment initiation. Following adoption of early and non-CD4-guided treatment initiation, their long-term clinical outcome is expected to improve.
在感染HIV的人群中，年龄与抗逆转录病毒治疗后CD4的最佳恢复呈负相关。然而，我们对老年人，尤其是中年人的情况了解有限。我们着手研究后者在抗逆转录病毒治疗后的CD4/CD8恢复模式。收集了1985年至2014年在香港诊断出的HIV患者的回顾性临床队列数据。根据开始治疗时的年龄对他们进行分类，即年轻人（18 - 49岁）、中年人（50 - 64岁）和老年人（≥65岁）。使用多变量线性广义估计方程研究了免疫恢复（CD4计数、CD8计数、CD4/CD8比率）随时间变化的预测因素。共有2754名年龄≥18岁的患者接受了抗逆转录病毒治疗，中年人和老年人的基线特征相似。晚期诊断定义为在HIV诊断后3个月内进展为艾滋病，在中年人中较少见（优势比 = 0.58，95%置信区间 = 0.37 - 0.91）。在接受治疗≥4年的中国患者（n = 913）中，年轻人、中年人、老年人分别占80.6%、14.6%和4.8%。延迟开始治疗定义为治疗前艾滋病诊断或CD4计数≤100个细胞/μL，在中年人和老年人中很常见，然而前者的CD4恢复更快（3.95对3.36个细胞/μL/月），但CD8下降较慢（-1.76对-4.34个细胞/μL/月）以及CD4/CD8正常化较慢（0.009对0.0101/月）。作为一个过渡年龄组，中年患者的免疫恢复在很大程度上落后于年轻人，这主要是因为治疗开始较晚。在采用早期且不依据CD4指导的治疗开始方式后，他们的长期临床结局有望得到改善。
