维生素 D 状态与 HIV 感染男性开始治疗时免疫功能重建。
Vitamin D status and immune function reconstitution in HIV-infected men initiating therapy.
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
出版信息
AIDS. 2018 May 15;32(8):1069-1076. doi: 10.1097/QAD.0000000000001782.
OBJECTIVE
Despite effective antiretroviral therapy (HAART) and durable viral suppression, many HIV-infected individuals still do not achieve CD4 cell count (CD4) normalization. Vitamin D has immunoregulatory functions, including inducing the development of T cells and higher levels may improve CD4 rebound.
DESIGN
Longitudinal study of men from the Multicenter AIDS Cohort Study who virally suppressed following HAART initiation and had pre-HAART and post-HAART 25(OH)D and 1,25(OH)2D measurements and repeated measures of CD4.
METHODS
CD4 rebound was modeled using a nonlinear mixed effects model. We estimated the adjusted effect (adjusted for pre-HAART antiretroviral exposure, black race, age and CD4 at HAART initiation) of pre-HAART and post-HAART vitamin D metabolite levels on the rate of CD4 increase and final CD4 plateau.
RESULTS
Among the 263 HIV-infected HAART initiators with pre-HAART vitamin D measurements, a 1-SD higher pre-HAART 25(OH)2D level was associated with a 9% faster rate of rise (P = 0.02) but no gain in final CD4 plateau. In contrast, a 1-SD higher 1,25(OH)2D level was associated with a 43-cell lower final CD4 (P = 0.04). Among 560 men with post-HAART measurements, findings were similar to those for pre-HAART 25(OH)2D with 1-SD higher level associated with faster rate of rise but no improvement in final CD4.
CONCLUSION
We found no evidence that higher vitamin D metabolite levels pre-HAART or post-HAART are associated with better CD4 outcomes among HIV-infected HAART initiators. However, the value of pre-HAART 1,25(OH)2D levels as an indicator of immune response dysregulation could be further explored.
目的
尽管有有效的抗逆转录病毒疗法（HAART）和持久的病毒抑制，但许多感染 HIV 的个体仍未实现 CD4 细胞计数（CD4）正常化。维生素 D 具有免疫调节功能，包括诱导 T 细胞的发育，较高的水平可能会改善 CD4 反弹。
设计
对接受 HAART 治疗后病毒得到抑制的多中心艾滋病队列研究中的男性进行纵向研究，这些男性在 HAART 治疗前和治疗后都进行了 25（OH）D 和 1,25（OH）2D 测量，并对 CD4 进行了重复测量。
方法
使用非线性混合效应模型对 CD4 反弹进行建模。我们估计了 HAART 前和 HAART 后维生素 D 代谢物水平对 CD4 增加率和最终 CD4 平台的调整效果（调整了 HAART 前的抗逆转录病毒暴露、黑种人、年龄和 HAART 开始时的 CD4）。
结果
在 263 名接受 HAART 治疗且有 HAART 前维生素 D 测量值的 HIV 感染者中，HAART 前 25（OH）2D 水平每增加 1 个标准差，CD4 上升速度就会加快 9%（P=0.02），但最终 CD4 平台没有增加。相比之下，1,25（OH）2D 水平每增加 1 个标准差，最终 CD4 就会降低 43 个细胞（P=0.04）。在 560 名接受 HAART 后测量的男性中，结果与 HAART 前 25（OH）2D 相似，1 个标准差的高水平与更快的上升速度相关，但最终 CD4 没有改善。
结论
我们没有发现 HAART 前或 HAART 后较高的维生素 D 代谢物水平与 HIV 感染者接受 HAART 治疗的 CD4 结果更好相关。然而，HAART 前 1,25（OH）2D 水平作为免疫反应失调的指标的价值可以进一步探讨。
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