van Welzen Berend J, de Vries Tamar I, Arends Joop E, Mudrikova Tania, Hoepelman Andy I M
Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands.
AIDS Care. 2020 Jun;32(6):701-704. doi: 10.1080/09540121.2019.1623376. Epub 2019 May 27.
Corticosteroids inhibit HIV-related immune activation and seem to have a mild favorable effect on immunological recovery in patients with CD4 counts ≥200 cells/mm. Data in patients with advanced immunodeficiency are lacking. We analyzed whether corticosteroids negatively influence the short-term CD4 lymphocyte recovery in patients with CD4 cell counts <200 cells/mm started on combination antiretroviral therapy (cART). We performed a retrospective cohort analysis including all HIV-infected patients under follow-up in our hospital with a documented episode of Pneumocystis Jirovecii Pneumonia (PJP) in the cART era. CD4 lymphocyte recovery was assessed at three months after the episode of PJP and subsequent start of cART, comparing patients that received adjunctive corticosteroids (AC) versus patients that did not receive corticosteroids (standard care (SC)). In total, 66 patients with an episode of PJP were identified with 38 patients in the AC-group versus 28 patients in the SC-group. Almost all baseline characteristics were similar, including mean CD4 lymphocyte counts. After three months, the mean CD4 cell count did not differ; 222 cells/mm for the SC-group versus 259 cells/mm for the AC-group ( = .29). The use of corticosteroids does not alter CD4 lymphocyte recovery in HIV-infected patients with advanced immunodeficiency in the first months of antiretroviral therapy.
皮质类固醇可抑制与HIV相关的免疫激活，对于CD4细胞计数≥200个/立方毫米的患者，似乎对免疫恢复有轻微的有利影响。目前缺乏晚期免疫缺陷患者的数据。我们分析了皮质类固醇是否会对开始接受联合抗逆转录病毒治疗（cART）的CD4细胞计数<200个/立方毫米的患者的短期CD4淋巴细胞恢复产生负面影响。我们进行了一项回顾性队列分析，纳入了在我们医院接受随访的所有HIV感染患者，这些患者在cART时代有记录的耶氏肺孢子菌肺炎（PJP）发作。在PJP发作及随后开始cART三个月后评估CD4淋巴细胞恢复情况，比较接受辅助皮质类固醇（AC）的患者与未接受皮质类固醇的患者（标准治疗（SC））。总共确定了66例有PJP发作的患者，其中AC组38例，SC组28例。几乎所有基线特征相似，包括平均CD4淋巴细胞计数。三个月后，平均CD4细胞计数无差异；SC组为222个/立方毫米，AC组为259个/立方毫米（P = 0.29）。在抗逆转录病毒治疗的头几个月，皮质类固醇的使用不会改变晚期免疫缺陷HIV感染患者的CD4淋巴细胞恢复情况。
