Tang L, Ling Q, Lyu P, Tang H L, Li P L, Ge L, Chen F F, Cai C, Li D M
Department of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Jun 10;41(6):861-865. doi: 10.3760/cma.j.cn112338-20190918-00679.
To understand the progression of CD(4)(+) T cells (CD(4)) declining rate in different age groups among MSM and to further explore the pathogenesis of HIV infection. Data regarding MSM who were diagnosed as HIV positive, aged ≥15 years, with homosexual route of transmission and with more than two records of CD(4) count retained before antiretroviral therapy (ART), were collected from the National AIDS Comprehensive Prevention Information System until May 31, 2019. Linear mixed effect model was used to fit the linear elimination relationship between the square root of CD(4) cell count and infection time before taking up the ART. To get the intercept estimation, we used the results from CD(4) count which containing the dates of last negativity and first positivity on HIV antibody testing. Both test and test were used to test the model parameters. Median intervals from HIV seroconversion to CD(4)<500, <350, <200 cells/μl were estimated. A total of 26 754 individuals were included in the study including 146 of them having records on the last date of being test negative. Their median age was 27 years old (=27, ()-():23-35). The intercept of the liner mixed models among 15-, 25- and ≥35 year olds were 24.84 (95: 23.76-25.92), 23.94 (95: 22.86-25.02), 23.44 (95: 21.91-24.96) and the slope of the liner mixed models among the 15-24, 25-34, 35-44 and ≥45 year olds were -1.31 (95: -1.33--1.25), -1.37(95: -1.40--1.33), -1.53 (95: -1.58--1.47) and -1.59 (95:-1.68--1.51), respectively. Estimation on the median intervals from HIV seroconversion to CD(4) <500, <350, <200 cells/μl counts were 1.29 (95: 0.79-1.81), 3.92 (95: 3.36-4.48) and 7.21 (95: 6.58-7.81), respectively. The median time of 15-24 age group from HIV seroconversion to reach the three CD(4) thresholds appeared the longest, as 1.89 (95: 1.05-2.85), 4.68(95: 3.80-5.77) and 8.17 (95: 7.23-9.42) years, respectively, the median time of ≥45 age group from HIV seroconversion to reach the three CD(4) thresholds appeared the shortest, as 0.68 (95: 0.00-1.72)、2.98 (95: 1.91-4.14)、5.85 (95: 4.62-7.16) years, respectively. Our findings suggested that the CD(4) declining rate had been accelerated along with ageing. Progression time from HIV seroconversion to different CD(4) thresholds appeared different, which was shorter in the older age group. Again, these findings showed the great impact of HIV infection among older age groups in the MSM population. Early diagnosis and treatment were bound to delay the progression of the disease.
为了解男男性行为者(MSM)不同年龄组CD4⁺T细胞(CD4)下降率的变化情况,并进一步探索HIV感染的发病机制。从国家艾滋病综合防治信息系统收集截至2019年5月31日,年龄≥15岁、经同性恋途径传播、在接受抗逆转录病毒治疗(ART)前有两条以上CD4计数记录且被诊断为HIV阳性的MSM数据。采用线性混合效应模型拟合接受ART前CD4细胞计数平方根与感染时间之间的线性消除关系。为获得截距估计值,我们使用了包含HIV抗体检测最后阴性日期和首次阳性日期的CD4计数结果。同时使用t检验和F检验对模型参数进行检验。估计了从HIV血清转化到CD4<500、<350、<200个细胞/μl的中位间隔时间。本研究共纳入26754名个体,其中146人有最后一次检测阴性日期的记录。他们的中位年龄为27岁(=27,四分位间距(IQR):23 - 35)。15岁、25岁和≥35岁年龄组线性混合模型的截距分别为24.84(95%置信区间:23.76 - 25.92)、23.94(95%置信区间:22.86 - 25.02)、23.44(95%置信区间:21.91 - 24.96);15 - 24岁、25 - 34岁、35 - 44岁和≥45岁年龄组线性混合模型的斜率分别为 -1.31(95%置信区间: -1.33 - -1.25)、 -1.37(95%置信区间: -1.40 - -1.33)、 -1.53(95%置信区间: -1.58 - -1.47)和 -1.59(95%置信区间: -1.68 - -1.51)。从HIV血清转化到CD4<500、<350、<200个细胞/μl计数的中位间隔时间估计分别为1.29(95%置信区间:0.79 - 1.81)、3.92(95%置信区间:3.36 - 4.48)和7.21(95%置信区间:6.58 - 7.81)。15 - 24岁年龄组从HIV血清转化到达到三个CD4阈值的中位时间似乎最长,分别为1.89(95%置信区间:1.05 - 2.85)、4.68(95%置信区间:,3.80 - 5.77)和8.17(95%置信区间:7.23 - 9.42)年;≥45岁年龄组从HIV血清转化到达到三个CD,4阈值的中位时间似乎最短,分别为0.68(95%置信区间:0.00 - 1.72)、2.98(95%置信区间:1.91 - 4.14)、5.85(95%置信区间:4.62 - 7.16)年。我们的研究结果表明,CD4下降率随年龄增长而加速。从HIV血清转化到不同CD4阈值的进展时间不同,老年组较短。同样,这些结果显示了HIV感染对MSM人群中老年人的巨大影响。早期诊断和治疗必然会延缓疾病进展。