CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire.
PACCI-ANRS Research Site, Côte d'Ivoire.
J Acquir Immune Defic Syndr. 2021 Jan 1;86(1):138-145. doi: 10.1097/QAI.0000000000002533.
Several biomarkers of inflammation and coagulation were reported to be associated with HIV disease progression in different settings. In this article, we report the association between 11 biomarkers and medium-term mortality in HIV-infected West African adults.
In Temprano ANRS 12136, antiretroviral therapy (ART)-naive HIV-infected adults with high CD4 counts were randomly assigned either to start ART immediately or defer ART until the World Health Organization criteria were met. Participants who completed the 30-month trial follow-up were invited to participate in a posttrial phase. The posttrial phase end point was all-cause death. We used multivariate Cox proportional models to analyze the association between baseline plasma biomarkers [IL-1ra, IL-6, soluble vascular cell adhesion molecule 1 (sVCAM-1), sCD14, D-dimer, fibrinogen, IP-10, sCD163, albumin, high-sensitivity C-reactive protein, and 16S rDNA] and all-cause death in the Temprano participants randomized to defer ART.
Four hundred seventy-seven patients (median age 35 years, 78% women, and median CD4 count: 379 cells/mm) were randomly assigned to defer starting ART until the World Health Organization criteria were met. The participants were followed for 2646 person-years (median 5.8 years). In the follow-up, 89% of participants started ART and 30 died. In the multivariate analysis adjusted for the study center, sex, baseline CD4 count, isoniazid preventive therapy, plasma HIV-1 RNA, peripheral blood mononuclear cell HIV-1 DNA, and ART, the risk of death was significantly associated with baseline sVCAM-1 (≥1458 vs. <1458: adjusted hazard ratio 2.57, 95% confidence interval: 1.13 to 5.82) and sCD14 (≥2187 vs. <2187: adjusted hazard ratio 2.79, interquartile range 1.29-6.02) levels.
In these sub-Saharan African adults with high CD4 counts, pre-ART plasma sVCAM-1 and sCD14 levels were independently associated with mortality.
一些炎症和凝血生物标志物已被报道与不同环境中的 HIV 疾病进展相关。在本文中，我们报告了 11 种生物标志物与感染 HIV 的西非成年人中期死亡率之间的关联。
在 Temprano ANRS 12136 中，CD4 计数较高的抗逆转录病毒治疗（ART）初治 HIV 感染成年人被随机分配立即开始 ART 或推迟 ART，直到符合世界卫生组织标准。完成 30 个月试验随访的参与者被邀请参加试验后阶段。试验后阶段的终点是全因死亡。我们使用多变量 Cox 比例模型分析了基线血浆生物标志物[白细胞介素-1受体拮抗剂（IL-1ra）、白细胞介素-6（IL-6）、可溶性血管细胞黏附分子 1（sVCAM-1）、可溶性 CD14、D-二聚体、纤维蛋白原、干扰素诱导蛋白 10（IP-10）、可溶性 CD163、白蛋白、高敏 C 反应蛋白和 16S rDNA]与 Temprano 中随机推迟 ART 的参与者全因死亡之间的关系。
477 名患者（中位年龄 35 岁，78%为女性，中位 CD4 计数为 379 个/立方毫米）被随机分配推迟至符合世界卫生组织标准时开始 ART。参与者随访了 2646 人年（中位随访时间为 5.8 年）。在随访期间，89%的参与者开始接受 ART，30 人死亡。在调整研究中心、性别、基线 CD4 计数、异烟肼预防性治疗、血浆 HIV-1 RNA、外周血单个核细胞 HIV-1 DNA 和 ART 后进行多变量分析，死亡风险与基线 sVCAM-1（≥1458 比 <1458：调整后的危险比 2.57，95%置信区间：1.13 至 5.82）和 sCD14（≥2187 比 <2187：调整后的危险比 2.79，四分位距 1.29 至 6.02）水平显著相关。
在这些 CD4 计数较高的撒哈拉以南非洲成年人中，ART 前血浆 sVCAM-1 和 sCD14 水平与死亡率独立相关。
