血浆可溶性血管细胞黏附分子-1 和 sCD14 与高 CD4 计数的 HIV-1 感染西非成年人死亡率的相关性。
Association of Plasma Soluble Vascular Cell Adhesion Molecule-1 and sCD14 With Mortality in HIV-1-Infected West African Adults With High CD4 Counts.
机构信息
CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire.
PACCI-ANRS Research Site, Côte d'Ivoire.
出版信息
J Acquir Immune Defic Syndr. 2021 Jan 1;86(1):138-145. doi: 10.1097/QAI.0000000000002533.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
In these sub-Saharan African adults with high CD4 counts, pre-ART plasma sVCAM-1 and sCD14 levels were independently associated with mortality.
背景
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。
方法
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。
结果
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。
结论
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。
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