CD4/CD8 比值与高效治疗人类免疫缺陷病毒（HIV）感染背景下卡波西肉瘤或非霍奇金淋巴瘤的风险：20 项欧洲队列研究的协作分析。

CD4/CD8 Ratio and the Risk of Kaposi Sarcoma or Non-Hodgkin Lymphoma in the Context of Efficiently Treated Human Immunodeficiency Virus (HIV) Infection: A Collaborative Analysis of 20 European Cohort Studies.

机构信息

Unité VIH-IST, Service d'Immuno-Hématologie, Hôpital Victor Dupouy, Argenteuil, France.

Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.

出版信息

Clin Infect Dis. 2021 Jul 1;73(1):50-59. doi: 10.1093/cid/ciaa1137.

DOI:10.1093/cid/ciaa1137

PMID:34370842

Abstract

BACKGROUND

A persistently low CD4/CD8 ratio has been reported to inversely correlate with the risk of non-AIDS defining cancer in people living with human immunodeficiency virus (HIV; PLWH) efficiently treated by combination antiretroviral therapy (cART). We evaluated the impact of the CD4/CD8 ratio on the risk of Kaposi sarcoma (KS) or non-Hodgkin lymphoma (NHL), still among the most frequent cancers in treated PLWH.

METHODS

PLWH from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) were included if they achieved virological control (viral load ≤ 500 copies/mL) within 9 months following cART and without previous KS/LNH diagnosis. Cox models were used to identify factors associated with KS or NHL risk, in all participants and those with CD4 ≥ 500/mm3 at virological control. We analyzed the CD4/CD8 ratio, CD4 count and CD8 count as time-dependent variables, using spline transformations.

RESULTS

We included 56 708 PLWH, enrolled between 2000 and 2014. At virological control, the median (interquartile range [IQR]) CD4 count, CD8 count, and CD4/CD8 ratio were 414 (296-552)/mm3, 936 (670-1304)/mm3, and 0.43 (0.28-0.65), respectively. Overall, 221 KS and 187 NHL were diagnosed 9 (2-37) and 18 (7-42) months after virological control. Low CD4/CD8 ratios were associated with KS risk (hazard ratio [HR] = 2.02 [95% confidence interval {CI } = 1.23-3.31]) when comparing CD4/CD8 = 0.3 to CD4/CD8 = 1) but not with NHL risk. High CD8 counts were associated with higher NHL risk (HR = 3.14 [95% CI = 1.58-6.22]) when comparing CD8 = 3000/mm3 to CD8 = 1000/mm3). Similar results with increased associations were found in PLWH with CD4 ≥ 500/mm3 at virological control (HR = 3.27 [95% CI = 1.60-6.56] for KS; HR = 5.28 [95% CI = 2.17-12.83] for NHL).

CONCLUSIONS

Low CD4/CD8 ratios and high CD8 counts despite effective cART were associated with increased KS/NHL risks respectively, especially when CD4 ≥ 500/mm3.

摘要

背景

一直以来，CD4/CD8 比值较低与接受高效抗逆转录病毒治疗（cART）的 HIV 感染者（PLWH）非艾滋病定义癌症的风险呈负相关。我们评估了 CD4/CD8 比值对卡波西肉瘤（KS）或非霍奇金淋巴瘤（NHL）风险的影响，这些癌症仍然是治疗后 PLWH 中最常见的癌症之一。

方法

如果 PLWH 在 cART 后 9 个月内实现病毒学控制（病毒载量≤500 拷贝/mL）且无 KS/LNH 先前诊断，则将其纳入 Collaboration of Observational HIV Epidemiological Research Europe（COHERE）的研究。使用 Cox 模型确定与 KS 或 NHL 风险相关的因素，包括所有参与者和病毒学控制时 CD4≥500/mm3 的参与者。我们使用样条变换将 CD4/CD8 比值、CD4 计数和 CD8 计数分析为时间依赖性变量。

结果

我们纳入了 56708 名 PLWH，他们于 2000 年至 2014 年期间入组。在病毒学控制时，中位数（四分位数范围 [IQR]）CD4 计数、CD8 计数和 CD4/CD8 比值分别为 414（296-552）/mm3、936（670-1304）/mm3 和 0.43（0.28-0.65）。总体而言，221 例 KS 和 187 例 NHL 在病毒学控制后 9（2-37）和 18（7-42）个月被诊断出。低 CD4/CD8 比值与 KS 风险相关（风险比 [HR]＝2.02[95%置信区间 {CI}＝1.23-3.31]），当比较 CD4/CD8＝0.3 与 CD4/CD8＝1 时），但与 NHL 风险无关。高 CD8 计数与 NHL 风险增加相关（HR＝3.14[95%CI＝1.58-6.22]），当比较 CD8＝3000/mm3 与 CD8＝1000/mm3 时）。在病毒学控制时 CD4≥500/mm3 的 PLWH 中发现了类似的结果，增加了相关性（KS 的 HR＝3.27[95%CI＝1.60-6.56]；NHL 的 HR＝5.28[95%CI＝2.17-12.83]）。