当前和既往免疫缺陷与接受抗病毒治疗长达 11 年的病毒学抑制的患者较高的住院率相关。

Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years.

机构信息

Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

出版信息

J Infect Dis. 2021 Aug 16;224(4):657-666. doi: 10.1093/infdis/jiaa786. Epub 2020 Dec 26.

DOI:10.1093/infdis/jiaa786

PMID:34398239

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8366443/

Abstract

BACKGROUND

Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk.

METHODS

In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count.

RESULTS

The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI, .93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression.

CONCLUSIONS

Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.

摘要

背景

尽管接受了有效的抗逆转录病毒治疗，但人类免疫缺陷病毒 (PWH) 患者的 CD4 计数持续较低，其住院风险可能更高。

方法

在 6 个美国和加拿大临床队列中，2005-2015 年病毒学抑制≥1 年的 PWH 随访至病毒学失败、失访、死亡或研究结束。根据早期（第 2-5 年）和长期（第 6-11 年）抑制以及最低预抑制 CD4 计数<200 和≥200 个细胞/μL 分层，使用泊松回归模型估计按时间更新的 CD4 计数类别分层的患者的住院发病率比（aIRR），调整队列、年龄、性别、日历年份、抑制持续时间和最低预抑制 CD4 计数。

结果

6997 例纳入患者（19980 人年）中，81%为顺性别男性，40%为白人。在最低预抑制 CD4 计数<200 个细胞/μL（44%）的患者中，当前 CD4 计数为 200-350 与>500 个细胞/μL 的患者，在早期抑制时的 aIRR 为 1.44（95%CI，1.01-2.06），在长期抑制时为 1.67（95%CI，1.03-2.72）。在最低预抑制 CD4 计数≥200（56%）的患者中，当前 CD4 计数为 351-500 与>500 个细胞/μL 的患者，在早期抑制时的 aIRR 为 1.22（95%CI，0.93-1.60），在长期抑制时为 2.09（95%CI，1.18-3.70）。