体质指数、蛋白尿和总淋巴细胞计数在预测坦桑尼亚达累斯萨拉姆开始抗逆转录病毒治疗的 HIV 初治个体中的治疗反应：一项队列研究。

Body mass index, proteinuria and total lymphocyte counts in predicting treatment responses among ART naïve individuals with HIV initiated on antiretroviral treatment in Dar es Salaam, Tanzania, 2019: a cohort study.

机构信息

Internal Medicine, Muhimbili University of Health and Allied Sciences School of Medicine, Dar es Salaam, Tanzania

Internal Medicine, Muhimbili University of Health and Allied Sciences School of Medicine, Dar es Salaam, Tanzania.

出版信息

BMJ Open. 2022 Jun 8;12(6):e059193. doi: 10.1136/bmjopen-2021-059193.

DOI:10.1136/bmjopen-2021-059193

PMID:35676009

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9185589/

Abstract

OBJECTIVES

To explore the potential use of body mass index (BMI), proteinuria and total lymphocyte count changes in predicting immunological and virological response in individuals with HIV initiated on antiretroviral treatment (ART).

DESIGN

Prospective cohort study.

SETTING

Three urban HIV care and treatment centres in Dar es Salaam.

PARTICIPANTS

Individuals with HIV initiating ART.

OUTCOME MEASURES

HIV viral load ≥1000 copies/mL (viral non-suppression) at 6 months after ART initiation.

RESULTS

Of 215 (out of 220 enrolled) participants who returned for evaluation at 6 months, 147 (66.8%) were women. At 6 months of follow-up, 89.4% (76/85) of participants with sustained weight gain were virally suppressed compared with 31.8% (7/22) with sustained loss, p<0.001. In participants who were lymphopaenic at baseline, an increase to normal total lymphocyte counts at 6 months was associated with an increase in CD4 count compared with participants who remained lymphopaenic, 96.2% (50/52) versus 54.8% (17/31), p<0.001. At baseline, 50.0% (110/220) had proteinuria. In participants without proteinuria from baseline to 6 months, 89.8% (79/88) were virally suppressed compared with participants with proteinuria at baseline and/or 3 months, 85.6% (77/90), those with persistent proteinuria, 30.8% (8/26), and proteinuria at 6 months only, 45.5% (5/11), p<0.001. In modified Poisson regression, the independent predictors other than CD4 cell counts for viral non-suppression at 6 months among individuals with HIV initiating on ART were BMI loss >5% from baseline to 6 months (adjusted RR 2.73, 95% CI (1.36 to 5.47)), lymphopaenia at 6 months (adjusted RR=4.54, 95% CI (2.19 to 9.39)) and proteinuria at 6 months (adjusted RR=2.63, 95% CI (1.25 to 5.54)).

CONCLUSIONS

Change in BMI, total lymphocyte count and presence of proteinuria can monitor and predict ART response and may be particularly helpful in settings when CD4 counts and viral load monitoring are unavailable.

摘要

目的

探讨体重指数（BMI）、蛋白尿和总淋巴细胞计数变化在预测开始抗逆转录病毒治疗（ART）的 HIV 感染者免疫和病毒学反应中的潜在作用。

设计

前瞻性队列研究。

地点

达累斯萨拉姆的三个城市 HIV 护理和治疗中心。

参与者

开始接受 ART 的 HIV 感染者。

主要结局测量

ART 开始后 6 个月时 HIV 病毒载量≥1000 拷贝/mL（病毒未抑制）。

结果

在 220 名入组的参与者中，有 215 名（占 88.6%）在 6 个月时返回进行评估，其中 147 名（占 66.8%）为女性。在 6 个月的随访中，与持续体重下降的参与者相比，持续体重增加的参与者中有 89.4%（76/85）病毒抑制，而持续体重下降的参与者只有 31.8%（7/22），p<0.001。在基线时淋巴细胞减少的参与者中，与仍淋巴细胞减少的参与者相比，6 个月时总淋巴细胞计数恢复正常与 CD4 计数增加相关，分别为 96.2%（50/52）和 54.8%（17/31），p<0.001。在基线时，50.0%（220/440）有蛋白尿。在从基线到 6 个月时没有蛋白尿的参与者中，与基线和/或 3 个月时有蛋白尿的参与者相比，89.8%（79/88）病毒抑制，持续有蛋白尿的参与者为 30.8%（8/26），只有 6 个月时有蛋白尿的参与者为 45.5%（5/11），p<0.001。在修正泊松回归中，除 CD4 细胞计数外，ART 开始时 HIV 感染者 6 个月时病毒未抑制的独立预测因素包括：从基线到 6 个月时 BMI 损失>5%（调整后的 RR 2.73，95%CI（1.36 至 5.47））、6 个月时淋巴细胞减少（调整后的 RR=4.54，95%CI（2.19 至 9.39））和 6 个月时蛋白尿（调整后的 RR=2.63，95%CI（1.25 至 5.54））。