潜伏性结核分枝杆菌感染治疗对急性、近期和慢性 HIV 感染中 CD4/CD8 恢复时间的影响。

Impact of Latent M. tuberculosis Infection Treatment on Time to CD4/CD8 Recovery in Acute, Recent, and Chronic HIV Infection.

机构信息

Department of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH.

Instituto de Pesquisa Clínica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil.

出版信息

J Acquir Immune Defic Syndr. 2023 Dec 1;94(4):355-363. doi: 10.1097/QAI.0000000000003284. Epub 2023 Oct 26.

DOI:10.1097/QAI.0000000000003284

PMID:37595204

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10609716/

Abstract

INTRODUCTION

In people living with HIV, active and latent tuberculosis (TB) coinfections are associated with immune activation that correlate with HIV progression and mortality. We investigated the effect of initiating antiretroviral therapy (ART) during acute (AHI), recent (RHI), or chronic HIV infection (CHI) on CD4/CD8 ratio normalization and associated factors, the impact of latent TB infection treatment, and prior/concomitant TB diagnosis at the time of ART initiation.

METHODS

We included sex with men and transgender women individuals initiating ART with AHI, RHI and CHI between 2013 and 2019, from a prospective cohort in Brazil. We compared time from ART initiation to the first normal CD4/CD8 ratio (CD4/CD8 ≥1) using Kaplan-Meier curves and multivariable Cox proportional hazards models. Sociodemographic and clinical variables were explored. Variables with P -values <0.20 in univariable analyses were included in multivariable analyses.

RESULTS

Five hundred fifty participants were included, 11.8% classified as AHI and 6.4% as RHI, 46.7% with CHI-CD4 cell counts ≥350 cells/mm 3 and 35.1% with CHI-CD4 cell counts <350 cells/mm 3 . Time to normalization was shortest among AHI patients, followed by RHI and CHI individuals with higher baseline CD4. In the multivariable model, AHI was associated with a six-fold increased likelihood of achieving a CD4/CD8 ratio ≥1 (hazard ratio [HR]: 6.03; 95% confidence interval [CI]: 3.70 to 9.82; P < 0.001), RHI with HR: 4.47 (95% CI: 2.57 to 7.76; P < 0.001), and CHI CD4 ≥350 cells/mm 3 with HR: 1.87 (95% CI: 1.24 to 2.84; P = 0.003). Latent TB infection treatment was significantly associated with a higher likelihood of the outcome (HR: 1.79; 95% CI: 1.22 to 2.62; P = 0.003). Previous history or concomitant active TB at ART initiation was associated with a lower likelihood of the outcome (HR: 0.41; 95% CI: 0.16 to 1.02; P = 0.054).

CONCLUSIONS

Initiating ART early during AHI may offer an opportunity to mitigate immune damage. Efforts to implement HIV diagnosis and ART initiation during AHI are critical to amplify ART benefits.

摘要

简介

在 HIV 感染者中，活动性和潜伏性结核病（TB）合并感染与免疫激活相关，而免疫激活与 HIV 进展和死亡率相关。我们研究了在急性（AHI）、近期（RHI）或慢性 HIV 感染（CHI）期间开始抗逆转录病毒治疗（ART）对 CD4/CD8 比值正常化的影响及其相关因素、潜伏性 TB 感染治疗的影响，以及 ART 起始时的既往/同时性 TB 诊断。

方法

我们纳入了 2013 年至 2019 年间，在巴西前瞻性队列中开始 AHI、RHI 和 CHI 的男男性行为者和跨性别女性个体。我们使用 Kaplan-Meier 曲线和多变量 Cox 比例风险模型比较了从 ART 开始到首次 CD4/CD8 比值正常（CD4/CD8≥1）的时间。我们探讨了社会人口统计学和临床变量。单变量分析中 P 值<0.20 的变量被纳入多变量分析。

结果

共纳入 550 名参与者，11.8%为 AHI，6.4%为 RHI，46.7%的患者 CHI-CD4 细胞计数≥350 个/立方毫米，35.1%的患者 CHI-CD4 细胞计数<350 个/立方毫米。AHI 患者达到 CD4/CD8 比值≥1 的时间最短，其次是 RHI 和 CHI 患者，基线 CD4 较高。多变量模型中，AHI 患者达到 CD4/CD8 比值≥1 的可能性增加了六倍（风险比 [HR]：6.03；95%置信区间 [CI]：3.70 至 9.82；P<0.001），RHI 的 HR 为 4.47（95%CI：2.57 至 7.76；P<0.001），CHI-CD4≥350 个/立方毫米的 HR 为 1.87（95%CI：1.24 至 2.84；P=0.003）。潜伏性 TB 感染治疗与结果的可能性增加显著相关（HR：1.79；95%CI：1.22 至 2.62；P=0.003）。ART 开始时的既往史或同时性活动性 TB 与结果的可能性降低相关（HR：0.41；95%CI：0.16 至 1.02；P=0.054）。