Alcabes P, Schoenbaum E E, Klein R S
Department of Epidemiology and Social Medicine, Montefiore Medical Center, Bronx, NY 10467.
AIDS. 1993 Apr;7(4):513-7. doi: 10.1097/00002030-199304000-00010.
To examine the relationship between rate of loss of CD4+ T lymphocytes and risk of AIDS in HIV-infected intravenous drug users (IVDU) enrolled in a methadone program in the Bronx, New York.
Serial CD4 percentages (CD4%) among lymphocytes before AIDS diagnosis were recorded at approximately 6-month intervals for 190 HIV-antibody-positive subjects.
A nested case-control study was performed, in which all subjects who developed AIDS were compared with those who remained AIDS-free. The relationship between CD4% decline and AIDS risk was evaluated using proportional-hazards regression.
Analyses that used a single baseline CD4% measurement to adjust for CD4+ lymphocyte count suggested that both low (1-5 CD4% per semester) and high (> 5 CD4% per semester) rates of decline might be related to AIDS risk: relative risks were 1.83 and 1.44, although the 95% confidence intervals (Cl) included 1.0 in each case. Adjustment for current level of CD4% eliminated the association between low rates of CD4% decline and AIDS risk, but not that between high rates of decline and AIDS risk (adjusted relative risk, 1.80; 95% Cl, 0.57-5.70). Serial observations showed that a rate of decline of CD4% > 5 per semester was a significant predictor of AIDS risk after controlling for level of CD4% achieved (adjusted relative risk, 3.58; 95% Cl, 1.07-11.95).
IVDU who develop AIDS have a greater rate of CD4 cell loss than subjects who remain AIDS-free. A low rate of CD4+ lymphocyte depletion is not an important predictor of the immediate onset of AIDS in HIV-infected IVDU, compared with CD4+ lymphocyte level, but a high rate of CD4+ decline can be.
在纽约布朗克斯区参与美沙酮治疗项目的感染人类免疫缺陷病毒（HIV）的静脉注射吸毒者（IVDU）中，研究CD4 + T淋巴细胞损失率与获得性免疫缺陷综合征（AIDS）风险之间的关系。
对190名HIV抗体阳性受试者，在艾滋病诊断前每隔约6个月记录淋巴细胞中的系列CD4百分比（CD4%）。
进行了一项巢式病例对照研究，将所有患艾滋病的受试者与未患艾滋病的受试者进行比较。使用比例风险回归评估CD4%下降与艾滋病风险之间的关系。
使用单一基线CD4%测量值来校正CD4 +淋巴细胞计数的分析表明，低（每半年1 - 5 CD4%）和高（每半年> 5 CD4%）下降率都可能与艾滋病风险有关：相对风险分别为1.83和1.44，尽管在每种情况下95%置信区间（Cl）都包含1.0。校正CD4%的当前水平消除了CD4%低下降率与艾滋病风险之间的关联，但未消除高下降率与艾滋病风险之间的关联（校正相对风险，1.80；95% Cl，0.57 - 5.70）。系列观察表明，在控制了达到的CD4%水平后，每半年CD4%下降率> 5是艾滋病风险的显著预测指标（校正相对风险，3.58；95% Cl，1.07 - 11.95）。
与未患艾滋病的受试者相比，患艾滋病的IVDU的CD4细胞损失率更高。与CD4 +淋巴细胞水平相比，CD4 +淋巴细胞低消耗率不是HIV感染的IVDU中艾滋病立即发病的重要预测指标，但CD4 +高下降率可能是。
