Schlumpberger J M, Wolde-Tsadik G, Yao J F, Hara J
Department of Family Practice, Kaiser Permanente Medical Center, Los Angeles, CA 90027.
J Fam Pract. 1994 Jan;38(1):33-8.
Mortality related to human immunodeficiency virus (HIV) infection occurs predominantly in patients with CD4+ lymphocyte counts of less than 50 cells/mm3. We followed 133 HIV-infected patients with enrollment CD4 counts of less than 50 cells/mm3 to determine if the risk of death during a 1-year period could be predicted by a single enrollment CD8+ lymphocyte count.
Enrollment data including age, sex, T-cell subset counts, p24 antigen status, antiretroviral use, and preexisting HIV-related illnesses were collected on a cohort of 133 consecutive patients with enrollment CD4 counts of less than 50 cells/mm3. The cohort was followed for 1 year, and survival data were analyzed in relation to enrollment variables.
The mean enrollment CD8 count of those patients alive at 1 year was 600 cells/mm3, compared with a mean enrollment CD8 count of only 370 cells/mm3 in patients who had died prior to 1 year (P < .001). For every 100-cell decline in the enrollment CD8 count, the risk of death increased by 16% (95% confidence interval [CI], 5% to 22%), independent of other enrollment variables, including CD4 counts and p24 antigen status. A significant CD8 count warning level of 415 cells/mm3, irrespective of the presence of other enrollment variables, was associated with death within 1 year. The Kaplan-Meier estimated chance of death within 1 year was 54% (95% CI, 42% to 66%) for patients with CD8 counts of less than 415 cells/mm3 compared with only 25% (95% CI, 14% to 36%) for patients with CD8 counts greater than 415 cells/mm3.
This study finds that a single CD8 count has important prognostic significance in patients with advanced HIV infection and suggests that potential therapies to enhance CD8 counts might be beneficial to patients with advanced HIV infection.
与人类免疫缺陷病毒（HIV）感染相关的死亡主要发生在CD4 +淋巴细胞计数低于50个细胞/mm³的患者中。我们对133例入组时CD4计数低于50个细胞/mm³的HIV感染患者进行了随访，以确定单次入组时的CD8 +淋巴细胞计数是否能够预测1年内的死亡风险。
收集了133例连续入组的CD4计数低于50个细胞/mm³患者的入组数据，包括年龄、性别、T细胞亚群计数、p24抗原状态、抗逆转录病毒药物使用情况以及既往存在的HIV相关疾病。对该队列进行了1年的随访，并根据入组变量分析了生存数据。
1年后存活患者的入组时平均CD8计数为600个细胞/mm³，而1年前死亡患者的入组时平均CD8计数仅为370个细胞/mm³（P <.001）。入组时CD8计数每下降100个细胞，死亡风险增加16%（95%置信区间[CI]，5%至22%），与包括CD4计数和p24抗原状态在内的其他入组变量无关。无论是否存在其他入组变量，显著的CD8计数警告水平为415个细胞/mm³与1年内死亡相关。CD8计数低于415个细胞/mm³的患者，Kaplan-Meier估计的1年内死亡几率为54%（95%CI，42%至66%），而CD8计数高于415个细胞/mm³的患者仅为25%（95%CI，14%至36%）。
本研究发现单次CD8计数在晚期HIV感染患者中具有重要的预后意义，并表明提高CD8计数的潜在疗法可能对晚期HIV感染患者有益。
