Cozzi Lepri A, Sabin C A, Phillips A N, Lee C A, Pezzotti P, Rezza G
Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, UK.
Epidemiol Infect. 1998 Oct;121(2):369-76. doi: 10.1017/s095026889800140x.
The data of two cohort studies of HIV-infected individuals were used to examine whether the rate of CD4 decline is a determinant of HIV progression, independent of the most recent CD4 count. Time from seroconversion to clinical AIDS was the main outcome measure. Rates of CD4 decline were estimated using the ordinary least squares regression method. AIDS incidences were compared in individuals who had previously experienced either a steeper or a less steep rate of CD4 decline. Cox proportional hazards model including a time-dependent covariate for the rate of CD4 decline was performed. The rate of prior CD4 decline was significantly associated with the risk of developing AIDS independently from the most recent CD4 count, with a 2% increase in hazard of AIDS (P < 0.01) for a difference of 10 cells/mm3 in the estimated yearly drop in CD4 count. This finding gives scientific credit to the belief that individuals with a prior steeper CD4 decline consistently have a higher subsequent risk of developing AIDS than those with a less steep prior decline.
两项针对HIV感染者的队列研究数据被用于检验CD4下降速率是否是HIV进展的一个决定因素，而不考虑最近的CD4计数。从血清转化到临床艾滋病的时间是主要的结局指标。使用普通最小二乘法回归方法估计CD4下降速率。比较先前经历过较快速率或较慢速率CD4下降的个体的艾滋病发病率。进行了Cox比例风险模型分析，该模型纳入了一个针对CD4下降速率的时间依存性协变量。先前的CD4下降速率与发展为艾滋病的风险显著相关，独立于最近的CD4计数，CD4计数估计每年下降10个细胞/mm³时，艾滋病风险增加2%（P<0.01）。这一发现为以下观点提供了科学依据：先前CD4下降速率较快的个体，相较于先前下降速率较慢的个体，后续发展为艾滋病的风险持续更高。
