CD4 Cell Count and the Risk of AIDS or Death in HIV-Infected Adults on Combination Antiretroviral Therapy with a Suppressed Viral Load A Longitudinal Cohort Study from COHERE 英文参考文献.docVIP

CD4CellCountandtheRiskofAIDSorDeathinHIV- InfectedAdultsonCombinationAntiretroviralTherapy withaSuppressedViralLoad:ALongitudinalCohort StudyfromCOHERE TheOpportunisticInfectionsProjectTeamoftheCollaborationofObservationalHIVEpidemiological ResearchinEurope(COHERE)inEuroCoord* Abstract Background: MostadultsinfectedwithHIVachieveviralsuppression withinayearofstartingcombinationantiretroviral therapy(cART).ItisimportanttounderstandtheriskofAIDSeventsordeathforpatientswithasuppressedviralload. Methods and Findings: Using data from the Collaboration of Observational HIV Epidemiological Research Europe (2010 merger), we assessed the risk of a new AIDS-defining event or death in successfully treated patients. We accumulated episodesofviralsuppressionforeachpatientwhileoncART,eachepisodebeginningwiththesecondoftwoconsecutive plasma viral load measurements ,50 copies/ml and ending with either a measurement .500 copies/ml, the first of two consecutive measurements between 50–500 copies/ml, cART interruption or administrative censoring. We used stratified multivariateCoxmodelstoestimatetheassociationbetweentimeupdatedCD4cellcountandanewAIDSeventordeath ordeathalone.75,336patientscontributed104,265suppressionepisodesandweresuppressedwhileoncARTforamedian 2.7years.Themortalityratewas4.8per1,000yearsofviralsuppression.AhigherCD4cellcountwasalwaysassociatedwith areducedriskofanewAIDSeventordeath;withahazardratioper100cells/ml(95%CI)of:0.35(0.30–0.40)forcounts,200 cells/ml,0.81(0.71–0.92)forcounts200to,350cells/ml,0.74(0.66–0.83)forcounts350to,500cells/ml,and0.96(0.92–0.99) forcounts$500cells/ml.AhigherCD4cellcountbecameevenmorebeneficialovertimeforpatientswithCD4cellcounts ,200cells/ml. Conclusions: Despite thelow mortality rate, therisk of a new AIDS eventor death follows aCD4 cell count gradient in patientswithviralsuppression.AhigherCD4cellcountwasassociatedwiththegreatestbenefitforpatientswithaCD4cell count,200cells/mlbutstillsomeslightbenefitforthosewithaCD4cellcount$5