Pretreatment CD4 Cell Slope and Progression to AIDS or Death in HIV-Infected Patients Initiating Antiretroviral Therapy—The CASCADE Collaboration A Collaboration of 23 Cohort Studies 英文参考文献.docVIP

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Pretreatment CD4 Cell Slope and Progression to AIDS or Death in HIV-Infected Patients Initiating Antiretroviral Therapy—The CASCADE Collaboration A Collaboration of 23 Cohort Studies 英文参考文献.doc

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Pretreatment CD4 Cell Slope and Progression to AIDS or Death in HIV-Infected Patients Initiating Antiretroviral Therapy—The CASCADE Collaboration A Collaboration of 23 Cohort Studies 英文参考文献

PretreatmentCD4CellSlopeandProgressiontoAIDSor DeathinHIV-InfectedPatientsInitiatingAntiretroviral Therapy—TheCASCADECollaboration:ACollaboration of23CohortStudies MarcelWolbers1,2*,AbdelBabiker3,CarolineSabin4,JimYoung1,MariaDorrucci5,Genevie`veChe?ne6, CristinaMussini7,KholoudPorter3,HeinerC.Bucher1,onbehalfoftheCASCADECollaboration 1BaselInstituteforClinicalEpidemiologyandBiostatistics,UniversityHospitalBasel,Basel,Switzerland,2OxfordUniversityClinicalResearchUnit,WellcomeTrustMajor OverseasProgram,HospitalforTropicalDiseases,HoChiMinhCity,Vietnam,3MedicalResearchCouncilClinicalTrialsUnit,London,UnitedKingdom,4UniversityCollege London Medical School, London, United Kingdom, 5Istituto Superiore di Sanita`, Rome, Italy, 6Universite′ Bordeaux II, Bordeaux, France, 7University of Modena and ReggioEmiliaandAziendaPoliclinico,Modena,Italy Abstract Background:CD4cellcountisastrongpredictorofthesubsequentriskofAIDSordeathinHIV-infectedpatientsinitiating combinationantiretroviraltherapy(cART).ItisnotknownwhethertherateofCD4celldeclinepriortotherapyisrelatedto prognosisandshould,therefore,influencethedecisiononwhentoinitiatecART. MethodsandFindings:Wecarriedoutsurvivalanalysesofpatientsfromthe23cohortsoftheCASCADE(ConcertedAction onSeroConversiontoAIDSandDeathinEurope)collaborationwithaknowndateofHIVseroconversionandwithatleast twoCD4measurementspriortoinitiatingcART.Foreachpatient,apre-cARTCD4slopewasestimatedusingalinearmixed effectsmodel.OurprimaryoutcomewastimefrominitiatingcARTtoafirstnewAIDSeventordeath.Weincluded2,820 treatment-na?¨vepatientsinitiatingcARTwithamedian(interquartilerange)pre-cARTCD4celldeclineof61(46–81)cells/ml peryear;255patientssubsequentlyexperiencedanewAIDSeventordeathand125patientsdied.Inananalysisadjusted forestablishedriskfactors,thehazardratioforAIDSordeathwas1.01(95%confidenceinterval0.97–1.04)foreach10cells/ ml per year reduction in pre-cART CD4 cell decline. There was also no association between pre-cART CD4 cell slope and survival.Alter