期刊
CLINICAL INFECTIOUS DISEASES
卷 65, 期 6, 页码 959-966出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/cix466
关键词
CD8 count; CD4:CD8 ratio; mortality; HIV; antiretroviral therapy
资金
- UK Medical Research Council (MRC) [MR/J002380/1]
- UK Department for International Development (DFID) under the MRC/DFID Concordat
- European Union
- National Institute for Health Research [NF-SI-0611-10168]
- Agence Nationale de Recherche sur le SIDA et les hepatites virales (ANRS)
- Institut National de la Sante et de la Recherche Medicale (INSERM)
- French Ministry of Health
- Italian Ministry of Health
- Spanish Ministry of Health
- Swiss National Science Foundation [33CS30_134277]
- Ministry of Science and Innovation
- Spanish Network for AIDS Research (RIS) [ISCIII-RETIC RD06/006]
- Dutch Ministry of Health, Welfare and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment
- European Commission [260694]
- British Columbia government
- Alberta government
- National Institutes of Health (NIH) (University of Washington Center for AIDS Research [CFAR]) (NIH) [P30 AI027757]
- University of Alabama at Birmingham CFAR (NIH) [P30-AI027767]
- Tennessee CFAR (NIH) [P30 AI110527]
- National Institute on Alcohol Abuse and Alcoholism [U10-AA13566, U24-AA020794]
- US Department of Veterans Affairs
- Michael Smith Foundation for Health Research
- Canadian Institutes of Health Research
- Veterans Health Administration Office of Research and Development
- European Union [260694]
- MRC [G0100221, G0700820, MR/J002380/1] Funding Source: UKRI
- Medical Research Council [G0100221, G0700820, MR/J002380/1] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0616-10111, NF-SI-0611-10168] Funding Source: researchfish
Background. We investigated whether CD4:CD8 ratio and CD8 count were prognostic for all-cause, AIDS, and non-AIDS mortality in virologically suppressed patients with high CD4 count. Methods. We used data from 13 European and North American cohorts of human immunodeficiency virus-infected, antiretroviral therapy (ART)-naive adults who started ART during 1996-2010, who were followed from the date they had CD4 count >= 350 cells/mu L and were virologically suppressed (baseline). We used stratified Cox models to estimate unadjusted and adjusted (for sex, people who inject drugs, ART initiation year, and baseline age, CD4 count, AIDS, duration of ART) all-cause and cause-specific mortality hazard ratios for tertiles of CD4: CD8 ratio (0-0.40, 0.41-0.64 [reference], >0.64) and CD8 count (0-760, 761-1138 [reference], >1138 cells/mu L) and examined the shape of associations using cubic splines. Results. During 276 526 person-years, 1834 of 49 865 patients died (249 AIDS-related; 1076 non-AIDS-defining; 509 unknown/unclassifiable deaths). There was little evidence that CD4: CD8 ratio was prognostic for all-cause mortality after adjustment for other factors: the adjusted hazard ratio (aHR) for lower vs middle tertile was 1.11 (95% confidence interval [CI], 1.00-1.25). The association of CD8 count with all-cause mortality was U-shaped: aHR for higher vs middle tertile was 1.13 (95% CI, 1.01-1.26). AIDS-related mortality declined with increasing CD4: CD8 ratio and decreasing CD8 count. There was little evidence that CD4: CD8 ratio or CD8 count was prognostic for non-AIDS mortality. Conclusions. In this large cohort collaboration, the magnitude of adjusted associations of CD4: CD8 ratio or CD8 count with mortality was too small for them to be useful as independent prognostic markers in virally suppressed patients on ART.
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