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结合CD4计数,CD8计数和CD4/CD8比率来预测治疗后艾滋病毒阳性成年人死亡风险:基于小组的多轨迹分析

Jing Ma^1,2, Guoyong Wang^2,3, Xiaoyan Zhu^2,3

¹Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.

Frontiers in immunology

|December 21, 2023

概括

这项研究确定了ART启动后四种不同的免疫恢复模式. 具有较低CD4计数和CD4/CD8逆转的个体面临更高的死亡风险,这凸显了需要量身定制的干预措施.

科学领域:

免疫学免疫学免疫学
艾滋病毒/艾滋病研究研究
生物统计学生物统计学

背景情况:

以前对ART开始后免疫恢复的研究依赖于单个免疫标记 (CD4计数或CD4 / CD8比率).
这些标记物是相互连接的,单独依赖可能导致不准确的恢复轨迹估计.
综合CD4计数,CD8计数和CD4/CD8比率的综合模型对于准确的评估至关重要.

研究的目的:

开发和应用一个综合CD4计数,CD8计数和CD4/CD8比率的综合性轨迹模型.
在开始抗逆转录病毒疗法 (ART) 后,描述不同的免疫恢复模式.
调查与这些轨迹相关的因素及其对死亡率的影响.

主要方法:

利用基于小组的多轨迹模型,与ART启动后高达96个月的纵向数据.
分析了CD4计数,CD8计数和CD4/CD8比率,以确定恢复集群.
采用考克斯回归和卡普兰-梅尔生存分析来评估与确定的轨迹相关的死亡风险,考虑性别和年龄.

主要成果:

在14718个人中确定了四个不同的免疫恢复子组.
第1小组 (低CD4,反转CD4/CD8) 和第3小组 (缓慢的CD4恢复,反转CD4/CD8) 显示所有原因和非艾滋病相关死亡率的风险显著增加.
与参考组 (第2小组) 相比,第1小组也表现出与艾滋病相关的死亡风险明显更高.
观察到,男性和老年人免疫恢复速度较慢.

结论:

对多种免疫指标的纵向分析揭示了ART后明显的恢复轨迹.
特定的轨迹,特别是低CD4计数和CD4/CD8逆转的轨迹,与死亡风险增加有关.
这些发现支持使用全面的轨迹模型来指导针对弱势群体的临床干预.

关键词:

CD4 细胞的数量在CD4/CD8比率上.CD8计数数量的CD8计数数量艾滋病病毒艾滋病病毒艾滋病病毒抗逆转录病毒药物治疗死亡率死亡率

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