CD4 deficit and tuberculosis risk persist with delayed antiretroviral therapy: 5-year data from CIPRA HT-001

被引：15

作者：

Collins, S. E. ^{[1
]}

Juste, M. A. Jean ^{[2
]}

Koenig, S. P. ^{[3
]}

Secours, R. ^{[2
]}

Ocheretina, O. ^{[1
]}

Bernard, D. ^{[2
]}

Riviere, C. ^{[2
]}

Calnan, M. ^{[4
]}

Dunning, A. ^{[5
]}

Rua, S. M. Hurtado ^{[5
]}

Johnson, W. D., Jr. ^{[1
]}

Pape, J. W. ^{[1
,2
]}

Fitzgerald, D. W. ^{[1
]}

Severe, P. ^{[2
]}

机构：

[1] Weill Cornell Med Coll, Ctr Global Hlth, Dept Med, New York, NY 10065 USA

[2] GHESKIO, Port Au Prince, Haiti

[3] Brigham & Womens Hosp, Div Global Hlth Equ, Boston, MA 02115 USA

[4] Anal Grp Inc, Boston, MA USA

[5] Weill Cornell Med Coll, Dept Publ Hlth, New York, NY 10065 USA

来源：

INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE | 2015年 / 19卷 / 01期

基金：

美国国家卫生研究院;

关键词：

human immunodeficiency virus; TB incidence; CD4 lymphocyte count; HIV-TB; ART; HIV-INFECTED ADULTS; CELL RECOVERY; COTE-DIVOIRE; TERM; AIDS; INDIVIDUALS; PROPHYLAXIS; PROGRESSION; PREVENTION; MORTALITY;

D O I：

10.5588/ijtld.14.0217

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

SETTING: Port-au-Prince, Haiti. OBJECTIVE: To determine long-term effects of early vs. delayed initiation of antiretroviral therapy (ART) on immune recovery and tuberculosis (TB) risk in human immunodeficiency virus (HEY) infected individuals. DESIGN: Open-label randomized controlled trial of immediate ART in HIV-infected adults with CD4 counts between 200 and 350 cells/mm(3) vs. deferring ART until the CD4 count was <200 cells/mm(3). The primary comparisons were CD4 counts over time and risk for incident TB, with 5 years of follow-up. RESULTS: A total of 816 participants were enrolled, with 408 in each treatment arm. The early treatment group started ART within 2 weeks, while the deferred treatment group started ART a median of 1.3 years after enrollment. After 5 years, the mean CD4 count in the early treatment group was significantly higher than in the deferred treatment group (496 cells/mm3, 95% confidence interval [CI ] 477-515 vs. 373 cells/mm3, 95%CI 357-389; P < 0.0001). TB risk was higher in the deferred treatment group (unadjusted HR 2.41, 95 %CI 1.56-3.74; P < 0.0001) and strongly correlated with lower CD4 counts in time-dependent multivariate analysis. CONCLUSION: Delays in ART initiation for HIV-infected adults with CD4 counts of 200-350 cells/mm3 can result in long-term immune dysfunction and persistent increased risk for TB.

引用

页码：50 / 57

页数：8

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