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Sauter R, Huang R, Ledergerber B, Battegay M, Bernasconi E, Cavassini M, Furrer H, Hoffmann M, Rougemont M, Günthard HF, Held L. CD4/CD8 ratio and CD8 counts predict CD4 response in HIV-1-infected drug naive and in patients on cART. Medicine (Baltimore) 2016; 95:e5094. [PMID: 27759638 PMCID: PMC5079322 DOI: 10.1097/md.0000000000005094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Plasma HIV viral load is related to declining CD4 lymphocytes. The extent to which CD8 cells, in addition to RNA viral load, predict the depletion of CD4 cells is not well characterized so far. We examine if CD8 cell count is a prognostic factor for CD4 cell counts during an HIV infection.A longitudinal analysis is conducted using data from the Swiss HIV cohort study collected between January 2000 and October 2014. Linear mixed regression models were applied to observations from HIV-1-infected treatment naive patients (NAIVE) and cART-treated patients to predict the short-term evolution of CD4 cell counts. For each subgroup, it was quantified to which extent CD8 cell counts or CD4/CD8 ratios are prognostic factors for disease progression.In both subgroups, 2500 NAIVE and 8902 cART patients, past CD4 cells are positively (P < 0.0001) and past viral load is negatively (P < 0.0001) associated with the outcome. Including additionally past CD8 cell counts improves the fit significantly (P < 0.0001) and increases the marginal explained variation 31.7% to 40.7% for the NAIVE and from 44.1% to 50.7% for the cART group. The past CD4/CD8 ratio (instead of the past CD8 level) is positively associated with the outcome, increasing the explained variation further to 41.8% for NAIVE and 51.9% for cART.
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Affiliation(s)
- Rafael Sauter
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Ruizhu Huang
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Matthias Hoffmann
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Switzerland
| | - Mathieu Rougemont
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Leonhard Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
- Correspondence: Leonhard Held, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland (e-mail: )
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Grijalva CG, Roumie CL, Murff HJ, Hung AM, Beck C, Liu X, Griffin MR, Greevy RA. The role of matching when adjusting for baseline differences in the outcome variable of comparative effectiveness studies. J Comp Eff Res 2016; 4:341-9. [PMID: 26274795 DOI: 10.2217/cer.15.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Evaluate performance of analytical strategies commonly used to adjust for baseline differences in continuous outcome variables for comparative effectiveness studies. PATIENTS & METHODS Data simulations resembling a comparison of HbA1c values after initiation of antidiabetic treatments adjusting for baseline HbA1c. We evaluated change scores, analyses of covariance including linear, nonlinear with/without robust variance estimations, before and after optimal matching. We also evaluated the impact of measurement error. RESULTS With increasing HbA1c baseline differences between groups, bias in effect estimates and suboptimal CI coverage probabilities increased in all approaches. These issues were further compounded by measurement error. Matching on baseline HbA1c, substantially mitigated these issues. CONCLUSION In comparative studies with continuous outcomes, matching on baseline values of the outcome variable improves analytical performance.
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Affiliation(s)
- Carlos G Grijalva
- Department of Health Policy, Vanderbilt University, Nashville, TN, 37232 USA.,VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, 37212 USA
| | - Christianne L Roumie
- VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, 37212 USA.,Department of Medicine, Vanderbilt University, Nashville, TN, 37232 USA
| | - Harvey J Murff
- VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, 37212 USA.,Department of Medicine, Vanderbilt University, Nashville, TN, 37232 USA
| | - Adriana M Hung
- VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, 37212 USA.,Department of Medicine, Vanderbilt University, Nashville, TN, 37232 USA
| | - Cole Beck
- Department of Biostatistics, Vanderbilt University, Nashville, TN, 37203 USA
| | - Xulei Liu
- VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, 37212 USA.,Department of Biostatistics, Vanderbilt University, Nashville, TN, 37203 USA
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University, Nashville, TN, 37232 USA.,VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, 37212 USA.,Department of Medicine, Vanderbilt University, Nashville, TN, 37232 USA
| | - Robert A Greevy
- VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, 37212 USA.,Department of Biostatistics, Vanderbilt University, Nashville, TN, 37203 USA
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Ciurea A, Scherer A, Weber U, Exer P, Bernhard J, Tamborrini G, Riek M, Müller RB, Weiss B, Nissen MJ, Kissling R, Michel BA, Finckh A. Impaired response to treatment with tumour necrosis factor α inhibitors in smokers with axial spondyloarthritis. Ann Rheum Dis 2015; 75:532-9. [PMID: 25667205 DOI: 10.1136/annrheumdis-2013-205133] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort. METHODS Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1 year were assessed with multiple adjusted logistic analyses. RESULTS A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1 year were significantly lower in current smokers than in non-smokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively). CONCLUSIONS Current smoking is associated with an impaired response to TNFi in axSpA.
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Affiliation(s)
- Adrian Ciurea
- Department of Rheumatology, University Hospital, Zurich, Switzerland
| | - Almut Scherer
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Ulrich Weber
- King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark
| | - Pascale Exer
- Private Rheumatology Practice, Basel, Switzerland
| | - Jürg Bernhard
- Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland
| | | | - Myriam Riek
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Rüdiger B Müller
- Department of Rheumatology, Cantonal Hospital, St. Gallen, Switzerland
| | - Bettina Weiss
- Division of Rheumatology, Uniklinik Balgrist, Zurich, Switzerland
| | - Michael J Nissen
- Department of Rheumatology, University Hospital, Geneva, Switzerland
| | - Rudolf Kissling
- Division of Rheumatology, Uniklinik Balgrist, Zurich, Switzerland
| | - Beat A Michel
- Department of Rheumatology, University Hospital, Zurich, Switzerland
| | - Axel Finckh
- Department of Rheumatology, University Hospital, Geneva, Switzerland
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