Anastos K, Gange S J, Lau B, Weiser B, Detels R, Giorgi J V, Margolick J B, Cohen M, Phair J, Melnick S, Rinaldo C R, Kovacs A, Levine A, Landesman S, Young M, Muñoz A, Greenblatt R M
Montefiore Medical Center, Bronx, New York 10467, USA.
J Acquir Immune Defic Syndr. 2000 Jul 1;24(3):218-26. doi: 10.1097/00126334-200007010-00004.
HIV-1 RNA and lymphocyte subset levels are the principal indications for antiretroviral treatment. Past reports have differed with regard to the effect of gender and race on these measures and in measures of disease progression.
To assess racial and gender differences in HIV-1 RNA levels and CD4+ lymphocyte decline.
A longitudinal study based in the two largest HIV natural history cohort studies conducted in 7 metropolitan areas of the United States.
In all, 1256 adult women and 1603 adult men for whom multiple data points were available prior to initiation of antiretroviral therapy were included. Women were more likely to be nonwhite, to have a history of injection drug use, and to have HIV-associated symptoms. After adjustment for differences in measurement method, baseline CD4+ cell count, age, and clinical symptoms, HIV-1 RNA levels were 32% to 50% lower in women than in men at CD4+ counts >200 cells/mm3 (p <.001) but not at CD4+ cell counts <200 cells/mm3. HIV-1 RNA levels were also 41% lower in nonwhites than in whites (p <.001) and 21% lower in persons reporting a prior history of injection drug use (p <.001). Women had more rapid declines in CD4+ cell counts over time than men (difference in slope of 46 cells/year) and nonwhite individuals had slower decline in CD4 cell counts than whites (difference of 39 cells/year).
Both race and gender influence the values of HIV-1 RNA and the rate of HIV-1 disease progression as indicated by decline in CD4 cell counts over time. These effects could provide clues regarding the factors that influence HIV-disease progression and may indicate that guidelines for therapy should be adjusted for demographic characteristics.
HIV-1 RNA和淋巴细胞亚群水平是抗逆转录病毒治疗的主要指标。过去的报告在性别和种族对这些指标以及疾病进展指标的影响方面存在差异。
评估HIV-1 RNA水平和CD4+淋巴细胞减少方面的种族和性别差异。
一项基于在美国7个大都市地区进行的两项最大的HIV自然史队列研究的纵向研究。
总共纳入了1256名成年女性和1603名成年男性，他们在开始抗逆转录病毒治疗之前有多个数据点。女性更有可能是非白人，有注射吸毒史，并且有HIV相关症状。在调整了测量方法、基线CD4+细胞计数、年龄和临床症状的差异后，在CD4+计数>200个细胞/mm3时，女性的HIV-1 RNA水平比男性低32%至50%（p<.001），但在CD4+细胞计数<200个细胞/mm3时并非如此。非白人的HIV-1 RNA水平也比白人低41%（p<.001），报告有注射吸毒史的人低21%（p<.001）。随着时间的推移，女性的CD4+细胞计数下降速度比男性更快（斜率差异为每年46个细胞），非白人个体的CD4细胞计数下降速度比白人慢（差异为每年39个细胞）。
种族和性别均会影响HIV-1 RNA的值以及随着时间推移CD4细胞计数下降所表明的HIV-1疾病进展速度。这些影响可能为影响HIV疾病进展的因素提供线索，并可能表明治疗指南应根据人口统计学特征进行调整。
