Celum C L, Buchbinder S P, Donnell D, Douglas J M, Mayer K, Koblin B, Marmor M, Bozeman S, Grant R M, Flores J, Sheppard H W
University of Washington HIV Prevention Trials Unit, Harborview Medical Center, Seattle, WA 98104, USA.
J Infect Dis. 2001 Jan 1;183(1):23-35. doi: 10.1086/317658. Epub 2000 Dec 8.
Risk behaviors, symptoms, and virologic characteristics were studied among 103 human immunodeficiency virus (HIV) seroconverters in vaccine preparedness cohorts during 1995-1998. Overall, 83% of subjects were men who had sex with men; most reported multiple risk episodes and symptoms (84%, > or =1 symptom) during seroconversion. Acute HIV was diagnosed in only 8 of 50 who sought medical care. Median initial pretreatment plasma virus load was 25,800 copies/mL (range, undetectable-262,000 copies/mL) a mean of 4 months after seroconversion, and 9.7% had nucleoside-associated mutations; none had multidrug resistance. Semen virus load was more variable, 1.3 log(10) lower and modestly correlated (r=.28; 95% confidence interval, 0.16-0.42) with plasma among untreated men. When the plasma RNA level was <5000 copies/mL, 32% of untreated men, 13% on nucleoside regimens, and 7% on protease inhibitor-containing regimens had detectable seminal RNA. Acute HIV was seldom diagnosed, representing missed opportunities for early treatment and prevention. Most subjects had several relatively stable virus loads before initiation of antiretrovirals, indicating feasibility of assessing HIV vaccines on virus set point in efficacy trials.
1995年至1998年期间，在疫苗准备队列中的103名人类免疫缺陷病毒（HIV）血清转化者中研究了风险行为、症状和病毒学特征。总体而言，83%的受试者为男男性行为者；大多数人在血清转化期间报告了多次风险事件和症状（84%，≥1种症状）。在寻求医疗护理的50人中，仅8人被诊断为急性HIV。血清转化后平均4个月时，初始预处理前血浆病毒载量中位数为25,800拷贝/mL（范围，不可检测至262,000拷贝/mL），9.7%的人有核苷相关突变；无人有多重耐药性。未治疗男性的精液病毒载量变化更大，比血浆低1.3 log(10)，且与血浆有适度相关性（r = 0.28；95%置信区间，0.16 - 0.42）。当血浆RNA水平<5000拷贝/mL时，32%的未治疗男性、13%接受核苷治疗方案的男性和7%接受含蛋白酶抑制剂治疗方案的男性精液RNA可检测到。急性HIV很少被诊断出来，这意味着错失了早期治疗和预防的机会。大多数受试者在开始抗逆转录病毒治疗之前有几个相对稳定的病毒载量，这表明在疗效试验中根据病毒设定点评估HIV疫苗是可行的。
