Sterling T R, Vlahov D, Astemborski J, Hoover D R, Margolick J B, Quinn T C
Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA.
N Engl J Med. 2001 Mar 8;344(10):720-5. doi: 10.1056/NEJM200103083441003.
It is unclear whether there are differences between men and women with human immunodeficiency virus type 1 (HIV-1) infection in the plasma level of viral RNA (the viral load). In men, the initial viral load after seroconversion predicts the likelihood of progression to the acquired immunodeficiency syndrome (AIDS), but the relation between the two has not been assessed in women. Currently, the guidelines for initiating antiretroviral therapy are applied uniformly to women and men.
From 1988 through 1998, the viral load and the CD4+ lymphocyte count were measured approximately every six months in 156 male and 46 female injection-drug users who were followed prospectively after HIV-1 seroconversion.
The median initial viral load was 50,766 copies of HIV-1 RNA per milliliter in the men but only 15,103 copies per milliliter in the women (P<0.001). The median initial CD4+ count did not differ significantly according to sex (659 and 672 cells per cubic millimeter, respectively). HIV-1 infection progressed to AIDS in 29 men and 15 women, and the risk of progression did not differ significantly according to sex. For each increase of 1 log in the viral load (on a base 10 scale), the hazard ratio for progression to AIDS was 1.55 (95 percent confidence interval, 0.97 to 2.47) among the men and 1.43 (95 percent confidence interval, 0.76 to 2.69) among the women. The median initial viral load was 77,822 HIV-1 RNA copies per milliliter in the men in whom AIDS developed and 40,634 copies per milliliter in the men in whom it did not; the corresponding values in the women were 17,149 and 12,043 copies per milliliter. Given the recommendation that treatment should be initiated when the viral load reaches 20,000 copies per milliliter, 74 percent of the men but only 37 percent of the women in our study would have been eligible for therapy at the first visit after seroconversion (P<0.001).
Although the initial level of HIV-1 RNA was lower in women than in men, the rates of progression to AIDS were similar. Treatment guidelines that are based on the viral load, rather than the CD4+ lymphocyte count, will lead to differences in eligibility for antiretroviral treatment according to sex.
1型人类免疫缺陷病毒（HIV-1）感染的男性和女性血浆中病毒RNA水平（病毒载量）是否存在差异尚不清楚。在男性中，血清转化后的初始病毒载量可预测进展为获得性免疫缺陷综合征（AIDS）的可能性，但二者之间的关系尚未在女性中进行评估。目前，启动抗逆转录病毒治疗的指南对男性和女性统一适用。
1988年至1998年期间，对156名男性和46名女性注射吸毒者在HIV-1血清转化后进行前瞻性随访，大约每六个月测量一次病毒载量和CD4+淋巴细胞计数。
男性的初始病毒载量中位数为每毫升50,766拷贝HIV-1 RNA，而女性仅为每毫升15,103拷贝（P<0.001）。初始CD4+计数中位数在性别上无显著差异（分别为每立方毫米659和672个细胞）。29名男性和15名女性的HIV-1感染进展为AIDS，进展风险在性别上无显著差异。病毒载量每增加1个对数（以10为底），男性进展为AIDS的风险比为1.55（95%置信区间为0.97至2.47），女性为1.43（95%置信区间为0.76至2.69）。发生AIDS的男性初始病毒载量中位数为每毫升77,822拷贝HIV-1 RNA，未发生AIDS的男性为每毫升40,634拷贝；女性相应的值分别为每毫升17,149和12,043拷贝。鉴于推荐当病毒载量达到每毫升20,000拷贝时开始治疗，在我们的研究中，74%的男性但只有37%的女性在血清转化后的首次就诊时符合治疗条件（P<0.001）。
尽管女性的HIV-1 RNA初始水平低于男性，但进展为AIDS的速率相似。基于病毒载量而非CD4+淋巴细胞计数的治疗指南将导致抗逆转录病毒治疗的符合条件情况在性别上存在差异。
