Kaleebu P, Ross A, Morgan D, Yirrell D, Oram J, Rutebemberwa A, Lyagoba F, Hamilton L, Biryahwaho B, Whitworth J
Medical Research Council Programme on AIDS in Uganda, Uganda Virus Research Institute, Entebbe.
AIDS. 2001 Feb 16;15(3):293-9. doi: 10.1097/00002030-200102160-00001.
To investigate the role of HIV-1 envelope subtypes on disease progression in a rural cohort of Ugandan adults where two major HIV-1 subtypes (A and D) exist.
Participants of a clinical cohort seen between December 1995 and December 1998 had blood collected for HIV-1 subtyping. These included prevalent cases (people already infected with HIV at the start of the study in 1990) and incident cases (those who seroconverted between 1990 and December 1998). HIV-1 subtyping was carried out by heteroduplex mobility assay and DNA sequencing in the V3 env region. Disease progression was measured by the rate of CD4 lymphocyte count decline, clinical progression for the incident cases as time from seroconversion to AIDS or death, to first CD4 lymphocyte count < 200 x 10(6)/l and to the World Health Organization clinical stage 3. All analyses were adjusted for age and sex.
One hundred and sixty-four individuals, including 47 prevalent and 117 incident cases, had V3 env subtype data of which 65 (40%) were subtyped as A and 99 as D. In the incident cases, 44 (38%) were subtyped as A and 73 as D. There was a suggestion that for most end-points A had a slower progression than D. The cumulative probability of remaining free from AIDS or death at 6 years post-seroconversion was 0.72 [95% confidence interval (CI), 0.50 to 0.85] for A and 0.58 (95% CI, 0.42 to 0.71) for D, and the adjusted hazard ratio of subtype D compared to A was estimated to be 1.39 (95% CI, 0.66 to 2.94; P = 0.39). The estimated difference in rates of decline in square root CD4 lymphocyte counts was -0.41 per year (95% CI, -0.98 to 0.15; P = 0.15).
This study suggests that although subtype A may have a slower progression than D, HIV-1 envelope subtype is not a major factor in determining the progression of HIV-1 disease in a rural population in Uganda.
在乌干达成年人的一个农村队列中，调查HIV-1包膜亚型在疾病进展中的作用，该队列中存在两种主要的HIV-1亚型（A和D）。
1995年12月至1998年12月期间就诊的临床队列参与者采集血液进行HIV-1亚型分型。这些参与者包括流行病例（1990年研究开始时已感染HIV的人）和新发病例（1990年至1998年12月期间血清转化的人）。通过异源双链迁移率分析和V3 env区域的DNA测序进行HIV-1亚型分型。通过CD4淋巴细胞计数下降率、新发病例从血清转化到艾滋病或死亡、首次CD4淋巴细胞计数<200×10⁶/L以及到世界卫生组织临床分期3的时间来衡量疾病进展。所有分析均根据年龄和性别进行了调整。
164名个体，包括47名流行病例和117名新发病例，有V3 env亚型数据，其中65例（40%）被分型为A，99例为D。在新发病例中，44例（38%）被分型为A，73例为D。有迹象表明，对于大多数终点，A型的进展比D型慢。血清转化后6年无艾滋病或死亡的累积概率，A型为0.72[95%置信区间（CI），0.50至0.85]，D型为0.58（95%CI，0.42至0.71），与A型相比，D型的调整后风险比估计为1.39（95%CI，0.66至2.94；P = 0.39）。平方根CD4淋巴细胞计数下降率的估计差异为每年-0.41（95%CI，-0.98至0.15；P = 0.15）。
本研究表明，虽然A型可能比D型进展慢，但HIV-1包膜亚型不是决定乌干达农村人群HIV-1疾病进展的主要因素。
