Smith Penelope R, Sarner Liat, Murphy Maurice, James Beki, Thomas Janice M, Skinner Celia J, Aitken Celia
Department of Virology, Barts and the London NHS Trust, 51-53 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
J Clin Virol. 2003 Jan;26(1):101-7. doi: 10.1016/s1386-6532(02)00180-4.
Guidelines for commencing therapy for HIV infection have been based upon HIV-1 RNA and CD4 lymphocyte thresholds. The influence of confounding factors such as gender, ethnicity and co-infections is unproven.
To analyse ethnic discordance in plasma HIV-1 viral load (VL) and CD4+ count and its potential clinical significance in Black and Caucasian groups.
Retrospective, cross-sectional, observational study of 537 antiretroviral nai;ve HIV-1-positive individuals attending two East London clinics. Baseline data were obtained from individuals who registered at the clinic from November 1996 to August 1999. An analysis was performed comparing ethnic differences in plasma HIV-1 VL, CD4+ count, CD8+ count, co-infections, CDC disease category, AIDS-defining illnesses and mode of transmission.
Plasma HIV-1 VL was significantly lower in Blacks (4.5 copies/ml versus 4.7 copies/ml; P<0.05) despite lower baseline CD4+ counts and similar rates of disease progression to Caucasian groups. This association remained for patients with less advanced disease after stratification for CD4+ count (CD4+ 200-500, VL 4.5 copies/ml versus 4.7 copies/ml, P<0.01; CD4+ >500, VL 3.4 copies/ml versus 4.3 copies/ml, P<0.001) and disease category (non-AIDS, 4.4 copies/ml versus 4.7 copies/ml; P<0.005). On multivariate analysis, the association persisted following adjustment for gender, age, co-infections, CD4+ count and mode of transmission.
These results suggest that plasma HIV-1 VL is discordantly low in Black compared with Caucasian groups stratified for CD4+ count, in this cohort of antiretroviral nai;ve HIV-1-positive individuals living in London. Although there are a number of possible explanations for this finding, it has considerable clinical relevance for the management of Black HIV-1-infected patients within UK, with significant implications for the decision about when to commence antiretroviral or immune-based therapies.
开始抗HIV感染治疗的指南一直基于HIV-1 RNA和CD4淋巴细胞阈值。诸如性别、种族和合并感染等混杂因素的影响尚未得到证实。
分析黑人和白人组血浆HIV-1病毒载量（VL）和CD4+计数的种族差异及其潜在临床意义。
对就诊于伦敦东部两家诊所的537例未接受过抗逆转录病毒治疗的HIV-1阳性个体进行回顾性、横断面观察研究。基线数据来自1996年11月至1999年8月在诊所登记的个体。对血浆HIV-1 VL、CD4+计数、CD8+计数、合并感染、疾病控制中心（CDC）疾病分类、艾滋病定义疾病和传播方式的种族差异进行了分析。
尽管黑人的基线CD4+计数较低且疾病进展率与白人组相似，但黑人的血浆HIV-1 VL显著较低（4.5拷贝/毫升对4.7拷贝/毫升；P<0.05）。在根据CD4+计数分层（CD4+ 200 - 500，VL 4.5拷贝/毫升对4.7拷贝/毫升，P<0.01；CD4+>500，VL 3.4拷贝/毫升对4.3拷贝/毫升，P<0.001）和疾病分类（非艾滋病，4.4拷贝/毫升对4.7拷贝/毫升；P<0.005）后，病情较轻的患者中这种关联仍然存在。多变量分析显示，在对性别、年龄、合并感染、CD4+计数和传播方式进行调整后，这种关联仍然存在。
这些结果表明，在这群居住在伦敦的未接受过抗逆转录病毒治疗的HIV-1阳性个体中，与根据CD4+计数分层的白人组相比，黑人的血浆HIV-1 VL异常低。尽管对此发现有多种可能的解释，但这对英国黑人HIV-1感染患者的管理具有相当大的临床意义，对决定何时开始抗逆转录病毒治疗或免疫治疗有重大影响。
