Friis Henrik, Gomo Exnevia, Nyazema Norman, Ndhlovu Patricia, Krarup Henrik, Madsen Poul H, Michaelsen Kim F
Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark.
J Acquir Immune Defic Syndr. 2003 May 1;33(1):74-81. doi: 10.1097/00126334-200305010-00011.
Viral load is a determinant of HIV-1 progression and transmission. Iron status and the phenotype of haptoglobin, a heme-binding acute phase reactant, may be determinants of viral load. We aimed to describe the effect of iron status, haptoglobin phenotype (Hp), and other predictors on HIV-1 viral load.
Based on a cross-sectional study among 1669 antenatal care attenders (22-35 weeks) in Zimbabwe, 526 (31.5%) were found to be HIV infected. The role of season, age, gravidity, gestational age, malaria parasitemia, Hp, and elevated serum alpha(1)-antichymotrypsin (ACT) as well as serum ferritin, folate, retinol, and beta-carotene on HIV viral load among the 526 HIV-infected women was assessed using multiple linear regression analysis.
The distribution of Hp 1-1 (32%), Hp 2-1 (48%), and Hp 2-2 (20%) was not different from that of 53 uninfected women. Mean viral load was 3.85 log(10) (95% CI: 3.77-3.93) genome equivalents (geq)/mL, ranging from 3.77 (95% CI: 3.64-3.90) geq/mL in women with Hp 1-1 to 4.05 (95% CI: 3.81-4.21) geq/mL in women with Hp 2-2. With elevated serum ACT controlled for, women with Hp 2-2 had viral loads twice (95% CI: 1.4-4.0, p =.002) that of women with Hp 1-1, whereas those with serum ferritin <6 micro g/L had viral loads less than one third (95% CI: 0.13-0.53, p =.013) that of women with serum ferritin >24 micro g/L. Viral loads were also higher in women enrolled in the early rainy season compared with the dry season, in gravidae 4+ compared with gravidae 1 through 3, and in those with moderately elevated compared with low serum alpha(1)-antichymotrypsin, but neither age, gestational age, serum folate, serum retinol, nor serum beta-carotene were predictors.
Storage iron, Hp 2-2, and elevated ACT are independent positive predictors of HIV-1 viral load. The positive relationship between serum ferritin and viral load was not the result of an acute phase response or iron accumulation with advanced HIV infection. A possible detrimental role of iron in HIV infection would have serious public health implications.
病毒载量是HIV-1病情进展和传播的一个决定因素。铁状态以及触珠蛋白（一种血红素结合急性期反应物）的表型可能是病毒载量的决定因素。我们旨在描述铁状态、触珠蛋白表型（Hp）及其他预测因素对HIV-1病毒载量的影响。
基于对津巴布韦1669名产前检查者（孕周22 - 35周）的横断面研究，发现526人（31.5%）感染了HIV。采用多元线性回归分析评估季节、年龄、妊娠次数、孕周、疟疾寄生虫血症、Hp、血清α1-抗糜蛋白酶（ACT）升高以及血清铁蛋白、叶酸、视黄醇和β-胡萝卜素对这526名HIV感染女性的HIV病毒载量的作用。
Hp 1-1（32%）、Hp 2-1（48%）和Hp 2-2（20%）的分布与53名未感染女性的分布无差异。平均病毒载量为3.85 log(10)（95%可信区间：3.77 - 3.93）基因组当量（geq）/mL，范围从Hp 1-1女性的3.77（95%可信区间：3.64 - 3.90）geq/mL到Hp 2-2女性的4.05（95%可信区间：3.81 - 4.21）geq/mL。在控制血清ACT升高的情况下，Hp 2-2女性的病毒载量是Hp 1-1女性的两倍（95%可信区间：1.4 - 4.0，p = 0.002），而血清铁蛋白<6μg/L的女性的病毒载量不到血清铁蛋白>24μg/L女性的三分之一（95%可信区间：0.13 - 0.53，p = 0.013）。与旱季相比，雨季早期入组的女性病毒载量也更高；与妊娠1至3次的孕妇相比，妊娠4次及以上的孕妇病毒载量更高；与血清α1-抗糜蛋白酶水平低相比，血清α1-抗糜蛋白酶中度升高的女性病毒载量更高，但年龄、孕周、血清叶酸、血清视黄醇和血清β-胡萝卜素均不是预测因素。
储存铁、Hp 2-2和ACT升高是HIV-1病毒载量的独立阳性预测因素。血清铁蛋白与病毒载量之间的正相关关系并非急性期反应或晚期HIV感染时铁蓄积的结果。铁在HIV感染中可能的有害作用将具有严重的公共卫生意义。
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