Learmont J, Tindall B, Evans L, Cunningham A, Cunningham P, Wells J, Penny R, Kaldor J, Cooper D A
New South Wales Red Cross Blood Transfusion Service, Sydney, Australia.
Lancet. 1992 Oct 10;340(8824):863-7. doi: 10.1016/0140-6736(92)93281-q.
There have been reported cases of long-term symptomless human immunodeficiency virus type 1 (HIV-1) infection, but it is not clear whether the benign course of infection was due to host, viral, or other unknown factors. During follow-up of subjects with transfusion-acquired HIV-1 infection in New South Wales, Australia, we identified a group of 6 subjects who had been infected through a single common donor. We were therefore able to study the contributions of various factors to the course of infection. Throughout follow-up (range 6.8-10.1 years after infection), 5 of the recipients and the donor (last follow-up 10.2 years after infection of the first recipient) remained clinically free of symptoms, with normal CD4 cell counts and no p24 antigenaemia. HIV-1 was isolated from only 1 recipient; the isolate did not induce syncytia in a SUPT1 co-culture assay and had a limited in-vitro host range. 1 infected recipient (who had received extensive immunosuppressive treatment for systemic lupus erythematosus) developed Pneumocystis carinii pneumonia and died 4.3 years after infection. The frequency of progression to AIDS or a CD4 cell count below 0.50 x 10(9)/l was significantly lower among the 6 subjects with a common donor (1/6) than among 101 other HIV-infected transfusion recipients for whom data from 7 years of follow-up were available (94/101; p less than 0.0001). These findings suggest that the subjects were infected by a less virulent strain of HIV-1. The identification of this group of subjects should stimulate a search for other similar groups, which will provide important information on the immunopathogenesis of HIV-1 disease.
已有报告称存在长期无症状的1型人类免疫缺陷病毒（HIV-1）感染病例，但尚不清楚感染的良性病程是由于宿主、病毒还是其他未知因素所致。在对澳大利亚新南威尔士州输血获得性HIV-1感染受试者的随访过程中，我们识别出一组6名通过单一共同供血者感染的受试者。因此，我们能够研究各种因素对感染病程的影响。在整个随访期间（感染后6.8 - 10.1年），5名受血者和供血者（首次受血者感染后最后一次随访为10.2年）临床上仍无症状，CD4细胞计数正常且无p24抗原血症。仅从1名受血者中分离出HIV-1；该分离株在SUPT1共培养试验中未诱导形成多核巨细胞，且体外宿主范围有限。1名受感染的受血者（因系统性红斑狼疮接受了广泛的免疫抑制治疗）发生了卡氏肺孢子虫肺炎，并在感染后4.3年死亡。6名有共同供血者的受试者中进展为艾滋病或CD4细胞计数低于0.50×10⁹/L的频率（1/6）显著低于另外101名有7年随访数据的HIV感染输血受血者（94/101；p<0.0001）。这些发现表明，这些受试者感染的是毒力较低的HIV-1毒株。识别出这组受试者应会促使寻找其他类似群体，这将为HIV-1疾病的免疫发病机制提供重要信息。
