持续性GB病毒C感染与HIV感染男性的生存情况

Persistent GB virus C infection and survival in HIV-infected men.

作者信息

Williams Carolyn F, Klinzman Donna, Yamashita Traci E, Xiang Jinhua, Polgreen Philip M, Rinaldo Charles, Liu Chenglong, Phair John, Margolick Joseph B, Zdunek Dietmar, Hess Georg, Stapleton Jack T

机构信息

Epidemiology Branch, Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Md, USA.

出版信息

N Engl J Med. 2004 Mar 4;350(10):981-90. doi: 10.1056/NEJMoa030107.

DOI:10.1056/NEJMoa030107

PMID:14999110

Abstract

BACKGROUND

GB virus C (GBV-C), which is not known to be pathogenic in humans, replicates in lymphocytes, inhibits the replication of human immunodeficiency virus (HIV) in vitro, and has been associated with a decreased risk of death among HIV-positive persons in some, but not all, studies. Previous studies did not control for differences in the duration of HIV or GBV-C infection.

METHODS

We evaluated 271 men who were participants in the Multicenter Acquired Immunodeficiency Syndrome Cohort Study for GBV-C viremia (by means of a reverse-transcriptase-polymerase-chain-reaction assay) or E2 antibody (by means of an enzyme-linked immunosorbent assay) 12 to 18 months after seroconversion to positivity for HIV (the early visit); a subgroup of 138 patients was also evaluated 5 to 6 years after HIV seroconversion (the late visit).

RESULTS

GBV-C infection was detected in 85 percent of men with HIV seroconversion on the basis of the presence of E2 antibody (46 percent) or GBV-C RNA (39 percent). Only one man acquired GBV-C viremia between the early and the late visit, but 9 percent of men had clearance of GBV-C RNA between these visits. GBV-C status 12 to 18 months after HIV seroconversion was not significantly associated with survival; however, men without GBV-C RNA 5 to 6 years after HIV seroconversion were 2.78 times as likely to die as men with persistent GBV-C viremia (95 percent confidence interval, 1.34 to 5.76; P=0.006). The poorest prognosis was associated with the loss of GBV-C RNA (relative hazard for death as compared with men with persistent GBV-C RNA, 5.87; P=0.003).

CONCLUSIONS

GBV-C viremia was significantly associated with prolonged survival among HIV-positive men 5 to 6 years after HIV seroconversion, but not at 12 to 18 months, and the loss of GBV-C RNA by 5 to 6 years after HIV seroconversion was associated with the poorest prognosis. Understanding the mechanisms of interaction between GBV-C and HIV may provide insight into the progression of HIV disease.

摘要

背景

丙型肝炎病毒GB病毒C型（GBV-C）在人类中不具有致病性，可在淋巴细胞中复制，在体外可抑制人类免疫缺陷病毒（HIV）复制，并且在一些（但并非所有）研究中，GBV-C感染与HIV阳性者死亡风险降低有关。既往研究未对HIV或GBV-C感染持续时间的差异进行控制。

方法

我们对参加多中心获得性免疫缺陷综合征队列研究的271名男性进行了评估，在其HIV血清转化呈阳性后12至18个月（早期访视）检测GBV-C病毒血症（采用逆转录-聚合酶链反应法）或E2抗体（采用酶联免疫吸附测定法）；还对138名患者的亚组在HIV血清转化后5至6年进行了评估（晚期访视）。

结果

根据E2抗体（46%）或GBV-C RNA（39%）的存在情况，在85%的HIV血清转化男性中检测到GBV-C感染。在早期和晚期访视之间，只有1名男性出现GBV-C病毒血症，但9%的男性在这两次访视期间GBV-C RNA清除。HIV血清转化后12至18个月时的GBV-C状态与生存无显著相关性；然而，HIV血清转化后5至6年时无GBV-C RNA的男性死亡可能性是持续存在GBV-C病毒血症男性的2.78倍（95%置信区间为1.34至5.76；P = 0.006）。预后最差与GBV-C RNA消失有关（与持续存在GBV-C RNA的男性相比，死亡相对风险为5.87；P = 0.003）。