Björkman Per, Flamholc Leo, Nauclér Anders, Molnegren Vilma, Wallmark Ewa, Widell Anders
Department of Infectious Diseases and Department of Medical Microbiology, Malmö University Hospital, Lund University, S-205 02 Malmö, Sweden.
AIDS. 2004 Apr 9;18(6):877-86. doi: 10.1097/00002030-200404090-00005.
To investigate whether GBV-C viremia at diagnosis of HIV-1 infection predicts disease outcome in patients not receiving combination antiretroviral therapy (ART), and whether longitudinal changes in GBV-C viremia are associated with disease progression.
Prospective cohort study.
230 patients with a serum sample available for testing obtained within 2 years of HIV-1 diagnosis were followed until either initiation of ART, death, or their last visit to our clinic (median follow-up 4.3 years). Baseline and follow-up serum samples (available from 163 patients) were tested for GBV-C RNA and antibodies against GBV-C envelope E2 protein (anti-E2; signifying resolved GBV-C viremia).
At inclusion, 62 patients (27%) had GBV-C viremia and 69 (30%) had anti-E2. Baseline GBV-C status was not associated with all-cause mortality (P = 0.12), HIV-related mortality (P = 0.18), or development of AIDS (P = 0.84). However, GBV-C RNA was less prevalent in patients with AIDS at inclusion (P = 0.008). Eleven of 44 patients with baseline GBV-C viremia lost GBV-C RNA during follow-up without showing anti-E2 seroconversion. In comparison with anti-E2-negative patients with either persistent absence, persistent presence, or acquisition of GBV-C viremia, these subjects had significantly increased all-cause mortality (P = 0.018), HIV-related mortality (P = 0.007), and AIDS incidence (P < 0.001).
GBV-C status at diagnosis did not predict disease outcome in this HIV cohort. GBV-C viremia was rare in patients with AIDS, and tended to disappear without occurrence of anti-E2 in patients with progressive disease. This suggests that the GBV-C status of HIV-1-infected patients could be a phenomenon secondary to HIV progression, rather than an independent prognostic factor.
探讨在未接受联合抗逆转录病毒治疗（ART）的患者中，HIV-1感染诊断时的GBV-C病毒血症是否可预测疾病转归，以及GBV-C病毒血症的纵向变化是否与疾病进展相关。
前瞻性队列研究。
对230例在HIV-1诊断后2年内可获得血清样本进行检测的患者进行随访，直至开始ART、死亡或最后一次就诊于我们的诊所（中位随访时间4.3年）。对基线和随访血清样本（163例患者可获得）检测GBV-C RNA及抗GBV-C包膜E2蛋白抗体（抗-E2；表示GBV-C病毒血症已消除）。
纳入时，62例患者（27%）有GBV-C病毒血症，69例（30%）有抗-E2。基线GBV-C状态与全因死亡率（P = 0.12）、HIV相关死亡率（P = 0.18）或艾滋病发生（P = 0.84）无关。然而，纳入时艾滋病患者中GBV-C RNA的流行率较低（P = 0.008）。44例基线有GBV-C病毒血症的患者中有11例在随访期间GBV-C RNA消失但未出现抗-E2血清转换。与抗-E2阴性且持续无、持续有或获得GBV-C病毒血症的患者相比，这些受试者的全因死亡率（P = 0.018）、HIV相关死亡率（P = 0.007）和艾滋病发病率（P < 0.001）显著增加。
在该HIV队列中，诊断时的GBV-C状态不能预测疾病转归。GBV-C病毒血症在艾滋病患者中罕见，且在疾病进展患者中倾向于不出现抗-E2而消失。这表明HIV-1感染患者的GBV-C状态可能是HIV进展的继发现象，而非独立的预后因素。
