Touloumi Giota, Pantazis Nikos, Babiker Abdel G, Walker Sarah A, Katsarou Olga, Karafoulidou Anastasia, Hatzakis Angelos, Porter Kholoud
Department of Hygiene and Epidemiology, Athens Univerity Medical School, Greece.
AIDS. 2004 Aug 20;18(12):1697-705. doi: 10.1097/01.aids.0000131395.14339.f5.
To assess the effects of sex, risk group, age at and year of seroconversion (SC), and presentation during acute infection on HIV RNA trends before antiretroviral therapy (ART) initiation.
Multiple HIV RNA measurements from 1864 individuals with reliably estimated dates of SC, aged >/= 15 years at SC were studied using random effects models. Models were adjusted for selective HIV RNA data truncation due to ART initiation or AIDS development and for HIV RNA quantification assay.
HIV RNA levels declined precipitously during the first 10 months after SC followed by a slow increase. Women infected heterosexually and through injecting drug use, had an average 34% [95% confidence interval (CI), 2.3-56%] and 46% (95% CI, 17-66%) lower HIV RNA load respectively, compared to men in the same risk group. Among men, those infected heterosexually and by injecting drug use had on average 56% (95% CI, 36-69%) lower HIV RNA levels than homosexual men. Older subjects tended to have higher viral levels. There was no evidence that differences by sex, risk or age group diminished over time, but follow-up was mostly before CD4 cell count had fallen below 200 x 10 cells/l.
HIV RNA levels at the same stage of HIV-1 infection differ significantly by sex, risk group and age at SC. Given the lack of evidence of a survival difference by sex or risk group prior to initiation of effective therapy, further research on differential effects of virus load on treatment-free disease progression is needed, before a conclusion about considering these factors for ART initiation is drawn.
评估性别、风险组、血清转化（SC）时的年龄和年份以及急性感染期表现对抗逆转录病毒治疗（ART）开始前HIV RNA趋势的影响。
使用随机效应模型研究了1864例血清转化日期估计可靠、血清转化时年龄≥15岁的个体的多次HIV RNA测量值。对因开始ART或发展为艾滋病导致的选择性HIV RNA数据截断以及HIV RNA定量检测进行了模型调整。
血清转化后的前10个月，HIV RNA水平急剧下降，随后缓慢上升。与相同风险组的男性相比，通过异性性行为和注射毒品感染的女性HIV RNA载量分别平均低34%[95%置信区间（CI），2.3 - 56%]和46%（95%CI，17 - 66%）。在男性中，通过异性性行为和注射毒品感染的男性HIV RNA水平平均比同性恋男性低56%（95%CI，36 - 69%）。年龄较大的受试者往往病毒水平较高。没有证据表明性别、风险或年龄组之间的差异会随着时间推移而减小，但随访大多是在CD4细胞计数降至低于200×10⁶个细胞/升之前。
在HIV - 1感染的同一阶段，HIV RNA水平因性别、风险组和血清转化时的年龄而有显著差异。鉴于在开始有效治疗之前缺乏性别或风险组生存差异的证据，在得出关于将这些因素纳入ART开始考虑因素的结论之前，需要进一步研究病毒载量对无治疗疾病进展的不同影响。
