Goujard Cécile, Bonarek Mojgan, Meyer Laurence, Bonnet Fabrice, Chaix Marie-Laure, Deveau Christiane, Sinet Martine, Galimand Julie, Delfraissy Jean-François, Venet Alain, Rouzioux Christine, Morlat Philippe
Service de Médecine Interne, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Clin Infect Dis. 2006 Mar 1;42(5):709-15. doi: 10.1086/500213. Epub 2006 Jan 24.
Treatment initiation at the time of primary human immunodeficiency virus (HIV) type 1 (HIV-1) infection has become less frequent in recent years.
In the French prospective PRIMO Cohort, in which patients are enrolled at the time of primary HIV-1 infection, 30% of the 552 patients recruited during 1996-2004 did not start receiving antiretroviral treatment during the first 3 months after diagnosis. We analyzed the patients' clinical and immunological outcomes and examined potential predictors of disease progression. Progression was defined as the occurrence of an acquired immunodeficiency syndrome (AIDS)-related clinical event or a CD4 cell count <350 cells/mm3.
Fifty-six (34%) of the untreated patients experienced immunological progression during a median duration of follow-up of 24 months, and 1 of these patients had an AIDS-related event. The estimated risks of progression were 25%, 34%, and 42% at 1, 2, and 3 years after enrollment, respectively. Compared with patients who did not have progression, those with progression had significantly lower CD4 cell counts at diagnosis (455 vs. 738 cells/mm3), higher plasma HIV RNA levels (4.9 vs. 4.5 log10 copies/mL), and higher HIV DNA levels (3.3 vs. 3.0 log(10) copies/10(6) peripheral blood mononuclear cells [PBMCs]). All 3 parameters were significantly associated with progression in univariate analysis. In multivariate analysis, only the CD4 cell count and HIV DNA level were independently predictive of disease progression (relative hazard for CD4 cell count, 1.84 per decrease of 100 cells/mm3; relative hazard for HIV DNA level, 2.73 per increase of 1 log(10) copies/10(6) PBMCs).
Both a low initial CD4 cell count and a high HIV DNA level are predictive of rapid progression of untreated primary HIV-1 infection. Affected patients may therefore benefit from close clinical and laboratory monitoring and/or early administration of treatment.
近年来，在原发性人类免疫缺陷病毒1型（HIV-1）感染时开始治疗的情况已不那么常见。
在法国前瞻性PRIMO队列中，患者在原发性HIV-1感染时入组，在1996年至2004年招募的552例患者中，30%在诊断后的前3个月内未开始接受抗逆转录病毒治疗。我们分析了患者的临床和免疫结局，并检查了疾病进展的潜在预测因素。进展被定义为发生与获得性免疫缺陷综合征（AIDS）相关的临床事件或CD4细胞计数<350个细胞/mm³。
在中位随访期24个月期间，56例（34%）未治疗的患者出现了免疫进展，其中1例患者发生了与AIDS相关的事件。入组后1年、2年和3年的进展估计风险分别为25%、34%和42%。与未进展的患者相比，进展患者在诊断时的CD4细胞计数显著更低（455对738个细胞/mm³），血浆HIV RNA水平更高（4.9对4.5 log10拷贝/mL），HIV DNA水平更高（3.3对3.0 log(10)拷贝/10(6)外周血单个核细胞[PBMC]）。在单变量分析中，所有这3个参数均与进展显著相关。在多变量分析中，只有CD4细胞计数和HIV DNA水平可独立预测疾病进展（CD4细胞计数每减少100个细胞/mm³的相对风险为1.84；HIV DNA水平每增加1 log(10)拷贝/10(6) PBMC的相对风险为2.73）。
初始CD4细胞计数低和HIV DNA水平高均预示着未治疗的原发性HIV-1感染进展迅速。因此，受影响的患者可能受益于密切的临床和实验室监测和/或早期治疗。
