Minga Albert K, Anglaret Xavier, d' Aquin Toni Thomas, Chaix Marie-Laure, Dohoun Lambert, Abo Yao, Coulibaly Ali, Duvignac Julien, Gabillard Delphine, Rouet François, Rouzioux Christine
Programme PAC-CI, Abidjan, Côte d'Ivoire, France.
J Acquir Immune Defic Syndr. 2008 Jul 1;48(3):350-4. doi: 10.1097/QAI.0b013e3181775e55.
To analyze the association between the HIV-1 DNA level in peripheral blood mononuclear cells (PBMCs) and disease progression in recently infected West African adults.
HIV-1 DNA levels were measured in the PBMCs of 200 adults in the French National Agency for Research on AIDS and viral Hepatitis (ANRS) 1220 cohort who had recently been infected with HIV-1. The association between baseline HIV-1 DNA levels and disease progression was analyzed using multivariate Cox regression. Disease progression was defined as the occurrence of any of the following outcomes: death, first World Health Organization stage 3-4 event, or CD4 count<200/mm.
About 200 participants were followed for a median of 30 months. At baseline, the median time from HIV-1 seroconversion was 9 months, median CD4 T-cell count was 471/mm, median HIV-1 DNA level was 3.0 log10 copies/10 PBMCs, and median plasma HIV-1 RNA level was 4.6 log10 copies/mL. The 5-year probability of remaining free of any outcome was 0.74 [95% confidence interval (CI): 0.61 to 0.83] and 0.36 (95% CI: 0.23 to 0.49) in patients with baseline HIV-1 DNA<or=3.0 and >3.0 log10 copies/10 PBMCs, respectively (P<0.001). The adjusted hazard ratio of disease progression was 2.17 in patients with HIV-1 DNA>3.0 log10 copies/10 PBMCs compared with other patients (95% CI: 1.24 to 3.80, P=0.007). The only other factor associated with progression was follow-up CD4 count (hazard ratio=1.23 per 100 cells/mm decrease; 95% CI: 1.07 to 1.41, P=0.003).
PBMC HIV-1 DNA level was strongly associated with HIV-1 disease progression, even after adjusting for HIV-1 RNA and CD4 T-cell count. Further studies should assess whether patients with high HIV-1 DNA levels should start antiretroviral therapy earlier than other patients.
分析西非近期感染成人外周血单个核细胞（PBMC）中HIV-1 DNA水平与疾病进展之间的关联。
在法国国家艾滋病和病毒性肝炎研究机构（ANRS）1220队列中，对200名近期感染HIV-1的成人的PBMC进行HIV-1 DNA水平检测。采用多变量Cox回归分析基线HIV-1 DNA水平与疾病进展之间的关联。疾病进展定义为出现以下任何一种结果：死亡、首次出现世界卫生组织3-4期事件或CD4细胞计数<200/mm³。
约200名参与者的中位随访时间为30个月。基线时，从HIV-1血清转化的中位时间为9个月，中位CD4 T细胞计数为471/mm³，中位HIV-1 DNA水平为3.0 log₁₀拷贝/10⁶ PBMC，中位血浆HIV-1 RNA水平为4.6 log₁₀拷贝/mL。基线HIV-1 DNA≤3.0和>3.0 log₁₀拷贝/10⁶ PBMC的患者中，5年无任何结局的概率分别为0.74 [95%置信区间（CI）：0.61至0.83]和0.36（95% CI：0.23至0.49）（P<0.001）。与其他患者相比，HIV-1 DNA>3.0 log₁₀拷贝/10⁶ PBMC的患者疾病进展的调整后风险比为2.17（95% CI：1.24至3.80，P=0.007）。与疾病进展相关的唯一其他因素是随访时的CD4细胞计数（每降低100个细胞/mm³风险比=1.23；95% CI：1.07至1.41，P=0.003）。
即使在调整了HIV-1 RNA和CD4 T细胞计数后，PBMC中HIV-1 DNA水平仍与HIV-1疾病进展密切相关。进一步的研究应评估HIV-1 DNA水平高的患者是否应比其他患者更早开始抗逆转录病毒治疗。
