自诊断以来，在法国国家艾滋病研究机构（ANRS）的SEROCO/HEMOCO队列中对长期不进展者的HIV-1感染进行早期控制。

Early control of HIV-1 infection in long-term nonprogressors followed since diagnosis in the ANRS SEROCO/HEMOCO cohort.

作者信息

Madec Yoann, Boufassa Faroudy, Avettand-Fenoel Veronique, Hendou Samia, Melard Adeline, Boucherit Soraya, Surzyn Janina, Meyer Laurence, Rouzioux Christine

机构信息

INSERM U822, Le Kremlin-Bicêtre, France.

出版信息

J Acquir Immune Defic Syndr. 2009 Jan 1;50(1):19-26. doi: 10.1097/QAI.0b013e31818ce709.

DOI:10.1097/QAI.0b013e31818ce709

PMID:19295331

Abstract

BACKGROUND

To clarify early correlates and natural history of HIV long-term nonprogressors (LTNPs) since HIV diagnosis.

METHODS

Patients enrolled in the French ANRS SEROCO/HEMOCO cohort with CD4 count >500 cells/mm3 at HIV diagnosis. LTNP status was defined as being asymptomatic, antiretroviral free, and with CD4 cell count >500 cells/mm3 for >8 years after HIV diagnosis. In LTNPs, we modeled the biological markers' progression through a joint model. Factors associated with loss of LTNP status were identified through a Cox model.

RESULTS

Sixty (9%) of 664 patients were identified as LTNPs during follow-up. At enrollment, HIV RNA was <or=2.6 log copies/mL in 24% of LTNPs and HIV DNA was <or=1.85 log copies/10 peripheral blood mononuclear cells (PBMCs) in 31% vs. 3% and 8% in others. In LTNPs, HIV RNA and HIV DNA levels increased by 0.04 log copies/mL per year and 0.07 log copies/10(6) PBMCs per year during the first 8 years after diagnosis. LTNP status was lost in 36 subjects; baseline HIV DNA >1.85 log copies/10(6) PBMCs and high HIV DNA increase were associated with an increased risk of losing LTNP status [adjusted hazard ratio: 2.8 (1.2-6.8) and 2.2 (1.0-4.8), respectively].

CONCLUSIONS

LTNP status is established in the first years of HIV infection, low HIV DNA level at enrollment and slow increase of HIV DNA being associated with maintained LTNP status.

摘要

背景

明确自艾滋病病毒（HIV）诊断以来，HIV长期不进展者（LTNP）的早期相关因素及自然病程。

方法

纳入法国ANRS SEROCO/HEMOCO队列中HIV诊断时CD4细胞计数>500个/立方毫米的患者。LTNP状态定义为无症状、未接受抗逆转录病毒治疗且HIV诊断后>8年CD4细胞计数>500个/立方毫米。在LTNP患者中，我们通过联合模型对生物标志物的进展进行建模。通过Cox模型确定与LTNP状态丧失相关的因素。

结果

随访期间，664例患者中有60例（9%）被确定为LTNP。入组时，24%的LTNP患者HIV RNA≤2.6 log拷贝/毫升，31%的患者HIV DNA≤1.85 log拷贝/10个外周血单个核细胞（PBMC），而其他患者中这一比例分别为3%和8%。在LTNP患者中，诊断后的前8年，HIV RNA和HIV DNA水平每年分别增加0.04 log拷贝/毫升和0.07 log拷贝/10⁶ PBMC。36例患者丧失LTNP状态；基线HIV DNA>1.85 log拷贝/10⁶ PBMC和HIV DNA的高增长与丧失LTNP状态的风险增加相关[调整后风险比分别为：2.8（1.2 - 6.8）和2.2（1.0 - 4.8）]。