Okulicz Jason F, Marconi Vincent C, Landrum Michael L, Wegner Scott, Weintrob Amy, Ganesan Anuradha, Hale Braden, Crum-Cianflone Nancy, Delmar Judith, Barthel Vincent, Quinnan Gerald, Agan Brian K, Dolan Matthew J
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
J Infect Dis. 2009 Dec 1;200(11):1714-23. doi: 10.1086/646609.
Durable control of human immunodeficiency virus (HIV) replication and lack of disease progression in the absence of antiretroviral therapy were studied in a military cohort of 4586 subjects. We examined groups of elite controllers (ie, subjects with plasma HIV RNA levels of <50 copies/mL; prevalence, 0.55% [95% confidence interval {CI}, 0.35%-0.80%]), viremic controllers (ie, subjects with plasma HIV RNA levels of 50-2000 copies/mL; prevalence, 3.34% [95% CI, 2.83%-3.91%]), and subjects with a lack of disease progression (ie, long-term nonprogressors [LTNPs]) through 7 years of follow-up (LTNP7s; prevalence, 3.32% [95% CI, 2.70%-4.01%]) or 10 years of follow-up (LTNP10s; prevalence, 2.04% [95% CI, 1.52%-2.68%]). For elite and viremic controllers, spontaneous virologic control was established early and was typically observed when the initial viral load measurement was obtained within 1 year of estimated seroconversion. Elite controllers had favorable time to development of AIDS (P=.048), a CD4 cell count of 350 cells/microL (P= .009), and more-stable CD4 cell trends, compared with viremic controllers. LTNPs defined by 10-year versus 7-year criteria had a longer survival time (P=.001), even after adjustment for differing periods of invulnerability (P= .042). Definitions of controllers and LTNPs describe distinct populations whose differing clinical outcomes improve with the stringency of criteria, underscoring the need for comparability between study populations.
在一个由4586名受试者组成的军事队列中，研究了在无抗逆转录病毒治疗的情况下人类免疫缺陷病毒（HIV）复制的持久控制和疾病无进展情况。我们检查了精英控制者组（即血浆HIV RNA水平<50拷贝/mL的受试者；患病率为0.55%[95%置信区间{CI}，0.35%-0.80%]）、病毒血症控制者组（即血浆HIV RNA水平为50-2000拷贝/mL的受试者；患病率为3.34%[95%CI，2.83%-3.91%]），以及通过7年随访（LTNP7s；患病率为3.32%[95%CI，2.70%-4.01%]）或10年随访（LTNP10s；患病率为2.04%[95%CI，1.52%-2.68%]）确定的疾病无进展受试者（即长期非进展者[LTNP]）。对于精英控制者和病毒血症控制者，自发病毒学控制在早期就已确立，通常在估计血清转化后1年内获得初始病毒载量测量值时即可观察到。与病毒血症控制者相比，精英控制者患艾滋病的时间更有利（P=0.048），CD4细胞计数为350个/微升（P=0.009），且CD4细胞趋势更稳定。采用10年标准与7年标准定义的LTNP具有更长的生存时间（P=0.001），即使在调整了不同的无病期后也是如此（P=0.042）。控制者和LTNP的定义描述了不同的人群，其不同的临床结局会随着标准的严格程度而改善，这突出了研究人群之间可比性的必要性。
