血浆病毒载量不可检测可预测西非村庄中感染 HIV-2 人群的正常存活。
Undetectable plasma viral load predicts normal survival in HIV-2-infected people in a West African village.
机构信息
MRC Laboratories Fajara, PO Box 273, Banjul, The Gambia.
出版信息
Retrovirology. 2010 May 19;7:46. doi: 10.1186/1742-4690-7-46.
BACKGROUND
There have been no previous studies of the long-term survival and temporal changes in plasma viral load among HIV-2 infected subjects.
METHODS
133 HIV-2 infected and 158 HIV-uninfected subjects from a rural area in North-west Guinea-Bissau, West Africa were enrolled into a prospective cohort study in 1991 and followed-up to mid-2009. Data were collected on four occasions during that period on HIV antibodies, CD4% and HIV-2 plasma viral load.
RESULTS
Median age (interquartile range [IQR]) of HIV-2 infected subjects at time of enrollment was 47 (36, 60) years, similar to that of HIV-uninfected control subjects, 49 (38, 62) (p = 0.4). Median (IQR) plasma viral load and CD4 percentage were 347 (50, 4,300) copies/ml and 29 (22, 35) respectively.Overall loss to follow-up to assess vital status was small, at 6.7% and 6.3% for HIV-2 infected and uninfected subjects respectively. An additional 17 (12.8%) and 16 (10.1%) of HIV-2 infected and uninfected subjects respectively were censored during follow-up due to infection with HIV-1. The mortality rate per 100 person-years (95% CI) was 4.5 (3.6, 5.8) among HIV-2 infected subjects compared to 2.1 (1.6, 2.9) among HIV-uninfected (age-sex adjusted rate ratio 1.9 (1.3, 2.8, p < 0.001) representing a 2-fold excess mortality rate associated with HIV-2 infection.Viral load measurements were available for 98%, 78%, 77% and 61% HIV-2 infected subjects who were alive and had not become super-infected with HIV-1, in 1991, 1996, 2003 and 2006 respectively. Median plasma viral load (RNA copies per ml) (IQR) did not change significantly over time, being 150 (50, 1,554; n = 77) in 1996, 203 (50, 2,837; n = 47) in 2003 and 171 (50, 497; n = 31) in 2006. Thirty seven percent of HIV-2 subjects had undetectable viraemia (<100 copies/ml) at baseline: strikingly, mortality in this group was similar to that of the general population.
CONCLUSIONS
A substantial proportion of HIV-2 infected subjects in this cohort have stable plasma viral load, and those with an undetectable viral load (37%) at study entry had a normal survival rate. However, the sequential laboratory findings need to be interpreted with caution given the number of individuals who could not be re-examined.
背景
此前尚无研究评估过 HIV-2 感染者的长期生存情况以及血浆病毒载量的时间变化。
方法
1991 年，我们在西非几内亚比绍西北部的一个农村地区招募了 133 名 HIV-2 感染者和 158 名 HIV 未感染者，将他们纳入一项前瞻性队列研究，并随访至 2009 年年中。在此期间，我们在四个时间点采集了 HIV 抗体、CD4%和 HIV-2 血浆病毒载量的数据。
结果
HIV-2 感染者在入组时的中位年龄（四分位间距[IQR]）为 47（36，60）岁，与 HIV 未感染者相似，为 49（38，62）岁（p = 0.4）。中位（IQR）血浆病毒载量和 CD4%分别为 347（50，4,300）拷贝/ml 和 29（22，35）。总的失访率评估生命状态很小，HIV-2 感染者和未感染者分别为 6.7%和 6.3%。另外，在随访期间，HIV-2 感染者和未感染者分别有 17（12.8%）和 16（10.1%）人因感染 HIV-1 而被删失。HIV-2 感染者的死亡率为每 100 人年 4.5（3.6，5.8），HIV 未感染者为 2.1（1.6，2.9）（年龄和性别调整后的率比为 1.9（1.3，2.8，p < 0.001），这表明 HIV-2 感染与 2 倍的超额死亡率相关。在仍存活且未感染 HIV-1 的 HIV-2 感染者中，分别有 98%、78%、77%和 61%的人在 1991 年、1996 年、2003 年和 2006 年接受了病毒载量检测。中位血浆病毒载量（RNA 拷贝/ml）（IQR）在不同时间点无显著变化，1996 年为 150（50，1,554；n = 77），2003 年为 203（50，2,837；n = 47），2006 年为 171（50，497；n = 31）。37%的 HIV-2 感染者基线时病毒血症不可检测（<100 拷贝/ml）：值得注意的是，该组的死亡率与一般人群相似。
结论
本队列中相当一部分 HIV-2 感染者的血浆病毒载量稳定，在研究入组时病毒载量不可检测（37%）的患者的生存率正常。然而，鉴于无法对许多人进行重新检查，需要谨慎解释这些连续的实验室发现。
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