Oral Infection and Immunity Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892-4352, USA.
J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):401-11. doi: 10.1097/QAI.0b013e31820cdfdb.
Mucosal tissues represent major targets for HIV transmission but differ in susceptibility and reservoir function by unknown mechanisms.
In a cross-sectional study, HIV RNA and infectious virus were compared between oral and genital compartments and blood in HIV-infected women, in association with clinical parameters, copathogens, and putative innate and adaptive HIV inhibitors.
HIV RNA was detectable in 24.5% of women from all 3 compartments, whereas 45% had RNA in only 1 or 2 sites. By comparison, infectious HIV, present in blood of the majority, was rare in mucosal sites. Innate mediators, secretory leukocyte protease inhibitor and thrombospondin, were highest in mucosae. Highly active antiretroviral therapy was associated with an 80% decreased probability of shedding. Multivariate logistic regression models revealed that mucosal HIV RNA was associated with higher plasma RNA, infectious virus, and total mucosal IgA, but not IgG. There was a 37-fold increased probability of detecting RNA in both genital and oral specimens (P = 0.008; P = 0.02, respectively) among women in highest versus lowest IgA tertiles.
Mucosal sites exhibit distinct characteristics of infectious HIV, viral shedding, and responses to therapy, dependent upon both systemic and local factors. Of the putative innate and adaptive mucosal defense factors examined, only IgA was associated with HIV RNA shedding. However, rather than being protective, there was a striking increase in probability of detectable HIV RNA shedding in women with highest total IgA.
黏膜组织是 HIV 传播的主要靶标，但通过未知机制，它们在易感性和储库功能方面存在差异。
在一项横断面研究中，比较了 HIV 感染者口腔和生殖器部位与血液中 HIV RNA 和感染性病毒，同时结合临床参数、共病原体以及潜在的先天和适应性 HIV 抑制剂。
所有 3 个部位的女性中，有 24.5%可检测到 HIV RNA，而 45%的女性仅在 1 或 2 个部位有 RNA。相比之下，存在于大多数血液中的感染性 HIV 在黏膜部位很少见。先天介质，如分泌白细胞蛋白酶抑制剂和血栓反应蛋白，在黏膜中含量最高。高效抗逆转录病毒治疗与降低 80%病毒脱落的可能性相关。多变量逻辑回归模型显示，黏膜 HIV RNA 与血浆 RNA、感染性病毒和总黏膜 IgA 水平升高有关，但与 IgG 无关。在 IgA 最高和最低三分位数的女性中，生殖道和口腔标本中均检测到 RNA 的概率分别增加了 37 倍（P = 0.008；P = 0.02）。
黏膜部位具有独特的感染性 HIV、病毒脱落和治疗反应特征，这取决于全身和局部因素。在所检查的潜在先天和适应性黏膜防御因素中，只有 IgA 与 HIV RNA 脱落有关。然而，与保护作用相反，在 IgA 总量最高的女性中，HIV RNA 脱落的检测概率显著增加。
