Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America.
PLoS One. 2011 May 10;6(5):e19617. doi: 10.1371/journal.pone.0019617.
Acute HIV infection (AHI) is a critical phase of infection when irreparable damage to the immune system occurs and subjects are very infectious. We studied subjects with AHI prospectively to develop better treatment and public health interventions.
Cross-sectional screening was employed to detect HIV RNA positive, antibody negative subjects. Date of HIV acquisition was estimated from clinical history and correlated with sequence diversity assessed by single genome amplification (SGA). Twenty-two cytokines/chemokines were measured from enrollment through week 24.
Thirty-seven AHI subjects were studied. In 7 participants with limited exposure windows, the median exposure to HIV occurred 14 days before symptom onset. Lack of viral sequence diversification confirmed the short duration of infection. Transmission dates estimated by SGA/sequencing using molecular clock models correlated with transmission dates estimated by symptom onset in individuals infected with single HIV variants (mean of 28 versus 33 days). Only 10 of 22 cytokines/chemokines were significantly elevated among AHI participants at enrollment compared to uninfected controls, and only 4 participants remained seronegative at enrollment.
The results emphasize the difficulty in recruiting subjects early in AHI. Viral sequence diversity proved accurate in estimating time of infection. Regardless of aggressive screening, peak viremia and inflammation occurred before enrollment and potential intervention. Given the personal and public health importance, improved AHI detection is urgently needed.
急性 HIV 感染（AHI）是感染的关键阶段，此时免疫系统会受到不可逆转的损害，且感染者具有很强的传染性。我们前瞻性地研究了 AHI 患者，以制定更好的治疗和公共卫生干预措施。
采用横断面筛查的方法检测 HIV RNA 阳性、抗体阴性的受试者。根据临床病史估计 HIV 感染获得日期，并与通过单基因组扩增（SGA）评估的序列多样性相关联。在入组时至第 24 周期间测量了 22 种细胞因子/趋化因子。
研究了 37 例 AHI 患者。在 7 名暴露窗口期有限的参与者中，中位 HIV 暴露时间发生在症状出现前 14 天。缺乏病毒序列多样化证实了感染的持续时间很短。使用分子钟模型通过 SGA/测序估计的传播日期与感染单一致病 HIV 变体的个体中通过症状出现估计的传播日期相关（平均为 28 天与 33 天）。与未感染者相比，只有 10 种细胞因子/趋化因子在 AHI 参与者入组时显著升高，并且只有 4 名参与者在入组时仍为血清阴性。
结果强调了在 AHI 早期招募受试者的困难。病毒序列多样性在估计感染时间方面被证明是准确的。无论筛查多么积极，病毒血症和炎症高峰都发生在入组之前和潜在的干预之前。鉴于个人和公共卫生的重要性，迫切需要改进 AHI 的检测。
