Department of Pediatrics, University of California, San Francisco, California, USA.
Clin Infect Dis. 2011 Sep;53(6):592-9. doi: 10.1093/cid/cir484. Epub 2011 Aug 12.
HIV-infected women have lower HIV RNA levels and higher CD4-cell counts than do men. This observation has been attributed to the immunomodulatory effects of sex steroid hormones, such as estrogen and progesterone. Limited data exist regarding potential sex differences in HIV RNA level and CD4 parameters among prepubertal children with untreated HIV infection.
We examined the relationship of sex to HIV RNA level and CD4 parameters among 670 perinatally HIV-infected, antiretroviral therapy-naive African children aged <18 years (median age, 4.8 years) using multivariate linear regression. In a subset of 188 children, we used longitudinal data to compare changes in HIV RNA levels and CD4 percentage over time. Levels of CD4 and CD8 T-cell activation (CD38+HLA-DR+) were also compared between boys and girls.
Female children had lower HIV RNA levels (P = .0004) and higher CD4 percentages (P < .0001), compared to male children. Multivariate linear regression demonstrated an independent association of sex with both HIV RNA level and CD4 percentages after controlling for other covariates. Multilevel mixed-effects linear regression analysis of longitudinal HIV RNA level and CD4 parameter data showed that sex differences persisted across all observed ages. Levels of T-cell activation did not differ between the sexes.
Significant sex differences in HIV RNA levels and CD4 parameters are present in HIV-infected children before the onset of puberty. These data suggest that intrinsic genetic differences between male and female individuals, unrelated to sex steroid hormone levels, influence HIV RNA level and CD4 parameters in HIV-infected individuals.
与男性相比，感染 HIV 的女性具有更低的 HIV RNA 水平和更高的 CD4 细胞计数。这一观察结果归因于性激素（如雌激素和孕激素）的免疫调节作用。关于未经治疗的 HIV 感染的青春期前儿童中 HIV RNA 水平和 CD4 参数的潜在性别差异，现有数据有限。
我们使用多元线性回归分析了 670 名未接受抗逆转录病毒治疗的、来自非洲的、感染 HIV 的、年龄<18 岁（中位年龄 4.8 岁）的先天 HIV 感染的儿童的性别与 HIV RNA 水平和 CD4 参数之间的关系。在 188 名儿童的亚组中，我们使用纵向数据比较了 HIV RNA 水平和 CD4 百分比随时间的变化。还比较了男孩和女孩之间 CD4 和 CD8 T 细胞激活（CD38+HLA-DR+）的水平。
与男童相比，女童的 HIV RNA 水平较低（P =.0004），CD4 百分比较高（P <.0001）。多元线性回归显示，在控制其他协变量后，性别与 HIV RNA 水平和 CD4 百分比均具有独立关联。对纵向 HIV RNA 水平和 CD4 参数数据的多层次混合效应线性回归分析表明，性别的差异在所有观察到的年龄中均存在。T 细胞激活水平在两性之间没有差异。
在青春期前，HIV 感染的儿童中存在 HIV RNA 水平和 CD4 参数的显著性别差异。这些数据表明，与性激素水平无关的男性和女性个体之间的固有遗传差异会影响 HIV 感染者的 HIV RNA 水平和 CD4 参数。
