McKellar Mehri S, Cope Anna B, Gay Cynthia L, McGee Kara S, Kuruc Joann D, Kerkau Melissa G, Hurt Christopher B, Fiscus Susan A, Ferrari Guido, Margolis David M, Eron Joseph J, Hicks Charles B
Duke University, Durham, NC 27710, USA.
AIDS Res Hum Retroviruses. 2013 Jan;29(1):121-8. doi: 10.1089/aid.2012.0064. Epub 2012 Sep 4.
In 1998 a collaboration between Duke University and the University of North Carolina, Chapel Hill (UNC) was founded to enhance identification of persons with acute HIV-1 infection (AHI). The Duke-UNC AHI Research Consortium Cohort consists of patients ≥18 years old with a positive nucleic acid amplification test (NAAT) and either a negative enzyme immunoassay (EIA) test or a positive EIA with a negative/indeterminate Western blot. Patients were referred to the cohort from acute care settings and state-funded HIV testing sites that use NAAT testing on pooled HIV-1 antibody-negative samples. Between 1998 and 2010, 155 patients with AHI were enrolled: 81 (52%) African-Americans, 63 (41%) white, non-Hispanics, 137 (88%) males, 108 (70%) men who have sex with men (MSM), and 18 (12%) females. The median age was 27 years (IQR 22-38). Most (n=138/155) reported symptoms with a median duration of 17.5 days. The median nadir CD4 count was 408 cells/mm(3) (IQR 289-563); the median observed peak HIV-1 level was 726,859 copies/ml (IQR 167,585-3,565,728). The emergency department was the most frequent site of initial presentation (n=55/152; 3 missing data). AHI diagnosis was made at time of first contact in 62/137 (45%; 18 missing data) patients. This prospectively enrolled cohort is the largest group of patients with AHI reported from the Southeastern United States. The demographics reflect the epidemic of this geographic area with a high proportion of African-Americans, including young black MSM. Highlighting the challenges of diagnosing AHI, less than half of the patients were diagnosed at the first healthcare visit. Women made up a small proportion despite increasing numbers in our clinics.
1998年，杜克大学与北卡罗来纳大学教堂山分校（UNC）开展合作，以加强对急性HIV-1感染（AHI）患者的识别。杜克大学-北卡罗来纳大学AHI研究联盟队列由年龄≥18岁、核酸扩增检测（NAAT）呈阳性且酶免疫测定（EIA）检测为阴性或EIA呈阳性但免疫印迹为阴性/不确定的患者组成。患者从急性护理机构和对合并的HIV-1抗体阴性样本进行NAAT检测的州资助HIV检测点被转诊至该队列。1998年至2010年期间，155例AHI患者入组：81例（52%）非裔美国人，63例（41%）白人、非西班牙裔，137例（88%）男性，108例（70%）男男性行为者（MSM），18例（12%）女性。中位年龄为27岁（四分位间距22 - 38岁）。大多数患者（n = 138/155）报告有症状，中位持续时间为17.5天。最低CD4细胞计数中位数为408个细胞/mm³（四分位间距289 - 563）；观察到的HIV-1水平峰值中位数为726,859拷贝/ml（四分位间距167,585 - 3,565,728）。急诊科是最常见的首次就诊地点（n = 55/152；3例数据缺失）。62/137例（45%；18例数据缺失）患者在首次接触时被诊断为AHI。这个前瞻性入组的队列是美国东南部报告的最大一组AHI患者。人口统计学特征反映了该地理区域的疫情情况，非裔美国人比例较高，包括年轻的黑人MSM。突出了诊断AHI的挑战，不到一半的患者在首次就诊时被诊断出来。尽管我们诊所中的女性数量在增加，但她们所占比例较小。
