UMR S-943, Pierre et Marie Curie University, Paris, France.
J Med Virol. 2012 Dec;84(12):1853-6. doi: 10.1002/jmv.23362.
The HIV-1 coreceptor usage may play a critical role in AIDS pathogenesis and the X4-using viruses are considered to be more pathogenic than the R5-tropic viruses. These observations may influence the therapeutic decisions by asking for an earlier antiretroviral (ARV) treatment for the patients infected by the X4-tropic viruses compared with those infected by the R5-tropic viruses. The natural evolution of CD4+ cell count for 109 non-treated patients infected by the R5- or X4-tropic HIV-1 viruses with CD4+ >350 and >500 cells/mm(3) at time of diagnosis was compared until the initiation of an ARV regimen. The coreceptor usage was determined from the V3 env region sequence by Geno2Pheno (false positive rate 10%). A mixed linear regression model to analyse the CD4+ data with tropism as fixed effect in the model was used. Overall, 93 (85.3%) and 16 (14.7%) were infected by R5- and X4-tropic viruses, respectively. The median age, baseline CD4+ cell count, and viral load were 34 years (IQR: 30-42), 523 cells/mm(3) (IQR: 420-604), and 4.5 log(10) copies/ml (IQR: 3.9-5.0), respectively. There was no statistical difference in time to progression between the patients harboring R5- or X4-tropic viruses. The same results were observed for the sub-group of patients with CD4+ cell count >500 cells/mm(3). The virus tropism has no impact on the CD4+ cell count evolution in these HIV-1 patients diagnosed with CD4+ >350 or >500 cells/mm(3) suggesting that the tropism determination at time of diagnosis does not seem to be a useful tool to predict the clinical progression.
HIV-1 核心受体的使用可能在艾滋病发病机制中起关键作用，并且 X4 使用的病毒被认为比 R5 嗜性病毒更具致病性。这些观察结果可能会影响治疗决策，要求对感染 X4 嗜性病毒的患者比感染 R5 嗜性病毒的患者更早开始抗逆转录病毒 (ARV) 治疗。
比较了 109 例未接受治疗的患者，这些患者在诊断时 CD4+>350 和 CD4+>500 个细胞/mm(3)时，感染了 R5 或 X4 嗜性 HIV-1 病毒，比较了其自然 CD4+细胞计数的演变，直到开始 ARV 治疗方案。核心受体的使用通过 Geno2Pheno 从 V3 env 区序列确定（假阳性率为 10%）。使用混合线性回归模型分析带有嗜性的 CD4+数据作为模型中的固定效应。
总体而言，93 例（85.3%）和 16 例（14.7%）分别感染了 R5 和 X4 嗜性病毒。中位年龄、基线 CD4+细胞计数和病毒载量分别为 34 岁（IQR：30-42）、523 个细胞/mm(3)（IQR：420-604）和 4.5 log(10) 拷贝/ml（IQR：3.9-5.0）。携带 R5 或 X4 嗜性病毒的患者在进展时间上无统计学差异。对于 CD4+细胞计数>500 个细胞/mm(3)的患者亚组，也观察到了相同的结果。在这些诊断时 CD4+>350 或 CD4+>500 个细胞/mm(3)的 HIV-1 患者中，病毒嗜性对 CD4+细胞计数的演变没有影响，表明诊断时确定嗜性似乎不是预测临床进展的有用工具。
