Karris Maile Y, Kao Yu-ting, Patel Derek, Dawson Matthew, Woods Steven P, Vaida Florin, Spina Celsa, Richman Douglas, Little Susan, Smith Davey M
aUniversity of California San Diego, La Jolla bVeterans Administration San Diego Healthcare System, San Diego, California, USA.
AIDS. 2014 Mar 27;28(6):841-9. doi: 10.1097/QAD.0000000000000149.
Despite evidence supporting antiretroviral therapy (ART) in recent HIV infection, little is known about factors that are associated with successful ART. We assessed demographic, virologic, and immunologic parameters to identify predictors of virologic response.
A 24-week observational study of ART on persons enrolled within 6 months of their estimated date of infection (EDI) evaluated baseline demographics and the collection of blood and gut specimens.
Flow cytometry analyses of blood and gut lymphocytes allowed characterization of CD4 and CD8 T cells at study entry and end. Additional assessments included soluble CD14 (sCD14), lipopolysaccharide, CD4 T-cell counts, and HIV RNA levels.
Twenty-nine participants initiated ART, and 17 achieved undetectable HIV RNA by study end. A longer time from EDI to ART, older age, higher sCD14, lower proportions of central memory CD4 T cells, and higher proportions of activated CD8 T cells were associated with detectable viremia. Multivariable logistic regression found only older age and elevated sCD14 were independently associated with persistent viremia. Additionally, we observed that ART in recent infection did not result in discernible recovery of CD4 T cells in the gut.
In persons who started ART within 3-33 weeks from EDI, age and microbial translocation were associated with detectable HIV RNA. As observed in other cohorts, ART in recent infection did not improve proportions of total CD4 T cells in gut-associated lymphoid tissue (GALT). This lends support to further evaluate the use of more potent ART or regimens that protect the GALT in recent HIV infection.
尽管有证据支持在近期感染艾滋病毒时进行抗逆转录病毒治疗（ART），但对于与ART成功相关的因素知之甚少。我们评估了人口统计学、病毒学和免疫学参数，以确定病毒学反应的预测因素。
一项对估计感染日期（EDI）后6个月内入组的人员进行的为期24周的ART观察性研究，评估了基线人口统计学以及血液和肠道标本的采集情况。
对血液和肠道淋巴细胞进行流式细胞术分析，以在研究开始和结束时对CD4和CD8 T细胞进行特征描述。其他评估包括可溶性CD14（sCD14）、脂多糖、CD4 T细胞计数和HIV RNA水平。
29名参与者开始接受ART治疗，17名在研究结束时实现了无法检测到的HIV RNA水平。从EDI到ART的时间更长、年龄较大、sCD14水平较高、中央记忆CD4 T细胞比例较低以及活化CD8 T细胞比例较高与可检测到的病毒血症相关。多变量逻辑回归发现只有年龄较大和sCD14升高与持续性病毒血症独立相关。此外，我们观察到近期感染时的ART并未导致肠道中CD4 T细胞有明显恢复。
在从EDI起3 - 33周内开始接受ART治疗的人群中，年龄和微生物易位与可检测到的HIV RNA相关。正如在其他队列中所观察到的，近期感染时的ART并未改善肠道相关淋巴组织（GALT）中总CD4 T细胞的比例。这支持进一步评估在近期艾滋病毒感染中使用更有效的ART或保护GALT的方案。
