Tsai Hung-Chin, Chou Pei-Yun, Wann Shue-Ren, Lee Susan Shin-Jung, Chen Yao-Shen
Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ROC National Yang-Ming University, Taipei, Taiwan ROC.
BMJ Open. 2015 Apr 29;5(4):e007334. doi: 10.1136/bmjopen-2014-007334.
The goal of this present study was to determine the proportion of CCR5-tropic and CXCR4-tropic viruses and impact of tropism test on clinical presentation, CD4 cell counts, viral load and genotypic drug resistance from drug-naïve, voluntary counselling and testing (VCT) clients in southern Taiwan.
This was a cross-sectional study. Plasma samples were collected from HIV-1-infected patients from January 2013 to December 2013; subjects were recruited from free VCT centres in southern Taiwan.
Taiwan.
Plasma samples from 108 HIV-1-infected, treatment-naïve, VCT clients were analysed. HIV-1 strains were sequenced, genotype resistance was determined by a commercial kit (Viro-seq) and co-receptor tropism (CRT) was predicted by an internet tool geno2pheno[coreceptor], with a 10% false-positive rate as the cut-off. Differences in progression markers, patient characteristics, VCT questionnaires and HIV subtype distribution were evaluated statistically.
All the 108 VCT clients were male with 90% between the ages of 20 and 40 years. Eighty-eight per cent of the patients were men who have sex with men (MSM). The median (IQR) CD4 cell count was 342 cells/µL (221-454) and the viral load was 4.6 log (4.0-5.0). HIV-transmitted drug resistance was found in 9.3% (10/108) of the patients. CRT predictions indicated that 74% of the patients had only R5-tropic strains. CRT was not associated with CD4 cell counts, patient characteristics, VCT questionnaire and transmitted drug resistance. There was a significant difference with regard to viral load at the time of presentation, showing that patients with R5 more often had a higher viral load as compared with those with X4/DM strains (4.6±0.6 log vs 4.33±0.7 log, p=0.036).
We found that 74% of the VCT clients were infected with R5-tropic virus strains. HIV-transmitted drug resistance was not associated with CRT predictions. Higher viral load at presentation was predictive of R5 co-receptor usage.
本研究旨在确定台湾南部初治自愿咨询检测（VCT）客户中CCR5嗜性和CXCR4嗜性病毒的比例，以及嗜性检测对临床表现、CD4细胞计数、病毒载量和基因型耐药性的影响。
这是一项横断面研究。2013年1月至2013年12月从HIV-1感染患者中采集血浆样本；研究对象来自台湾南部的免费VCT中心。
台湾。
分析了108例HIV-1感染、初治VCT客户的血浆样本。对HIV-1毒株进行测序，使用商用试剂盒（Viro-seq）确定基因型耐药性，并通过互联网工具geno2pheno[coreceptor]预测共受体嗜性（CRT），以10%的假阳性率为临界值。对进展标志物、患者特征、VCT问卷和HIV亚型分布的差异进行统计学评估。
108例VCT客户均为男性，90%年龄在20至40岁之间。88%的患者为男男性行为者（MSM）。CD4细胞计数中位数（IQR）为342个/μL（221 - 454），病毒载量为4.6 log（4.0 - 5.0）。9.3%（10/108）的患者存在HIV传播的耐药性。CRT预测表明，74%的患者仅具有R5嗜性毒株。CRT与CD4细胞计数、患者特征、VCT问卷及传播耐药性无关。就诊时病毒载量存在显著差异，表明与具有X4/DM毒株的患者相比，具有R5嗜性的患者病毒载量更高（4.6±0.6 log对4.33±0.7 log，p = 0.036）。
我们发现74%的VCT客户感染了R5嗜性病毒株。HIV传播的耐药性与CRT预测无关。就诊时较高的病毒载量预示着R5共受体的使用。
