Casadellà Maria, Cozzi-Lepri Alessandro, Phillips Andrew, Noguera-Julian Marc, Bickel Markus, Sedlacek Dalibor, Zilmer Kai, Clotet Bonaventura, Lundgren Jens D, Paredes Roger
IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain.
Universitat Autònoma de Barcelona, Catalonia, Spain.
PLoS One. 2017 Jan 27;12(1):e0166613. doi: 10.1371/journal.pone.0166613. eCollection 2017.
To investigate if plasma HIV-1 tropism testing could identify subjects at higher risk for clinical progression and death in routine clinical management.
Nested case-control study within the EuroSIDA cohort.
Cases were subjects with AIDS or who died from any cause, with a plasma sample with HIV-1 RNA >1000 copies/mL available for tropism testing 3 to 12 months prior to the event. At least 1 control matched for age, HIV-1 RNA and HCV status at the time of sampling were selected per each case. Conditional logistic regression was used to investigate exposures associated with clinical progression to AIDS or death. A linear mixed model with random intercept was used to compare CD4+T-cell slopes by HIV tropism over the 12 months following the date of sampling.
The study included 266 subjects, 100 cases and 166 controls; one quarter had X4 HIV; 26% were ART-naïve. Baseline factors independently associated with clinical progression or death were female gender (OR = 2.13 vs. male, 95CI = 1.04, 4.36), p = 0.038), CD4+T-cell count (OR = 0.90 (95CI = 0.80, 1.00) per 100 cells/mm3 higher, p = 0.058), being on ART (OR = 2.72 vs. being off-ART (95CI = 1.15, 6.41), p = 0.022) and calendar year of sample [OR = 0.84 (95CI = 0.77, 0.91) per more recent year, p<0.001). Baseline tropism was not associated with the risk of clinical progression or death. CD4+T-cell slopes did not differ within or between tropism groups.
The predictive role of plasma tropism determined using 454 sequencing in the context of people receiving cART with detectable VL is not helpful to identify subjects at higher risk for clinical progression to AIDS or death.
探讨在常规临床管理中，血浆HIV-1嗜性检测能否识别出临床进展和死亡风险较高的受试者。
欧洲艾滋病临床数据库（EuroSIDA）队列中的巢式病例对照研究。
病例为患有艾滋病或因任何原因死亡的受试者，在事件发生前3至12个月有一份HIV-1 RNA>1000拷贝/mL的血浆样本可用于嗜性检测。每个病例至少选择1名在采样时年龄、HIV-1 RNA和丙型肝炎病毒（HCV）状态相匹配的对照。采用条件逻辑回归研究与艾滋病临床进展或死亡相关的暴露因素。使用具有随机截距的线性混合模型比较采样日期后12个月内按HIV嗜性分类的CD4+T细胞斜率。
该研究纳入266名受试者，100例病例和166名对照；四分之一的受试者感染X4型HIV；26%未接受抗逆转录病毒治疗（ART）。与临床进展或死亡独立相关的基线因素为女性（与男性相比，比值比[OR]=2.13，95%置信区间[CI]=1.04，4.36），P=0.038）、CD4+T细胞计数（每升高100个细胞/mm3，OR=0.90（95%CI=0.80，1.00），P=0.058）、接受ART治疗（与未接受ART治疗相比，OR=2.72（95%CI=1.15，6.41），P=0.022）以及样本采集的日历年[每最近一年，OR=0.84（95%CI=0.77，0.91），P<0.001]。基线嗜性与临床进展或死亡风险无关。嗜性组内和组间的CD4+T细胞斜率无差异。
在接受cART且病毒载量可检测的人群中，使用454测序法测定的血浆嗜性的预测作用无助于识别临床进展为艾滋病或死亡风险较高的受试者。
