Yang Otto O, Cumberland William G, Escobar Robert, Liao Diana, Chew Kara W
aAIDS Healthcare Foundation bDavid Geffen School of Medicine cDepartment of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California, USA.
AIDS. 2017 May 15;31(8):1091-1098. doi: 10.1097/QAD.0000000000001443.
HIV-1-infected persons spontaneously controlling viremia without treatment (SCV) are rare. Sex and race effects on prevalence and outcome are poorly defined, and it is unclear whether SCV qualitatively or quantitatively differs from typical infection. These issues are examined in this article.
Medical records of 46 524 persons receiving outpatient care for HIV-1 infection were reviewed. Of these, 29 811 had adequate viremia testing for SCV screening.
SCV was defined as at least three consecutive plasma viremia measurements <50 RNA copies/ml spanning at least 1 year without treatment. SCV loss was defined as at least three consecutive viremia measurements ≥50 RNA copies/ml or one ≥1000 RNA copies/ml. Demographics of persons with SCV were compared with the total population. Viremia and blood CD4 T-cell levels during SCV were compared between demographic subgroups and persons who maintained or lost SCV during observation.
In total, 53 persons (0.18%) met SCV criteria. Prevalence was higher for women versus men and blacks versus whites; these appeared independent. Loss of SCV was observed at 1.22% per year, and significantly associated with viremia 'blips'. Blip magnitudes fit log-normal distributions with means below 50 RNA copies/ml.
Our novel observation of higher SCV prevalence in women and blacks is consistent with prior studies of typical chronic infection. Viremia blips correspond to greater risk of loss of SCV, likely reflecting higher set-point viremia under the limit of detection. Our findings suggest that SCV represents an extreme along a continuum of HIV-1 infection, and not qualitative difference.
未经治疗而能自发控制病毒血症的HIV-1感染者（SCV）很罕见。性别和种族对其患病率及转归的影响尚不明确，且不清楚SCV在性质或数量上是否与典型感染有所不同。本文对这些问题进行了研究。
回顾了46524例接受HIV-1感染门诊治疗患者的病历。其中，29811例有足够的病毒血症检测结果用于SCV筛查。
SCV定义为至少连续三次血浆病毒血症测量值<50 RNA拷贝/ml，持续至少1年且未经治疗。SCV丧失定义为至少连续三次病毒血症测量值≥50 RNA拷贝/ml或一次≥1000 RNA拷贝/ml。将SCV患者的人口统计学特征与总体人群进行比较。比较了不同人口统计学亚组以及观察期间维持或丧失SCV的患者在SCV期间的病毒血症和血液CD4 T细胞水平。
共有53例患者（0.18%）符合SCV标准。女性患病率高于男性，黑人高于白人；这些差异似乎具有独立性。每年观察到1.22%的患者丧失SCV，且与病毒血症“波动”显著相关。波动幅度符合均值低于50 RNA拷贝/ml的对数正态分布。
我们关于女性和黑人中SCV患病率较高的新观察结果与先前关于典型慢性感染的研究一致。病毒血症波动与丧失SCV的风险增加相关，这可能反映了在检测限以下更高的病毒血症设定点。我们的研究结果表明，SCV代表了HIV-1感染连续谱中的一个极端情况，而非性质上的差异。
