Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA; Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA.
HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Lancet HIV. 2018 Jan;5(1):e35-e44. doi: 10.1016/S2352-3018(17)30146-7. Epub 2017 Oct 1.
HIV incidence among young women in sub-Saharan Africa remains high and their inclusion in vaccine and cure efforts is crucial. We aimed to establish a cohort of young women detected during Fiebig stage I acute HIV infection in whom treatment was initiated immediately after diagnosis to advance research in this high-risk group.
945 women aged 18-23 years in KwaZulu-Natal, South Africa, who were HIV uninfected and sexually active consented to HIV-1 RNA testing twice a week and biological sampling and risk assessment every 3 months during participation in a 48-96 week life-skills and job-readiness programme. We analysed the effect of immediate combination antiretroviral therapy (ART) on viraemia and immune responses, sexual risk behaviour, and the effect of the socioeconomic intervention.
42 women were diagnosed with acute HIV infection between Dec 1, 2012, and June 30, 2016, (incidence 8·2 per 100 person-years, 95% CI 5·9-11·1), of whom 36 (86%) were diagnosed in Fiebig stage I infection with a median initial viral load of 2·97 log copies per mL (IQR 2·42-3·85). 23 of these 36 women started ART at a median of 1 day (1-1) after detection, which limited the median peak viral load to 4·22 log copies per mL (3·27-4·83) and the CD4 nadir to 685 cells per μL (561-802). ART also suppressed viral load (to <20 copies per mL) within a median of 16 days (12-26) and, in 20 (87%) of 23 women, prevented seroconversion, as shown with western blotting. 385 women completed the 48 week socioeconomic intervention, of whom 231 were followed up for 1 year. 202 (87%) of these 231 women were placed in jobs, returned to school, or started a business.
Frequent HIV screening combined with a socioeconomic intervention facilitated sampling and risk assessment before and after infection. In addition to detection of acute infection and immediate treatment, we established a cohort optimised for prevention and cure research.
Bill & Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases, International AIDS Vaccine Initiative, Wellcome Trust, Howard Hughes Medical Institute.
撒哈拉以南非洲地区青年女性的艾滋病毒感染率仍然很高，将她们纳入疫苗和治疗工作至关重要。我们的目的是建立一个队列，其中包括在 Fiebig 期 I 急性 HIV 感染期间发现的年轻女性，在诊断后立即开始对她们进行治疗，以推进这一高风险群体的研究。
在南非夸祖鲁-纳塔尔省，945 名年龄在 18-23 岁之间、HIV 阴性且有性行为的女性同意在参与为期 48-96 周的生活技能和就业准备计划期间，每周两次进行 HIV-1 RNA 检测，并每 3 个月进行一次生物样本采集和风险评估。我们分析了立即开始联合抗逆转录病毒治疗（ART）对病毒血症和免疫反应、性风险行为的影响，以及社会经济干预的效果。
2012 年 12 月 1 日至 2016 年 6 月 30 日期间，共有 42 名妇女被诊断患有急性 HIV 感染（发病率为 8.2 例/100 人年，95%CI 5.9-11.1），其中 36 名（86%）被诊断为 Fiebig 期 I 感染，初始病毒载量中位数为 2.97 log 拷贝/mL（2.42-3.85）。这 36 名妇女中有 23 名在中位时间为 1 天（1-1）后开始接受 ART 治疗，这将中位峰值病毒载量限制在 4.22 log 拷贝/mL（3.27-4.83）和 CD4 最低点至 685 个细胞/μL（561-802）。ART 还在中位数为 16 天（12-26）内抑制了病毒载量（<20 拷贝/mL），在 23 名妇女中的 20 名（87%）中，如 Western blot 所示，阻止了血清转换。385 名妇女完成了 48 周的社会经济干预，其中 231 名妇女接受了 1 年的随访。在这 231 名妇女中，有 202 名（87%）被安置在工作岗位、返回学校或创业。
频繁的 HIV 筛查结合社会经济干预措施，在感染前和感染后都能方便地进行采样和风险评估。除了发现急性感染和立即治疗外，我们还建立了一个队列，该队列最适合预防和治疗研究。
比尔及梅琳达·盖茨基金会、美国国立过敏和传染病研究所、国际艾滋病疫苗倡议、惠康信托基金会、霍华德·休斯医学研究所。
