Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands
Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands.
Sex Transm Infect. 2019 Dec;95(8):562-568. doi: 10.1136/sextrans-2018-053522. Epub 2019 Feb 7.
Pathogen load has been linked to disease severity in patients infected with HIV, resulting in international standards to adequately and reproducibly quantify load. (CT) load has been inconsistently linked to disease severity since extensive differences exist in quantification methods (14 methods in 28 articles). Differences include normalisation for human cell load due to CT's intracellular nature, despite the inability to distinguish inflammatory cells from epithelial cells with molecular techniques. We compared the human cell load in CT-positive men and women at the genital and anal site to a CT-negative control group to estimate the impact of inflammatory cells in these samples.
188 women (tested at genital and anal site) and 519 men (207 tested at the anal site and 312 tested at the urogenital site) were included from our STI-clinic in the Netherlands. Specimens were self-collected vaginal swabs, anal swabs and urine samples. Quantitative-PCR targeting the HLA-gene quantified human cell load. Mann-Whitney-U-test was used for statistical analyses.
The genital cell load had a similar range and median (6.5 log10) between CT-negative and CT-positive women . The urogenital cell load was significantly higher than the anal cell load (median 3.6 log10). The anal cell load was significantly higher in men with- than without anal CT infection (median 4.5 versus 3.9 respectively). The anal cell load is significantly higher in CT-positive men than in women. Both Neisseria gonorrhoeae-co-infections and reported anal intercourse significantly increased the human cell load in anal samples.
Standardisation in CT load studies is necessary as current studies show 14 different quantification methods in 28 studies . In this study we demonstrate the inappropriateness of normalising the CT load for the human cell load using molecular techniques, as the presence of inflammatory cells cannot be excluded.
病原体载量与感染 HIV 的患者的疾病严重程度相关，因此制定了国际标准来充分且可重复地定量载量。（CT）载量与疾病严重程度的相关性不一致，因为定量方法存在广泛差异（28 篇文章中有 14 种方法）。差异包括由于 CT 的细胞内性质，对人类细胞载量进行归一化，尽管分子技术无法区分炎症细胞和上皮细胞。我们比较了生殖器和肛门部位 CT 阳性男性和女性与 CT 阴性对照组的人类细胞载量，以估计这些样本中炎症细胞的影响。
从我们在荷兰的性传播感染诊所纳入了 188 名女性（在生殖器和肛门部位检测）和 519 名男性（207 名在肛门部位检测，312 名在泌尿生殖道部位检测）。标本为自我采集的阴道拭子、肛门拭子和尿液样本。针对 HLA 基因的定量 PCR 定量了人类细胞载量。使用 Mann-Whitney-U 检验进行统计分析。
CT 阴性和 CT 阳性女性的生殖器细胞载量范围和中位数（6.5 log10）相似。泌尿生殖道细胞载量明显高于肛门细胞载量（中位数 3.6 log10）。与无肛门 CT 感染的男性相比，肛门 CT 感染的男性肛门细胞载量明显更高（中位数分别为 4.5 与 3.9）。CT 阳性男性的肛门细胞载量明显高于女性。淋病奈瑟菌合并感染和报告的肛交均显著增加了肛门样本中的人类细胞载量。
由于目前的研究显示在 28 项研究中有 14 种不同的定量方法，因此 CT 载量研究需要标准化。在这项研究中，我们证明了使用分子技术对 CT 载量进行人类细胞载量归一化是不恰当的，因为不能排除炎症细胞的存在。
