NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.
Front Immunol. 2021 Jul 22;12:712802. doi: 10.3389/fimmu.2021.712802. eCollection 2021.
In the "treat all" era, there are few data on the nature of HIV clinical progression in middle-income countries. The aim of the current study was to prospectively analyze the clinical progression of HIV and its indicators among men in China with acute HIV who have sex with men.
From 2009-2014 a total of 400 men with acute HIV infection (AHI) were identified among 7,893 men who have sex with men periodic pooled nucleic acid amplification testing, and they were assigned to an AHI prospective cohort in Beijing and Shenyang, China. Rapid progression was defined as two consecutive CD4 T cell counts < 350/µL within 3-24 months post-infection. Kaplan-Meier and Cox-regression analyses were conducted to identify predictors of rapid progression.
Among 400 men with AHI 46.5% were rapid progressors, 35.1% reached rapid progressor status by 12 months post-infection, and 63.9% reached rapid progressor status by 24 months. Rapid progression was associated with herpes simplex-2 virus coinfection (adjusted hazard ratio [aHR] 1.7, 95% confidence interval [CI] 1.2-2.3], depression (aHR 1.9, 95% CI 1.5-2.6), baseline CD4 T cell count < 500/μL (aHR 3.5, 95% CI 2.4-5.1), higher baseline HIV viral load (aHR 1.6, 95% CI 1.2-2.3), acute symptoms lasting ≥ 2 weeks (aHR 1.6, 95% CI 1.1-2.2), higher body mass index (aHR 0.9, 95% CI 0.9-1.0), higher HIV viral load (aHR 1.7, 95% CI 1.4-2.1), set point viral load at 3 months (aHR 2.0, 95% CI 1.6-2.5), each 100-cell/μL decrease in CD4 T cell count at 3 months (aHR 2.2, 95% CI 1.9-2.5), and baseline routine blood tests including white blood cell count < 5.32, hemoglobin ≥ 151, mean corpuscular hemoglobin ≥ 30.5, hemoglobin concentration ≥ 342, mean platelet count ≥ 342, lymphocytes ≥ 1.98, and mixed cell count ≥ 0.4 (all < 0.05).
Almost half of the patients underwent rapid clinical progression within 2 years after HIV infection. A treat-all policy is necessary and should be strengthened globally. Rapid progression was correlated with herpes simplex-2 virus coinfection, depression, low CD4 T cell counts, and high set point viral load in acute infection stage. Rapid progression can be identified simple indicators such as body mass index and routine blood test parameters in low and middle-income countries.
在“治疗所有”时代，中低收入国家关于 HIV 临床进展性质的数据很少。本研究的目的是前瞻性分析急性 HIV 感染的男同性恋者中 HIV 的临床进展及其指标。
2009-2014 年，通过对定期进行的 7893 名男同性恋者的核酸联合检测，在其中发现了 400 名急性 HIV 感染（AHI）男性，他们被分配到中国北京和沈阳的 AHI 前瞻性队列中。快速进展定义为感染后 3-24 个月内连续两次 CD4 T 细胞计数 < 350/µL。采用 Kaplan-Meier 和 Cox 回归分析确定快速进展的预测因素。
在 400 名 AHI 男性中，46.5%为快速进展者，35.1%在感染后 12 个月达到快速进展者状态，63.9%在 24 个月达到快速进展者状态。快速进展与单纯疱疹病毒 2 型合并感染（调整后的危险比 [aHR] 1.7，95%置信区间 [CI] 1.2-2.3）、抑郁（aHR 1.9，95% CI 1.5-2.6）、基线 CD4 T 细胞计数 < 500/μL（aHR 3.5，95% CI 2.4-5.1）、基线 HIV 病毒载量较高（aHR 1.6，95% CI 1.2-2.3）、急性症状持续时间≥2 周（aHR 1.6，95% CI 1.1-2.2）、较高的体重指数（aHR 0.9，95% CI 0.9-1.0）、较高的 HIV 病毒载量（aHR 1.7，95% CI 1.4-2.1）、3 个月时的设定点病毒载量（aHR 2.0，95% CI 1.6-2.5）、3 个月时每减少 100 个/μL CD4 T 细胞计数（aHR 2.2，95% CI 1.9-2.5）以及基线常规血液检查包括白细胞计数<5.32、血红蛋白≥151、平均红细胞血红蛋白≥30.5、血红蛋白浓度≥342、血小板计数≥342、淋巴细胞≥1.98 和混合细胞计数≥0.4（均 < 0.05）。
近一半的患者在 HIV 感染后 2 年内经历了快速临床进展。在全球范围内，需要采取“治疗所有”政策并加以加强。快速进展与单纯疱疹病毒 2 型合并感染、抑郁、低 CD4 T 细胞计数和急性感染阶段的高设定点病毒载量相关。在中低收入国家，可以通过体重指数和常规血液检查参数等简单指标来识别快速进展。
