Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy.
Unit of Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
Immun Inflamm Dis. 2023 Feb;11(2):e778. doi: 10.1002/iid3.778.
Young adults with vertical transmission (VT) of human immunodeficiency virus (HIV) represent a fragile population. This study evaluates factors associated with viro-immunological outcome of these patients.
We performed a multicenter study including HIV-infected subjects with VT ≥ 18 years old from six Italian clinics. Subjects were observed from birth to death, lost to follow-up, or last visit until December 31, 2019. Condition of "optimal viro-immunological status" (OS) was defined as the simultaneous presence of HIV ribonucleic acid (RNA) < 50 copies/mL, CD4+ > 500 cells/mm , and CD4+/CD8+ ratio ≥ 1.
A total of 126 subjects were enrolled. At 18 years of age, 52/126 (44.4%) had HIV-RNA > 50 copies/mL, 47/126 (38.2%) had CD4+ < 500/mm , and 78/126 (67.2%) had CD4+/CD8+ < 1; 28 subjects (23.7%) presented in the condition of OS. Having a CD4+/CD8+ ratio ≥ 1 at 18 years of age was related with an increased probability of shift from suboptimal viro-immunological status (SOS) to OS (HR: 7.7, 95% confidence interval [CI]: 4.23-14.04), and a reduced risk of shift from the OS to the SOS (HR: 0.49, 95% CI: 0.26-0.92). Acquired immunodeficiency syndrome (AIDS) diagnosis significantly reduced the probability of shift from a viro-immunological SOS to OS (HR: 0.09, 95% CI: 0.03-0.30). Subjects who had not achieved an OS at 18 years of age had an increased risk of discontinuation of combination antiretroviral therapy (cART, p = .019).
Only a small proportion of subjects with VT of HIV reached the adult age with "OS". Transition to the adult care with a compromised viro-immunological condition represents a negative driver for future optimal infection control, with a higher risk of discontinuation of cART and a reduced probability to improve the immunological status later in the years.
携带人类免疫缺陷病毒（HIV）垂直传播的年轻成年人是一个脆弱的群体。本研究评估了与这些患者病毒免疫结果相关的因素。
我们进行了一项多中心研究，纳入了来自意大利六家诊所的 18 岁及以上携带 HIV 垂直传播的感染患者。研究对象从出生到死亡、失访或截至 2019 年 12 月 31 日的最后一次就诊进行观察。“最佳病毒免疫状态”（OS）的定义为同时满足 HIV 核糖核酸（RNA）<50 拷贝/ml、CD4+>500 个细胞/mm3 和 CD4+/CD8+比值≥1。
共纳入 126 例患者。18 岁时，52/126（44.4%）的患者 HIV-RNA>50 拷贝/ml，47/126（38.2%）的患者 CD4+<500/mm3，78/126（67.2%）的患者 CD4+/CD8+<1；28 例（23.7%）患者达到 OS 状态。18 岁时 CD4+/CD8+比值≥1与从亚最佳病毒免疫状态（SOS）向 OS 状态转变的概率增加相关（HR：7.7，95%置信区间[CI]：4.23-14.04），向 SOS 状态转变的风险降低（HR：0.49，95% CI：0.26-0.92）。获得性免疫缺陷综合征（AIDS）诊断显著降低了从病毒免疫 SOS 向 OS 转变的概率（HR：0.09，95% CI：0.03-0.30）。18 岁时未达到 OS 的患者中断联合抗逆转录病毒治疗（cART）的风险增加（p=0.019）。
只有一小部分 HIV 垂直传播的患者在成年后达到“OS”。在病毒免疫状态较差的情况下过渡到成人护理是未来最佳感染控制的负面驱动因素，中断 cART 的风险更高，以后几年改善免疫状态的可能性降低。
