Henrard D R, Phillips J F, Muenz L R, Blattner W A, Wiesner D, Eyster M E, Goedert J J
Department of Medical Research, Abbott Laboratories, North Chicago, Ill., USA.
JAMA. 1995 Aug 16;274(7):554-8.
To characterize the natural history of viremia with human immunodeficiency virus type 1 (HIV-1) and its association with disease progression from infection to acquired immunodeficiency syndrome (AIDS).
Prospective cohort study. Annual specimens were tested for quantitative virion-associated HIV-1 RNA, p24 antigen, and CD4+ lymphocyte levels.
A total of 42 homosexual men who seroconverted to HIV-1 between 1982 and 1985.
Trends over time in serum HIV-1 RNA level, correlations between serum HIV-1 RNA and other markers, and prediction of AIDS using these markers.
HIV-1 RNA levels were stable over time, increasing by 10-fold or more in only six (14%) of the 42 subjects during 3 to 11 years of follow-up. Mean HIV-1 RNA levels were 10(3.8) copies/mL if AIDS occurred in less than 4 years, 10(3.07) copies/mL if AIDS developed within 4 through 9 years, and 10(2.27) copies/mL if AIDS did not develop within 6 through 11 years. In both univariate and multivariate models, initial and subsequent HIV-1 RNA levels, p24 antigenemia, and percentage of CD4+ lymphocytes were independently predictive of AIDS.
The stability of virion-associated HIV-1 RNA levels suggests that an equilibrium between HIV-1 replication rate and efficacy of immunologic response is established shortly after infection and persists throughout the asymptomatic period of the disease. Thus, defective immunologic control of HIV-1 infection may be as important as the viral replication rate for determining AIDS-free survival. Because individual steady-state levels of viremia were established soon after infection, HIV-1 RNA levels may be useful markers for predicting clinical outcome.
描述1型人类免疫缺陷病毒（HIV-1）病毒血症的自然史及其与从感染到获得性免疫缺陷综合征（AIDS）疾病进展的关联。
前瞻性队列研究。每年对标本进行定量病毒体相关HIV-1 RNA、p24抗原和CD4+淋巴细胞水平检测。
1982年至1985年间血清转化为HIV-1的42名同性恋男性。
血清HIV-1 RNA水平随时间的变化趋势、血清HIV-1 RNA与其他标志物之间的相关性以及使用这些标志物对AIDS的预测。
HIV-1 RNA水平随时间稳定，在3至11年的随访期间，42名受试者中只有6名（14%）升高了10倍或更多。如果在不到4年的时间内发生AIDS，平均HIV-1 RNA水平为10(3.8)拷贝/毫升；如果在4至9年内发展为AIDS，为10(3.07)拷贝/毫升；如果在6至11年内未发展为AIDS，为10(2.27)拷贝/毫升。在单变量和多变量模型中，初始和随后的HIV-1 RNA水平、p24抗原血症以及CD4+淋巴细胞百分比均独立预测AIDS。
病毒体相关HIV-1 RNA水平的稳定性表明，HIV-1复制率与免疫反应效能之间的平衡在感染后不久即建立，并在疾病的无症状期持续存在。因此，HIV-1感染的免疫控制缺陷对于确定无AIDS生存可能与病毒复制率同样重要。由于个体病毒血症稳态水平在感染后不久即确立，HIV-1 RNA水平可能是预测临床结局的有用标志物。
