血浆中HIV-1 RNA的定量可预测血清转化后的结果。

Quantitation of HIV-1 RNA in plasma predicts outcome after seroconversion.

作者信息

Mellors J W, Kingsley L A, Rinaldo C R, Todd J A, Hoo B S, Kokka R P, Gupta P

机构信息

University of Pittsburgh, Pennsylvania.

出版信息

Ann Intern Med. 1995 Apr 15;122(8):573-9. doi: 10.7326/0003-4819-122-8-199504150-00003.

DOI:10.7326/0003-4819-122-8-199504150-00003

PMID:7887550

Abstract

OBJECTIVE

To investigate the relation between the quantity of human immunodeficiency virus type 1 (HIV-1) RNA in plasma and the risk for the acquired immunodeficiency syndrome (AIDS) or a decline in the CD4+ T-cell count after seroconversion.

DESIGN

Prospective study.

PATIENTS

62 homosexual men with documented HIV-1 seroconversion.

SETTING

University outpatient setting.

MEASUREMENTS

Clinical status, CD4+ T-cell counts, and plasma and serum samples were obtained every 6 months. Human immunodeficiency virus RNA in plasma was quantitated with a branched-DNA (bDNA) assay. Serum samples were assayed for neopterin, beta 2-microglobulin, and immune complex dissociated HIV-1 p24 antigen.

RESULTS

18 of 62 (29%) men developed AIDS; 21 (34%) had a significant decline in the CD4+ T-cell count without AIDS; and 23 (37%) had a stable CD4+ T-cell count. For each participant, HIV-1 RNA results were categorized into one of four groups: 1) detection of HIV-1 RNA (> 1 x 10(4) genome equivalents/mL [Eq/mL]) in all samples; 2) detection in most samples (> or = 50%); 3) detection in fewer than 50% of samples; and 4) detection in none of the samples. Detection of HIV-1 RNA in all or most samples was strongly associated with AIDS (16 of 18 patients) and a decline in the CD4+ T-cell count (13 of 21 patients) compared with a stable CD4+ T-cell count (4 of 23 patients; P < 0.001). Conversely, the absence of HIV-1 RNA (< 1 x 10(4) Eq/mL) in all or most samples was associated with stable CD4+ T-cell counts (19 of 23 patients) and a lower risk for AIDS or decline in the CD4+ T-cell count (10 of 39 patients; P < 0.001). In multivariate analysis of all laboratory values at the seroconversion visit, a plasma HIV-1 RNA level greater than 1 x 10(5) Eq/mL was the most powerful predictor of AIDS (odds ratio, 10.8; P = 0.01).

CONCLUSIONS

Plasma HIV-1 RNA is a strong, CD4+ T-cell-independent predictor of a rapid progression to AIDS after HIV-1 seroconversion.

摘要

目的

研究1型人类免疫缺陷病毒（HIV-1）血浆RNA数量与获得性免疫缺陷综合征（AIDS）风险或血清转化后CD4+ T细胞计数下降之间的关系。

设计

前瞻性研究。

患者

62名有记录的HIV-1血清转化的同性恋男性。

地点

大学门诊。

测量

每6个月获取临床状态、CD4+ T细胞计数以及血浆和血清样本。用分支DNA（bDNA）分析法对血浆中的人类免疫缺陷病毒RNA进行定量。检测血清样本中的新蝶呤、β2-微球蛋白和免疫复合物解离的HIV-1 p24抗原。

结果

62名男性中有18名（29%）发展为AIDS；21名（34%）CD4+ T细胞计数显著下降但未患AIDS；23名（37%）CD4+ T细胞计数稳定。对于每位参与者，HIV-1 RNA结果被分为四组之一：1）所有样本中均检测到HIV-1 RNA（>1×10⁴基因组当量/毫升[Eq/mL]）；2）大多数样本中检测到（≥50%）；3）少于50%的样本中检测到；4）所有样本中均未检测到。与CD4+ T细胞计数稳定的情况（23名患者中的4名；P<0.001）相比，所有或大多数样本中检测到HIV-1 RNA与AIDS（18名患者中的16名）和CD4+ T细胞计数下降（21名患者中的13名）密切相关。相反，所有或大多数样本中未检测到HIV-1 RNA（<1×10⁴ Eq/mL）与CD4+ T细胞计数稳定（23名患者中的19名）以及患AIDS或CD4+ T细胞计数下降的风险较低（39名患者中的10名；P<0.001）相关。在对血清转化访视时的所有实验室值进行多变量分析时，血浆HIV-1 RNA水平大于1×10⁵ Eq/mL是AIDS最有力的预测指标（优势比，10.8；P = 0.01）。