HIV-1 合胞体诱导表型对 CD4+ 细胞耗竭率及进展至艾滋病的预后价值。

Prognostic value of HIV-1 syncytium-inducing phenotype for rate of CD4+ cell depletion and progression to AIDS.

作者信息

Koot M, Keet I P, Vos A H, de Goede R E, Roos M T, Coutinho R A, Miedema F, Schellekens P T, Tersmette M

机构信息

Department of Clinical Viro-Immunology, Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam.

出版信息

Ann Intern Med. 1993 May 1;118(9):681-8. doi: 10.7326/0003-4819-118-9-199305010-00004.

DOI:10.7326/0003-4819-118-9-199305010-00004

PMID:8096374

Abstract

OBJECTIVE

To investigate the relation between detection of syncytium-inducing (SI), human immunodeficiency virus type 1 (HIV-1) variants, rate of CD4+ cell decline, and clinical progression.

DESIGN

Prospective study during a 2.5-year follow-up period; cohort study with pairwise matched controls.

SETTING

The Amsterdam cohort study on the course of HIV-1 infection in homosexual men.

PARTICIPANTS

Asymptomatic HIV-1 infected men (n = 225) were tested for the presence of SI variants and were studied prospectively for CD4+ cell decline and clinical progression. In addition, 45 men with a defined moment of appearance of SI variants and 45 matched controls without SI variants were compared for CD4+ cell decline.

MEASUREMENTS

Syncytium-inducing variants were detected by cocultivation of peripheral blood mononuclear cells with the MT-2 T-cell line.

RESULTS

During a 30-month period, 70.8% of the men with SI variants progressed to AIDS, compared with 15.8% of men without SI variants at entry (P < 0.0001). Multivariable Cox proportional hazard analysis, controlling for CD4+ cell count and HIV-p24 antigenemia, showed a relative hazard for SI variants of 6.7 (95% Cl, 3.5 to 12.7). In the matched control study, before the appearance of SI variants, CD4+ cell counts of 45 men with SI variants and their controls were compared. Syncytium-inducing variants emerged at a mean CD4+ cell count of 0.48 x 10(9)/L(Cl, 0.42 to 0.54), coinciding with the onset of a threefold increased rate of CD4+ cell decline. Men developing AIDS with SI variants had decreased CD4+ cell counts (0.08 x 10(9)/L; 95% Cl, 0.05 to 0.12) at the time of diagnosis compared with persons progressing to AIDS without SI variants (0.25 x 10(9)/L 95% Cl, 0.15 to 0.41) (P = 0.0035].

CONCLUSIONS

The HIV-1 biological phenotype is a practical, binary marker for progression to AIDS, which is independent of decreased CD4+ cell counts and antigenemia. Appearance of SI variants, occurring 2 years before progression to AIDS on the average, is predictive for a significantly increased rate of CD4+ cell decline.

摘要

目的

研究合胞体诱导（SI）的人类免疫缺陷病毒1型（HIV-1）变异体的检测、CD4+细胞下降率与临床进展之间的关系。

设计

为期2.5年的随访期前瞻性研究；配对对照队列研究。

地点

阿姆斯特丹男同性恋者HIV-1感染病程队列研究。

参与者

对225名无症状HIV-1感染男性进行SI变异体检测，并对其CD4+细胞下降和临床进展进行前瞻性研究。此外，比较了45名已确定出现SI变异体的男性和45名未出现SI变异体的配对对照者的CD4+细胞下降情况。

测量

通过外周血单核细胞与MT-2 T细胞系共培养检测合胞体诱导变异体。

结果

在30个月期间，携带SI变异体的男性中有70.8%进展为艾滋病，而基线时未携带SI变异体的男性中这一比例为15.8%（P<0.0001）。多变量Cox比例风险分析在控制CD4+细胞计数和HIV-p24抗原血症后显示，SI变异体的相对风险为6.7（95%CI，3.5至12.7）。在配对对照研究中，在SI变异体出现前，比较了45名携带SI变异体的男性及其对照者的CD4+细胞计数。合胞体诱导变异体出现时的平均CD4+细胞计数为0.48×10⁹/L（CI，0.42至0.54），此时CD4+细胞下降率增加了两倍。与未携带SI变异体而进展为艾滋病的人相比，携带SI变异体进展为艾滋病的男性在诊断时CD4+细胞计数较低（0.08×10⁹/L；95%CI，0.05至0.12），而未携带SI变异体进展为艾滋病的人CD4+细胞计数为0.25×10⁹/L（95%CI，0.15至0.41）（P = 0.0035）。