Morand-Joubert L, Bludau H, Lerable J, Petit J C, Lefrère J J
Service de Bacterio-Virologie, Hôpital Saint-Antoine, Paris, France.
J Med Virol. 1995 Sep;47(1):87-91. doi: 10.1002/jmv.1890470116.
We studied the prognostic value on the decrease of CD4 lymphocyte count of anti-p24 antibody (ab) titer and compared this value with that of polyclonal and monoclonal p24 (ag) titer before and after immune complex dissociation (ICD); 53 human immunodeficiency virus (HIV)-infected patients having CD4+ counts above 400/mm3 when first examined were followed up over a 3-year period including at least four visits; HIV disease progressors (n = 18) were defined as having CD4+ counts below 200/mm3 and non-progressors (n = 35) as having CD4+ counts still above 400/mm3 at the end of follow-up. Sera were collected at each visit and assayed for p24 ag with and without ICD and for anti-p24 ab titer. The mean anti-p24 ab titer of progressors and of non-progressors at entry was significantly different. A threshold of anti-p24 ab titer indicating a HIV progression was determined at 1/300. The proportion of individuals with an anti-p24 ab titer lower than 1/300 at least once during the study period was 34% in non-progressors and 94% in progressors. The difference between progressors and non-progressors at entry was significant with monoclonal p24 ag without ICD and more significant with monoclonal p24 ag after ICD. The marker having the highest predictive value was the anti-p24 ab titer, then monoclonal p24 ag with ICD, then polyclonal p24 ag with ICD. Anti-p24 ab is an earlier and stronger marker of the decrease of CD4 lymphocyte count than p24 ag even after ICD.
我们研究了抗 p24 抗体（ab）滴度降低对 CD4 淋巴细胞计数的预后价值，并将该价值与免疫复合物解离（ICD）前后多克隆和单克隆 p24（ag）滴度的预后价值进行比较；对 53 例初次检查时 CD4 + 计数高于 400/mm³ 的人类免疫缺陷病毒（HIV）感染患者进行了为期 3 年的随访，包括至少四次就诊；HIV 疾病进展者（n = 18）定义为随访结束时 CD4 + 计数低于 200/mm³，非进展者（n = 35）定义为随访结束时 CD4 + 计数仍高于 400/mm³。每次就诊时采集血清，检测有无 ICD 时的 p24 抗原以及抗 p24 抗体滴度。进展者和非进展者入院时的平均抗 p24 抗体滴度有显著差异。确定抗 p24 抗体滴度表明 HIV 进展的阈值为 1/300。在研究期间至少有一次抗 p24 抗体滴度低于 1/300 的个体比例，非进展者为 34%，进展者为 94%。入院时进展者和非进展者之间在未进行 ICD 的单克隆 p24 抗原方面差异显著，在进行 ICD 后的单克隆 p24 抗原方面差异更显著。预测价值最高的标志物是抗 p24 抗体滴度，其次是进行 ICD 的单克隆 p24 抗原，然后是进行 ICD 的多克隆 p24 抗原。即使在 ICD 后，抗 p24 抗体也是比 p24 抗原更早、更强的 CD4 淋巴细胞计数降低的标志物。
