O'Brien T R, Blattner W A, Waters D, Eyster E, Hilgartner M W, Cohen A R, Luban N, Hatzakis A, Aledort L M, Rosenberg P S, Miley W J, Kroner B L, Goedert J J
Viral Epidemiology Branch, National Cancer Institute, Rockville, MD 20852, USA.
JAMA. 1996 Jul 10;276(2):105-10.
To determine if the long-term incidence of the acquired immunodeficiency syndrome (AIDS) is related to human immunodeficiency virus type 1 (HIV-1) RNA levels measured early in HIV-1 infection.
Epidemiologic cohort study.
Five hemophilia treatment centers in the United States.
A total of 165 subjects with hemophilia and HIV-1 infection (age at HIV-1 seroconversion, 1-66 years) followed from 1979 to 1995.
The HIV-1 RNA level was measured by polymerase chain reaction over a range of 200 to 1 million or more HIV-1 RNA copies/mL in archived serum specimens collected 12 to 36 months (median, 27 months) after the estimated date of HIV-1 seroconversion. Kaplan-Meier methods were used to examine the risk of AIDS and proportional hazards models were used to estimate relative hazards.
The HIV-1 RNA values were similar in subjects younger than 17 years at seroconversion (median, 5214 copies/mL) and those 18 to 34 years old (median, 4693 copies/mL), but higher in those 35 years or older (median, 12069 copies/mL) (P = .02 compared with each younger group). At 10 years after seroconversion, the proportions of subjects with AIDS were 72% among subjects with 100,000 or more HIV-1 RNA copies/mL measured 12 to 36 months after HIV-1 seroconversion (n = 9), 52% among subjects with 10,000 to 99,999 copies/mL (n = 55), 22% among subjects with 1000 to 9,999 copies/mL (n = 82), and 0% among subjects with fewer than 1000 copies/mL (n = 19) (P < .001). The age-adjusted relative hazard for AIDS for subjects with 10,000 or more copies/mL was 14.3 (95% confidence interval, 1.9-105.6) compared with subjects with fewer than 1000 copies/mL.
The HIV-1 RNA level during early chronic HIV-1 infection is a strong, age-independent predictor of clinical outcome; low levels define persons with a high probability of long-term AIDS-free survival.
确定获得性免疫缺陷综合征（AIDS）的长期发病率是否与人类免疫缺陷病毒1型（HIV-1）感染早期检测到的HIV-1 RNA水平相关。
流行病学队列研究。
美国的五个血友病治疗中心。
共有165例血友病合并HIV-1感染患者（HIV-1血清转化时年龄为1至66岁），随访时间为1979年至1995年。
在估计的HIV-1血清转化日期后12至36个月（中位数为27个月）收集的存档血清标本中，通过聚合酶链反应测量HIV-1 RNA水平，范围为200至100万或更多HIV-1 RNA拷贝/毫升。采用Kaplan-Meier方法检查患AIDS的风险，采用比例风险模型估计相对风险。
血清转化时年龄小于17岁的患者（中位数为5214拷贝/毫升）和18至34岁的患者（中位数为4693拷贝/毫升）的HIV-1 RNA值相似，但35岁及以上患者的值更高（中位数为12069拷贝/毫升）（与每个较年轻组相比，P = 0.02）。血清转化后10年，在HIV-1血清转化后12至36个月测量的HIV-1 RNA拷贝数为100,000或更多的患者中，患AIDS的比例为72%（n = 9），在10,000至99,999拷贝/毫升的患者中为52%（n = 55），在1000至9999拷贝/毫升的患者中为22%（n = 82），在少于1000拷贝/毫升的患者中为0%（n = 19）（P < 0.001）。与少于1000拷贝/毫升的患者相比，HIV-1 RNA拷贝数为10,000或更多的患者患AIDS的年龄调整相对风险为14.3（95%置信区间，1.9 - 105.6）。
慢性HIV-1感染早期的HIV-1 RNA水平是临床结局的一个强大的、与年龄无关的预测指标；低水平表明长期无AIDS生存的可能性高。
