Ruiz L, Romeu J, Clotet B, Balagué M, Cabrera C, Sirera G, Ibáñez A, Martínez-Picado J, Raventós A, Tural C, Segura A, Foz M
Retrovirology Laboratory, Institut de Recerca de la SIDA-Caixa, Spain.
AIDS. 1996 Sep;10(11):F39-44. doi: 10.1097/00002030-199609000-00001.
To analyse plasma HIV-1 RNA levels as a marker of clinical stability and survival in a cohort of HIV-infected patients whose time of seroconversion is unknown.
Retrospective cohort study.
Retrovirology laboratory and AIDS Unit in a teaching hospital.
A total of 916 samples from 302 patients, most on antiretroviral therapy, were analysed. Mean initial CD4 cell counts and HIV-1 RNA were 299 x 10(6)/l (range: 0-1600) and 134,261 copies/ml (range: < 200-4,300,000), respectively. Sixty-six cases had been diagnosed previously with AIDS.
Analysis of progression to AIDS and survival, according to initial and longitudinal viral load (VL) and CD4 cell count measurements was performed by Kaplan-Meier test. Relative risks were calculated by Cox's proportional hazards model.
During a mean follow-up of 444 +/- 309 days, 29 patients developed AIDS and 21 died. Relative risk (RR) of progression related to the group with VL < 35,000 was: 10.4 when CD4 > or = 250 x 10(6)/l and VL > or = 35,000 (P = 0.001); and 45.3 when CD4 < 250 x 10(6)/l and VL > or = 35,000 (P < 0.0001). Cumulative probability of progression was: 0%, 0% and 12.3%, at the first, second and third year respectively, for patients with all their sequential VL determinations < 60,000; and 13.3%, 34.7% and 79.3% for patients who did not maintain VL values always < 60,000 (RR = 23; P < 0.0001). The minimum value of VL that reached statistical significance for the survival analysis was 100,000 copies/ml (P < 0.0001).
VL > or = or < 35,000 is a better discriminant for progression than a CD4 cell count > or = or < 250 x 10(6)/l. Sequential VL determinations < 60,000 are associated with a better prognosis.
分析血浆HIV-1 RNA水平，以此作为一组血清转化时间未知的HIV感染患者临床稳定性和生存情况的标志物。
回顾性队列研究。
一家教学医院的逆转录病毒实验室和艾滋病科。
共分析了来自302例患者的916份样本，大多数患者正在接受抗逆转录病毒治疗。初始CD4细胞计数和HIV-1 RNA的平均值分别为299×10⁶/L（范围：0 - 1600）和134,261拷贝/毫升（范围：<200 - 4,300,000）。66例患者先前已被诊断为艾滋病。
通过Kaplan-Meier检验，根据初始和纵向病毒载量（VL）以及CD4细胞计数测量结果，分析进展为艾滋病的情况和生存情况。通过Cox比例风险模型计算相对风险。
在平均444±309天的随访期间，29例患者进展为艾滋病，21例死亡。与VL<35,000的组相比，进展的相对风险（RR）为：当CD4≥250×10⁶/L且VL≥35,000时为10.4（P = 0.001）；当CD4<250×10⁶/L且VL≥35,000时为45.3（P<0.0001）。对于所有连续VL测定值<60,000的患者，第一年、第二年和第三年进展累积概率分别为0%、0%和12.3%；对于未始终保持VL值<60,000的患者，进展累积概率分别为13.3%、34.7%和79.3%（RR = 23；P<0.0001）。生存分析中达到统计学显著性的VL最小值为100,000拷贝/毫升（P<0.0001）。
VL≥或<35,000比CD4细胞计数≥或<250×10⁶/L是更好的进展判别指标。连续VL测定值<60,000与较好的预后相关。
