尿道炎治疗后精液中HIV-1浓度的降低：对预防HIV-1性传播的意义。艾滋病关怀组织马拉维研究小组

Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group.

作者信息

Cohen M S, Hoffman I F, Royce R A, Kazembe P, Dyer J R, Daly C C, Zimba D, Vernazza P L, Maida M, Fiscus S A, Eron J J

机构信息

Department of Medicine, University of North Carolina, Chapel Hill 27599-7030, USA.

出版信息

Lancet. 1997 Jun 28;349(9069):1868-73. doi: 10.1016/s0140-6736(97)02190-9.

DOI:10.1016/s0140-6736(97)02190-9

PMID:9217758

Abstract

BACKGROUND

Transmission of HIV-1 is predominantly by heterosexual contact in sub-Saharan Africa, where sexually transmitted diseases (STDs) are also common. Epidemiological studies suggest that STDs facilitate transmission of HIV-1, but the biological mechanism remains unclear. We investigated the hypothesis that STDs increase the likelihood of transmission of HIV-1 through increased concentration of the virus in semen.

METHODS

HIV-1 RNA concentrations were measured in seminal and blood plasma from 135 HIV-1-seropositive men in Malawi; 86 had urethritis and 49 controls did not have urethritis. Men with urethritis received antibiotic treatment according to the guidelines of the Malawian STD Advisory Committee. Samples were analysed at baseline and at week 1 and week 2 after antibiotic therapy in urethritis patients, and at baseline and week 2 in the control group.

FINDINGS

HIV-1-seropositive men with urethritis had HIV-1 RNA concentrations in seminal plasma eight times higher than those in seropositive men without urethritis (12.4 vs 1.51 x 10(4) copies/mL, p = 0.035), despite similar CD4 counts and concentrations of blood plasma viral RNA. Gonorrhoea was associated with the greatest concentration of HIV-1 in semen (15.8 x 10(4) copies/mL). After the urethritis patients received antimicrobial therapy directed against STDs, the concentration of HIV-1 RNA in semen decreased significantly (from 12.4 x 10(4) copies/mL to 8.91 x 10(4) copies/mL at 1 week [p = 0.03] and 4.12 x 10(4) copies/mL at 2 weeks [p = 0.0001]). Blood plasma viral RNA concentrations did not change. There was no significant change in seminal plasma HIV-1 RNA concentrations during the 2-week period in the control group (p = 0.421).

INTERPRETATION

These results suggest that urethritis increases the infectiousness of men with HIV-1 infection. HIV-1-control programmes, which include detection and treatment of STDs in patients already infected with HIV-1, may help to curb the epidemic. Targeting of gonococcal urethritis may be a particularly effective strategy.

摘要

背景

在撒哈拉以南非洲地区，HIV-1主要通过异性接触传播，而性传播疾病（STD）在该地区也很常见。流行病学研究表明，STD会促进HIV-1的传播，但生物学机制仍不清楚。我们研究了这样一个假说，即STD通过增加精液中病毒浓度来提高HIV-1传播的可能性。

方法

对马拉维135名HIV-1血清阳性男性的精液和血浆中的HIV-1 RNA浓度进行了测量；其中86人患有尿道炎，49名对照者未患尿道炎。患有尿道炎的男性根据马拉维STD咨询委员会的指南接受了抗生素治疗。对尿道炎患者在基线时以及抗生素治疗后第1周和第2周进行样本分析，对对照组在基线时和第2周进行样本分析。

研究结果

患有尿道炎的HIV-1血清阳性男性精液血浆中的HIV-1 RNA浓度比未患尿道炎的血清阳性男性高8倍（分别为12.4对1.51×10⁴拷贝/毫升，p = 0.035），尽管他们的CD4细胞计数和血浆病毒RNA浓度相似。淋病与精液中HIV-1的最高浓度相关（15.8×10⁴拷贝/毫升）。尿道炎患者接受针对STD的抗菌治疗后，精液中HIV-1 RNA的浓度显著下降（从12.4×10⁴拷贝/毫升降至第1周时的8.91×10⁴拷贝/毫升[p = 0.03]和第2周时的4.12×10⁴拷贝/毫升[p = 0.0001]）。血浆病毒RNA浓度没有变化。对照组在2周期间精液血浆中HIV-1 RNA浓度没有显著变化（p = 0.421）。