Schacker T W, Hughes J P, Shea T, Coombs R W, Corey L
University of Washington and the Fred Hutchinson Cancer Research Center, Seattle 98104, USA.
Ann Intern Med. 1998 Apr 15;128(8):613-20. doi: 10.7326/0003-4819-128-8-199804150-00001.
The clinical events surrounding acute HIV-1 infection have been well described, but little is known about whether the virologic course of acute HIV-1 infection influences the subsequent progression of disease.
To define the virologic natural history of acute and very early HIV infection.
Prospective, longitudinal cohort study.
University of Washington Research Clinic
74 adults enrolled soon after acquisition of HIV (mean, 69 days).
Plasma HIV-1 RNA levels; quantitative cell cultures; CD4 cell counts; and detailed clinical assessments done at study entry, biweekly for 1 month, monthly for 2 months, and quarterly thereafter.
In the first 30 days after acquisition of HIV, HIV-1 RNA levels varied greatly among participants (range, 27,200 to 1.6 x 10(6) copies per mL of plasma). Levels of HIV-1 RNA decreased by a mean of 6.5% per week for the first 120 days and then increased by a mean of 0.15% per week. CD4 cell counts decreased by a mean of 5.2 cells/mm3 per week for the first 160 days and by a mean of 1.9 cells/mm3 per week thereafter (P < 0.01). Disease progressed faster in participants who sought medical care for their acute seroconversion syndrome (P = 0.01) and those who had high plasma HIV-1 RNA levels 120 to 365 days after acquisition (P < 0.01). Peak levels in the first 120 days were not predictive of disease progression.
The variability in viral RNA levels associated with acute HIV-1 infection is greater than previously appreciated. Within 120 days of acquisition, plasma HIV RNA levels rapidly decrease to an inflection point, after which they gradually increase. Virus-host interactions soon after acquisition seem to have a major influence on the long-term outcome of HIV-1 disease.
围绕急性HIV-1感染的临床事件已有详尽描述，但对于急性HIV-1感染的病毒学进程是否会影响疾病的后续进展，人们却知之甚少。
明确急性及极早期HIV感染的病毒学自然史。
前瞻性纵向队列研究。
华盛顿大学研究诊所
74名在感染HIV后不久（平均69天）入组的成年人。
血浆HIV-1 RNA水平；定量细胞培养；CD4细胞计数；以及在研究入组时、第1个月每两周、第2个月每月、此后每季度进行的详细临床评估。
在感染HIV后的前30天内，参与者的HIV-1 RNA水平差异很大（范围为每毫升血浆27,200至1.6×10⁶拷贝）。在最初的120天里，HIV-1 RNA水平平均每周下降6.5%，之后平均每周上升0.15%。在最初的160天里，CD4细胞计数平均每周下降5.2个细胞/mm³，此后平均每周下降1.9个细胞/mm³（P<0.01）。因急性血清转化综合征寻求医疗护理的参与者（P = 0.01）以及感染后120至365天血浆HIV-1 RNA水平较高的参与者（P<0.01）疾病进展更快。最初120天内的峰值水平并不能预测疾病进展。
与急性HIV-1感染相关的病毒RNA水平的变异性比之前认为的更大。在感染后的120天内，血浆HIV RNA水平迅速下降至一个转折点，之后逐渐上升。感染后不久的病毒-宿主相互作用似乎对HIV-1疾病的长期结局有重大影响。
