Farzadegan H, Hoover D R, Astemborski J, Lyles C M, Margolick J B, Markham R B, Quinn T C, Vlahov D
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.
Lancet. 1998 Nov 7;352(9139):1510-4. doi: 10.1016/S0140-6736(98)02372-1.
Plasma HIV-1 RNA measurements are used for initiation of antiretroviral treatments. Whether the viral-load association with prognosis is similar in women and men is unknown.
We studied 812 specimens from 650 injection-drug users (IDUs) participating in a continuous observational study of patients based in a community clinic. HIV-1 load was measured by branched-chain DNA on samples from 527 IDUs from the baseline visit, and by reverse-transcriptase PCR and quantitative microculture on samples from 285 IDUs at a follow-up visit 3 years later. FNDINGS: Women had lower median viral-load measurements than men by branched-chain DNA (3365 vs 8907 copies/mL; p=0.001), reverse-transcriptase PCR (45416 vs 93130 copies/mL; p=0.02), and quantitative microculture (5 vs 8 infectious units per million peripheral blood mononuclear cells; p=0.015). This association remained even after adjustment for CD4 cell count, race, and drug use within the previous 6 months. Time to AIDS was statistically similar for men and women in a univariate proportional-hazards model and in a model adjusting for CD4 cell count. Proportional-hazards models showed that women with the same viral load as men had a 1.6-fold higher risk of AIDS (95% CI 1.10-2.32); or, equivalently, that women with half the viral load of men had a similar time to AIDS as men.
Although a biological mechanism remains unclear, these data suggest that current recommendations for HIV-1 viral-load thresholds to initiate antiretroviral therapy should be revised downwards for women.
血浆HIV-1 RNA检测用于启动抗逆转录病毒治疗。病毒载量与预后的关联在男性和女性中是否相似尚不清楚。
我们研究了来自650名注射吸毒者（IDU）的812份样本，这些样本来自一个社区诊所对患者进行的连续观察性研究。通过分支DNA法对527名IDU基线访视时的样本进行HIV-1载量检测，3年后随访时通过逆转录酶PCR和定量微培养法对285名IDU的样本进行检测。
通过分支DNA法（3365对8907拷贝/毫升；p=0.001）、逆转录酶PCR法（45416对93130拷贝/毫升；p=0.02）和定量微培养法（每百万外周血单个核细胞中5对8个感染单位；p=0.015），女性的病毒载量中位数低于男性。即使在对CD4细胞计数、种族和前6个月内的吸毒情况进行调整后，这种关联仍然存在。在单变量比例风险模型和调整了CD4细胞计数的模型中，男性和女性患艾滋病的时间在统计学上相似。比例风险模型显示，病毒载量与男性相同的女性患艾滋病的风险高1.6倍（95%可信区间1.10-2.32）；或者，等效地说，病毒载量为男性一半的女性患艾滋病的时间与男性相似。
尽管生物学机制尚不清楚，但这些数据表明，目前关于启动抗逆转录病毒治疗的HIV-1病毒载量阈值的建议应针对女性向下调整。
