Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection
Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection
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DOI：
10.1097/00002030-200309050-00005
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发表时间：
2003-09-05
期刊：
影响因子：
3.8
通讯作者：
Busch, MP
中科院分区：
文献类型：
--
作者：
Fiebig, EW;Wright, DJ;Busch, MP
目的：通过对新感染者的连续血浆样本进行多标准病毒检测分析，以确定HIV原发感染的特征。设计：两组来自HIV感染者血浆献血者的存档样本。(A)1984-1994年间捐献的51名捐献者的435份样本；(B)1996-1998年间捐献的44名捐赠者的145份P24抗原筛查样本。地点：两家美国血浆制品公司。主要观察指标：HIV-1标志物出现的时间点和初次HIV感染期间的病毒载量浓度。结果：A组中病毒标志物的顺序出现模式高度一致，允许定义和估计6个连续阶段的持续时间。通过回归分析得出p24抗原血清转换时的病毒载量为10 000拷贝/毫升(95%可信区间为2000-93 000)，HIV复制率为0.35对数拷贝/毫升/天，相应于转阴前阶段的倍增时间为20.5小时(95%可信区间为18.2-23.4小时)。因此，灵敏度为50拷贝/毫升的RNA检测可以在p24抗原检测前约7天和敏感的抗HIV检测前12天检测到HIV感染。结论：通过检测反应性的顺序出现，可以将原发HIV-1感染划分为不同的实验室阶段，这可能有助于近期感染的诊断和临床试验患者的分层。定量分析HIV感染前的复制率有助于预测针对初次HIV感染的检测结果和预测价值。(C)2003年，里平科特·威廉姆斯·威尔金斯。
Objectives: The characterization of primary HIV infection by the analysis of serial plasma samples from newly infected persons using multiple standard viral assays.Design: A retrospective study involving two sets of archived samples from HIV-infected plasma donors. (A) 435 samples from 51 donors detected by anti-HIV enzyme immunoassays donated during 1984-1994; (B) 145 specimens from 44 donors detected by p24 antigen screening donated during 1996-1998.Setting: Two US plasma products companies.Main outcome measures: The timepoints of appearance of HIV-1 markers and viral load concentrations during primary HIV infection.Results: The pattern of sequential emergence of viral markers in the 'A' panels was highly consistent, allowing the definition and estimation of the duration of six sequential stages. From the 'B' panels, the viral load at p24 antigen seroconversion was estimated by regression analysis at 10 000 copies/ml (95% CI 2000-93 000) and the HIV replication rate at 0.35 log copies/ml/day, corresponding to a doubling time in the preseroconversion phase of 20.5 h (95% Cl 18.2-23.4 h). Consequently, an RNA test with 50 copies/ml sensitivity would detect HIV infection approximately 7 days before a p24 antigen test, and 12 days before a sensitive anti-HIV test.Conclusion: The sequential emergence of assay reactivity allows the classification of primary HIV-1 infection into distinct laboratory stages, which may facilitate the diagnosis of recent infection and stratification of patients enrolled in clinical trials. Quantitative analysis of preseroconversion replication rates of HIV is useful for projecting the yield and predictive value of assays targeting primary HIV infection. (C) 2003 Lippincott Williams Wilkins.