Better Control of Early Viral Replication Is Associated With Slower Rate of Elicited Antiviral Antibodies in the Detuned Enzyme Immunoassay During Primary HIV-1C Infection
Better Control of Early Viral Replication Is Associated With Slower Rate of Elicited Antiviral Antibodies in the Detuned Enzyme Immunoassay During Primary HIV-1C Infection
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DOI：
10.1097/qai.0b013e3181ab6ef0
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发表时间：
2009-10-01
影响因子：
3.6
通讯作者：
Essex, M.
中科院分区：
文献类型：
--
作者：
Novitsky, Vladimir;Wang, Rui;Essex, M.
背景：艾滋病毒发病率的估计对干预措施的时机选择、预防研究的规划和流行病监测都很重要。这需要准确估计血清转化和达到特定可检测的抗hiv抗体滴度水平（如HIV-1感染早期的标准化光密度（SOD））之间的“最近期”（也称为“窗口期”）。方法：为了更好地了解近期患者间的变化，采用Vironostika-LS对HIV-1亚型C感染早期的抗病毒抗体滴度进行了前瞻性测量。采用Fiebig分期法估计血清转换时间。结果：在感染的第一年，SOD值的分布通常表现为初始缓慢升高，随后迅速升高，但在一些患者中，SOD值在血清转化后很快升高。使用超氧化物歧化酶（SOD）临界值1.0，估计博茨瓦纳当地流行的C亚型感染的最近期平均持续时间为血清转化后151天（95%置信区间：130至172天）。最近一段时间与血清转化后前2-3个月的病毒复制水平显著相关（P = 0.007）。开始抗逆转录病毒治疗（ART）后SOD值降低是抗逆转录病毒药物（ARV）治疗对象的主要模式。结论：我们的数据表明，基于敏感/不敏感的酶免疫测定横断面检测的HIV发病率估计可以通过在检测最近感染时合并病毒载量水平来潜在地改进。
Background: Estimation of HIV incidence rates is important for timing interventions, planning prevention studies, and monitoring the epidemic. This requires accurate estimation of the "recency period" (also known as the "window period") between seroconversion and achievement of specific detectable levels of anti-HIV antibody titers, such as the standardized optical density (SOD) in the early phase of HIV-1 infection.Methods: To obtain a better understanding of interpatient variation of the recency period, prospective measurements of antiviral antibody titers in the early phase of HIV-1 subtype C infection were quantified by Vironostika-LS. Time of seroconversion was estimated by Fiebig staging.Results: The profiles of SOD values during the first year of infection commonly showed slow initial increase followed by a more rapid increase, although in some patients, SOD values increased rapidly soon after seroconversion. Using an SOD cutoff of 1.0, the average duration of the recency period in subtype C infection in the local epidemic in Botswana was estimated to be 151 days (95% confidence interval: 130 to 172 days) post seroconversion. The recency period was significantly associated (P = 0.007) with the level of viral replication during the first 2-3 months post seroconversion. Reduction of SOD values after initiation of antiretroviral therapy (ART) was a dominant pattern in antiretroviral drug (ARV)-treated subjects.Conclusions: Our data suggest that HIV incidence estimation based on sensitive/less sensitive enzyme immunoassay cross-sectional testing could be potentially improved by incorporation of viral load levels at the time of detection of a recent infection.