Higher set point plasma viral load and more-severe acute HIV type 1 (HIV-1) illness predict mortality among high-risk HIV-1-infected African women
Higher set point plasma viral load and more-severe acute HIV type 1 (HIV-1) illness predict mortality among high-risk HIV-1-infected African women
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DOI：
10.1086/503258
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发表时间：
2006-05-01
影响因子：
11.8
通讯作者：
Overbaugh, J
中科院分区：
文献类型：
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作者：
Lavreys, L;Baeten, JM;Overbaugh, J
背景。关于非洲人类免疫缺陷病毒 1 型 (HIV-1) 感染自然史的信息有限，尤其是来自具有明确感染日期的个体的信息。我们使用了一项针对肯尼亚蒙巴萨女性性工作者的前瞻性队列研究的数据，这些女性性工作者从感染 HIV-1 之日起每月进行一次随访。方法。本次分析包括未接受过抗逆转录病毒治疗且明确感染 HIV-1 日期的女性。使用Cox比例风险分析评估设定点血浆病毒载量（感染后4-24个月测量）、早期CD4(+)细胞计数和急性HIV-1感染症状对死亡率的影响。结果。在 218 名女性中，HIV-1 感染后的中位随访时间为 4.6 年。 40 名女性死亡，在 8.7 年（最后一次死亡时间）时，根据 Kaplan-Meier 分析，累积生存率为 51%。较高的设定点病毒载量、较低的早期 CD4(+) 细胞计数以及症状较多的急性 HIV-1 疾病均预示着死亡。在多变量分析中，设定点病毒载量（风险比 [HR]，每 1 log 10 拷贝/mL 增加 2.28；P = .001）和急性 HIV-1 疾病（HR，每增加一个症状 1.14；P = .05）与较高死亡率独立相关。结论。在这组非洲妇女中，生存率与引入联合抗逆转录病毒疗法之前工业化国家的 HIV-1 感染者的生存率相似。较高的设定点病毒载量和更严重的急性 HIV-1 疾病预示着更快的死亡进展。及早识别有疾病快速进展风险的个体可以进行更密切的临床监测，包括及时开始抗逆转录病毒治疗。
Background. There is limited information on the natural history of human immunodeficiency virus type 1 (HIV-1) infection in Africa, especially from individuals with well-defined dates of infection. We used data from a prospective cohort study of female sex workers in Mombasa, Kenya, who were followed up monthly from before the date of HIV-1 infection.Methods. Antiretroviral-naive women who had a well-defined date of HIV-1 infection were included in this analysis. The effects of set point plasma viral load ( measured 4-24 months after infection), early CD4(+) cell count, and symptoms of acute HIV-1 infection on mortality were assessed using Cox proportional hazards analysis.Results. Among 218 women, the median duration of follow-up after HIV-1 infection was 4.6 years. Forty women died, and at 8.7 years ( the time of the last death), the cumulative survival rate was 51% by Kaplan-Meier analysis. Higher set point viral load, lower early CD4(+) cell count, and more-symptomatic acute HIV-1 illness each predicted death. In multivariate analysis, set point viral load ( hazard ratio [HR], 2.28 per 1 log 10 copies/mL increase; P = .001) and acute HIV-1 illness ( HR, 1.14 per each additional symptom; P = .05) were independently associated with higher mortality.Conclusion. Among this group of African women, the survival rate was similar to that for HIV-1-infected individuals in industrialized nations before the introduction of combination antiretroviral therapy. Higher set point viral load and more-severe acute HIV-1 illness predicted faster progression to death. Early identification of individuals at risk for rapid disease progression may allow closer clinical monitoring, including timely initiation of antiretroviral treatment.