Prospective Study of Acute HIV-1 Infection in Adults in East Africa and Thailand
Prospective Study of Acute HIV-1 Infection in Adults in East Africa and Thailand
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DOI：
10.1056/nejmoa1508952
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发表时间：
2016-06-02
影响因子：
158.5
通讯作者：
Michael, Nelson L.
中科院分区：
文献类型：
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作者：
Robb, Merlin L.;Eller, Leigh A.;Michael, Nelson L.
背景急性人类免疫缺陷病毒1型(HIV-1)感染是HIV-1传播的主要原因。了解急性 HIV-1 感染对于制定根除 HIV-1 或实现功能性治愈的治疗策略可能很重要。方法我们对 2276 名 HIV-1 感染高危志愿者进行每周两次定性血浆 HIV-1 RNA 核酸检测。对于检测到急性 HIV-1 感染的参与者，每周两次获得临床观察、血浆 HIV-1 RNA 水平（以评估病毒血症）和 HIV 抗体的定量测量以及淋巴细胞免疫表型分析结果。 结果 112 名急性 HIV-1 感染志愿者中的 50 名在 HIV-1 感染之前采集了两份或更多血液样本 检测到抗体。第一个样本在核酸检测中显示出反应性后 13 天，病毒血症中位数达到峰值（6.7 log 10 拷贝/毫升）。酶免疫测定反应的中位时间为 14 天。病毒血症的最低点（4.3 log 10 拷贝/毫升）发生在中位 31 天，几乎等于病毒载量设定点，即急性病毒血症消退后持久持续的稳态病毒血症（中位血浆 HIV-1 RNA 水平，4.4 log 10 拷贝/毫升）。病毒血症峰值和下降斜率与病毒载量设定点相关。急性 HIV-1 感染的临床表现最常见于病毒血症高峰期之前和高峰期。平均两次研究访视时记录到一种急性 HIV-1 感染症状的中位数，平均 3 次研究访视时记录到一种急性 HIV-1 感染症状的中位数。 结论 病毒载量设定点发生在首次检测到血浆病毒血症后的中位数 31 天，并与病毒血症峰值相关。在急性 HIV-1 感染期间观察到的症状和体征很少，并且在病毒血症高峰之前最常见。 （由国防部和国家过敏和传染病研究所资助。）
BACKGROUNDAcute human immunodeficiency virus type 1 (HIV-1) infection is a major contributor to transmission of HIV-1. An understanding of acute HIV-1 infection may be important in the development of treatment strategies to eradicate HIV-1 or achieve a functional cure.METHODSWe performed twice-weekly qualitative plasma HIV-1 RNA nucleic acid testing in 2276 volunteers who were at high risk for HIV-1 infection. For participants in whom acute HIV-1 infection was detected, clinical observations, quantitative measurements of plasma HIV-1 RNA levels (to assess viremia) and HIV antibodies, and results of immuno-phenotyping of lymphocytes were obtained twice weekly.RESULTSFifty of 112 volunteers with acute HIV-1 infection had two or more blood samples collected before HIV-1 antibodies were detected. The median peak viremia (6.7 log 10 copies per milliliter) occurred 13 days after the first sample showed reactivity on nucleic acid testing. Reactivity on an enzyme immunoassay occurred at a median of 14 days. The nadir of viremia (4.3 log 10 copies per milliliter) occurred at a median of 31 days and was nearly equivalent to the viral-load set point, the steady-state viremia that persists durably after resolution of acute viremia (median plasma HIV-1 RNA level, 4.4 log 10 copies per milliliter). The peak viremia and downslope were correlated with the viralload set point. Clinical manifestations of acute HIV-1 infection were most common just before and at the time of peak viremia. A median of one symptom of acute HIV-1 infection was recorded at a median of two study visits, and a median of one sign of acute HIV-1 infection was recorded at a median of three visits.CONCLUSIONSThe viral-load set point occurred at a median of 31 days after the first detection of plasma viremia and correlated with peak viremia. Few symptoms and signs were observed during acute HIV-1 infection, and they were most common before peak viremia. (Funded by the Department of Defense and the National Institute of Allergy and Infectious Diseases.)