Detection and treatment of Fiebig stage I HIV-1 infection in young at-risk women in South Africa: a prospective cohort study
Detection and treatment of Fiebig stage I HIV-1 infection in young at-risk women in South Africa: a prospective cohort study
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DOI：
10.1016/s2352-3018(17)30146-7
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发表时间：
2018-01-01
期刊：
影响因子：
16.1
通讯作者：
Ndung'u, Thumbi
中科院分区：
文献类型：
--
作者：
Dong, Krista L.;Moodley, Amber;Ndung'u, Thumbi
背景：撒哈拉以南非洲年轻妇女的艾滋病毒发病率仍然很高，将她们纳入疫苗和治疗工作至关重要。我们的目的是建立一个在Fiebig I期急性HIV感染期间检测到的年轻女性队列，她们在诊断后立即开始治疗，以推进对这一高危群体的研究。方法南非夸祖鲁-纳塔尔省945名年龄在18-23岁、未感染艾滋病毒且性活跃的妇女同意在参加为期48-96周的生活技能和就业准备规划期间，每周进行两次HIV-1 RNA检测，每3个月进行一次生物采样和风险评估。我们分析了立即联合抗逆转录病毒治疗（ART）对病毒血症和免疫反应、性危险行为的影响，以及社会经济干预的影响。结果：2012年12月1日至2016年6月30日期间，42名女性被诊断为急性HIV感染（发病率为8.2 / 100人年，95% CI 5.9-11.1），其中36名（86%）被诊断为Fiebig I期感染，初始病毒载量中位数为2.97 log 10拷贝/ mL （IQR 2.42- 3.85）。这36名妇女中有23名在检测后1天（1-1）开始抗逆转录病毒治疗，这将病毒载量的中位峰值限制在每毫升4.22 log（10）拷贝（3.27-4.83），CD4最低点限制在每毫升685个细胞（561-802）。抗逆转录病毒疗法还能在16天（12-26天）内抑制病毒载量（低于每毫升20拷贝），并且在23名妇女中有20名（87%）阻止血清转化，如免疫印迹所示。385名妇女完成了48周的社会经济干预，其中231人随访1年。在这231名妇女中，有202名（87%）找到了工作、重返校园或创业。频繁的艾滋病毒筛查与社会经济干预相结合，有助于在感染前后进行抽样和风险评估。除了检测急性感染和立即治疗外，我们还建立了一个优化的预防和治疗研究队列。
Background HIV incidence among young women in sub-Saharan Africa remains high and their inclusion in vaccine and cure efforts is crucial. We aimed to establish a cohort of young women detected during Fiebig stage I acute HIV infection in whom treatment was initiated immediately after diagnosis to advance research in this high-risk group.Methods 945 women aged 18-23 years in KwaZulu-Natal, South Africa, who were HIV uninfected and sexually active consented to HIV-1 RNA testing twice a week and biological sampling and risk assessment every 3 months during participation in a 48-96 week life-skills and job-readiness programme. We analysed the effect of immediate combination antiretroviral therapy (ART) on viraemia and immune responses, sexual risk behaviour, and the effect of the socioeconomic intervention.Findings 42 women were diagnosed with acute HIV infection between Dec 1, 2012, and June 30, 2016, (incidence 8.2 per 100 person-years, 95% CI 5.9-11.1), of whom 36 (86%) were diagnosed in Fiebig stage I infection with a median initial viral load of 2.97 log 10 copies per mL (IQR 2.42-3 .85). 23 of these 36 women started ART at a median of 1 day (1-1) after detection, which limited the median peak viral load to 4.22 log(10) copies per mL (3.27-4.83) and the CD4 nadir to 685 cells per mu L (561-802). ART also suppressed viral load (to < 20 copies per mL) within a median of 16 days (12-26) and, in 20 (87%) of 23 women, prevented seroconversion, as shown with western blotting. 385 women completed the 48 week socioeconomic intervention, of whom 231 were followed up for 1 year. 202 (87%) of these 231 women were placed in jobs, returned to school, or started a business.Interpretation Frequent HIV screening combined with a socioeconomic intervention facilitated sampling and risk assessment before and after infection. In addition to detection of acute infection and immediate treatment, we established a cohort optimised for prevention and cure research.