INCREASING VIRAL BURDEN IN CD4+ T-CELLS FROM PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS (HIV) INFECTION REFLECTS RAPIDLY PROGRESSIVE IMMUNOSUPPRESSION AND CLINICAL-DISEASE
INCREASING VIRAL BURDEN IN CD4+ T-CELLS FROM PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS (HIV) INFECTION REFLECTS RAPIDLY PROGRESSIVE IMMUNOSUPPRESSION AND CLINICAL-DISEASE
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DOI：
10.7326/0003-4819-113-6-438
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发表时间：
1990-09-15
影响因子：
39.2
通讯作者：
LANE, HC
中科院分区：
文献类型：
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作者：
SCHNITTMAN, SM;GREENHOUSE, JJ;LANE, HC
目的：随时间推移确定无症状人类免疫缺陷病毒（HIV）感染患者的病毒载量与免疫功能下降之间的关系。
设计：通过聚合酶链反应对匹配队列的细胞样本进行HIV前病毒DNA盲法分析，对患者的临床数据进行回顾性分析，并对1型人类免疫缺陷病毒（HIV - 1）血清阳性患者进行前瞻性随访。
地点：国家研究诊所和学术医疗中心。
患者：队列1包括12名健康的HIV - 1血清阳性患者（平均随访14个月）；6名患者病情稳定，6名患者病情迅速进展。队列2包括来自多中心艾滋病队列研究的15名健康的HIV - 1血清阳性患者（平均随访32个月）：8名患者病情稳定，7名患者病情迅速进展。
实验室研究：进行定量聚合酶链反应以确定在不同时间点从患者获取的经分选纯化的CD4 + T细胞中的HIV - 1病毒载量。
测量和主要结果：在仍无症状的患者中，HIV感染的CD4 + T细胞频率在研究开始时较低（<1/10000至1/1000），且仅轻微增加（无一高于1/1000）。相反，在尽管CD4计数相似但出现包括获得性免疫缺陷综合征（AIDS）在内的HIV相关症状的患者中，HIV感染的CD4 + T细胞频率在入组时较高（>1/1000），且在大多数病情进展的患者中在3个月内大幅增加（>1/100）。HIV载量的这种增加与T4细胞百分比随时间显著下降（31%至16%）同时发生，而在仍无症状的患者中T4细胞百分比无变化（33%至34%）。
结论：外周血CD4 + T细胞中病毒载量的增加与HIV感染患者的CD4 +细胞逐渐减少和临床病程恶化直接相关。
Objective: To determine over time the relation between viral burden and immunologic decline in patients with asymptomatic human immunodeficiency virus (HIV) infection. Design: Blind analysis of cell samples from matched cohorts for HIV proviral DNA by polymerase chain reaction, retrospective analysis of clinical data on patients, and prospective follow-up of patients seropositive for the human immunodeficiency virus type 1 (HIV-1). Setting: National research clinic and academic medical centers. Patients: Cohort 1 included 12 healthy HIV-1 seropositive patients (average follow-up, 14 months); Six patients had stable disease and 6 developed rapidly progressive disease. Cohort 2 included 15 healthy HIV-1-seropositive patients from the Multicenter AIDS Cohort Study (average follow-up 32 months): Eight patients had stable disease and 7 developed rapidly progressive disease. Laboratory Studies: Quantitative polymerase chain reaction was done to determine the HIV-1 viral burden in sort-purified CD4+ T cells obtained from patients at various timepoints. Measurements and Main Results: In patients who remained asymptomatic, frequencies of HIV-infected CD4+ T cells were low (< 1/10 000 to 1/1000) at study entry and increased only minimally (none higher than 1/1000). In contrast, among patients who developed HIV-related symptoms including the acquired immunodeficiency syndrome (AIDS) despite having similar CD4 counts, frequencies of HIV-infected CD4+ T cells were higher at entry (> 1/1000) and increased substantially (> 1/100) in most within 3 months of developing progressive disease. This increase in HIV burden coincided with a significant decline over time in the percent of T4 cells (31% to 16%), whereas the percent of T4 cells was unchanged in persons who remained asymptomatic (33% to 34%). Conclusions: Increasing viral burden in peripheral blood CD4+ T-cells is directly associated with a progressive decline in CD4+ cells and deteriorating clinical course in HIV-infected patients.