Predictors of disease progression in HIV infection: a review.
Predictors of disease progression in HIV infection: a review.
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DOI：
10.1186/1742-6405-4-11
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发表时间：
2007-05-14
影响因子：
2.2
通讯作者：
Cooper DA
中科院分区：
文献类型：
--
作者：
Langford SE;Ananworanich J;Cooper DA
在与人类免疫缺陷病毒（HIV）感染相关的延长的临床潜伏期期间，病毒本身远不是潜伏的。这一阶段的感染通常随着症状性疾病的发展而结束。了解影响疾病进展的因素可以帮助治疗开始和治疗监测决策。这方面的一个例子是CD 4 + T细胞计数和HIV-RNA用于疾病分期和进展评估的明确效用。免疫反应的要素，如HIV特异性细胞毒性淋巴细胞反应和细胞表面CD 38表达的多样性与病毒复制的控制显着相关。然而，免疫激活的可溶性标志物和疾病进展之间的关系仍然没有定论。在接受治疗的患者中，持续病毒学反弹至>10 000拷贝/mL与不良临床结局相关。然而，对于HIV RNA的短暂升高（blips），情况并非如此。另一个病毒学因素-耐药性-正在成为地球仪各地日益严重的问题，监测工作必须在全世界监测和控制这一流行病方面发挥作用。趋化因子受体嗜性和疾病进展速度之间的联系仍然不确定，监测病毒株的临床效用尚未确定。大量的混杂因素使得调查种族和病毒亚型的作用变得困难，需要进一步的研究来阐明它们的意义。宿主因素，如年龄，HLA和HLA多态性和心理社会因素仍然是重要的，但往往是不可改变的，疾病进展的预测因素。虽然性别和传播方式在疾病进展中的作用较小，但它们可能会影响其他标志物，如病毒载量。最后，随着抗逆转录病毒疗法在世界上资源有限的地区越来越普及，容易测量的疾病标志物，如淋巴细胞总数、血红蛋白、体重指数和迟发型超敏反应可能会受到青睐。这些因素和其他因素对HIV感染的临床进展的影响进行了详细审查，治疗开始之前和之后。
During the extended clinically latent period associated with Human Immunodeficiency Virus (HIV) infection the virus itself is far from latent. This phase of infection generally comes to an end with the development of symptomatic illness. Understanding the factors affecting disease progression can aid treatment commencement and therapeutic monitoring decisions. An example of this is the clear utility of CD4+ T-cell count and HIV-RNA for disease stage and progression assessment. Elements of the immune response such as the diversity of HIV-specific cytotoxic lymphocyte responses and cell-surface CD38 expression correlate significantly with the control of viral replication. However, the relationship between soluble markers of immune activation and disease progression remains inconclusive. In patients on treatment, sustained virological rebound to >10 000 copies/mL is associated with poor clinical outcome. However, the same is not true of transient elevations of HIV RNA (blips). Another virological factor, drug resistance, is becoming a growing problem around the globe and monitoring must play a part in the surveillance and control of the epidemic worldwide. The links between chemokine receptor tropism and rate of disease progression remain uncertain and the clinical utility of monitoring viral strain is yet to be determined. The large number of confounding factors has made investigation of the roles of race and viral subtype difficult, and further research is needed to elucidate their significance. Host factors such as age, HLA and CYP polymorphisms and psychosocial factors remain important, though often unalterable, predictors of disease progression. Although gender and mode of transmission have a lesser role in disease progression, they may impact other markers such as viral load. Finally, readily measurable markers of disease such as total lymphocyte count, haemoglobin, body mass index and delayed type hypersensitivity may come into favour as ART becomes increasingly available in resource-limited parts of the world. The influence of these, and other factors, on the clinical progression of HIV infection are reviewed in detail, both preceding and following treatment initiation.