Impact of small reductions in plasma HIV RNA levels on the risk of heterosexual transmission and disease progression.
Impact of small reductions in plasma HIV RNA levels on the risk of heterosexual transmission and disease progression.
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DOI：
10.1097/qad.0b013e328312c756
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发表时间：
2008-10-18
期刊：
影响因子：
--
通讯作者：
Vermund SH
中科院分区：
文献类型：
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作者：
Modjarrad K;Chamot E;Vermund SH
估计HIV-1 RNA血浆水平的微小变化对异性性传播或疾病进展为AIDS定义事件或死亡的风险的影响。我们系统地回顾了已发表的文献，以评估抗逆转录病毒治疗（ART）初治成人人群中病毒载量的微小变化。我们根据HIV载量的0.3、0.5和1.0 log 10增量，对病毒传播和疾病进展的相对风险估计进行建模。我们计算出，通过异性接触传播HIV的可能性平均增加20%，HIV RNA每增加0.3 log 10，进展为艾滋病定义疾病或相关死亡的年风险增加25%。HIV RNA增加0.5 log 10与异性性传播风险增加40%和进展为艾滋病或死亡风险增加44%相关。HIV RNA增加1.0 log 10与异性性传播风险增加100%和进展为艾滋病或死亡风险增加113%相关。世界上72%的艾滋病毒感染者仍然得不到抗逆转录病毒疗法或尚未得到治疗。越来越多的证据表明，治疗合并感染可以减少艾滋病毒病毒载量，即使是适度的，这表明即使没有接受抗逆转录病毒治疗，也必须优先改善艾滋病毒感染者的辅助护理，以减缓疾病进展并减少传染性。
To estimate the impact of small changes in plasma levels of HIV-1 RNA on the risk of heterosexual transmission or disease progression to an AIDS-defining event or death. We systematically reviewed the published literature for studies that evaluated small viral load changes among antiretroviral therapy (ART)-naïve, adult populations. We modeled relative risk estimates for viral transmission and disease progression according to 0.3, 0.5, and 1.0 log10 increments of HIV load. We calculated that the likelihood of transmitting HIV by heterosexual contact increased, on average, by 20% and that the annual risk of progression to an AIDS-defining illness or related death increased by 25% with every 0.3 log10 increment in HIV RNA. A 0.5 log10 increment in HIV RNA was associated with 40% greater risk of heterosexual transmission and 44% increased risk of progression to AIDS or death. A 1.0 log10 increment in HIV RNA was associated with 100% greater risk of heterosexual transmission and 113% increased risk of progression to AIDS or death. ART continues to be unavailable or not-yet-indicated for 72% of the world’s HIV-infected persons. Mounting evidence that treatment of co-infections may reduce HIV viral load, even modestly, suggests the priority of improved adjunctive care for HIV-infected persons even without ART, both to slow disease progression and to reduce infectiousness.