Ongoing changes in HIV RNA levels during untreated HIV infection: implications for CD4 cell count depletion
Ongoing changes in HIV RNA levels during untreated HIV infection: implications for CD4 cell count depletion
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DOI：
10.1097/qad.0b013e32833a6056
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发表时间：
2010-06-19
期刊：
影响因子：
3.8
通讯作者：
Johnson, Margaret A.
中科院分区：
文献类型：
--
作者：
Phillips, Andrew N.;Lampe, Fiona C.;Johnson, Margaret A.
背景资料：在未经治疗的infection.Methods：我们研究了1169人与艾滋病毒看到的护理在一个主要的伦敦诊所，而天真的抗逆转录病毒治疗之间的相互作用的血浆HIV RNA水平和CD 4细胞计数耗尽的理解仍然不完整。我们考虑了从未开始治疗的患者的连续同时测量的CD 4细胞计数和血浆HIV RNA值对（n = 5940）。基线是第一个日期时，这两个措施是knowed.Results：HIV RNA水平增加了10%，往往大幅从基线（60%的经验增加超过50 000拷贝/毫升的5年的后续行动）。当前HIV RNA水平（即第一个值）与CD 4细胞计数的时间标准化变化密切相关，当前HIV RNA水平越高，每对数拷贝/ml的CD 4细胞计数下降率平均每年增加106个细胞/μ l（P < 0.0001）。调整当前水平后，较高的基线HIV RNA与CD 4细胞计数下降无关。目前HIV RNA水平低于3.0 log拷贝/ml时，平均CD 4细胞计数没有下降，而HIV RNA水平至少为5.5 log拷贝/ml的患者每年下降159个细胞/μ l（P < 0.0001）。此外，当前的CD 4细胞计数预测随后的HIV RNA水平的变化（0.04对数拷贝/年增加每100个细胞/μ l的CD 4细胞计数降低; P < 0.0001）。结论：在未经治疗的HIV感染中观察到的HIV RNA水平的经常大幅增加似乎从根本上与CD 4细胞计数耗竭有关。对HIV RNA水平随时间推移而升高的机制的研究应有助于深入了解CD 4细胞计数减少的原因，因为这两个过程密切相关。(C)2010年Wolters Kluwer Health竖条Lippincott威廉姆斯&威尔金斯
Background: Understanding of the interplay between plasma HIV RNA level and CD4 cell count depletion in untreated infection remains incomplete.Methods: We studied 1169 people with HIV seen for care at a major London clinic while naive to antiretroviral therapy. We considered pairs (n = 5940) of consecutive simultaneously measured CD4 cell count and plasma HIV RNA values from patients who had never started therapy. Baseline was the first date when both measures were known.Results: HIV RNA levels increased variably and often substantially from baseline (60% experience an increase of over 50 000 copies/ml by 5 years of follow-up). The current HIV RNA level (i.e. first value of the pair) was strongly associated with the time-standardized change in CD4 cell count, with a mean 106 cells/mu l per year greater rate of CD4 cell count decline per log-copy/ml higher current HIV RNA level (P < 0.0001). After adjustment for the current level, higher baseline HIV RNA was not associated with CD4 cell count decline. There was no average CD4 cell count decline with current HIV RNA level below 3.0 log-copies/ml, compared with a 159 cells/mu l per year decline for those with HIV RNA at least 5.5 log-copies/ml (P < 0.0001). Further, the current CD4 cell count predicted subsequent changes in HIV RNA level (0.04 log-copies/year greater increases per 100 cells/mu l lower CD4 cell count; P < 0.0001).Conclusion: The often substantial increases in HIV RNA level observed in untreated HIV infection appear fundamentally linked to CD4 cell count depletion. Research into mechanisms by which HIV RNA levels rise over time should yield insights into the causes of CD4 cell count depletion, as the two processes are intimately linked. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins