Sex differences in HIV-1 viral load and progression to AIDS
Sex differences in HIV-1 viral load and progression to AIDS
复制标题
DOI：
10.1016/s0140-6736(98)02372-1
复制
发表时间：
1998-11-07
期刊：
影响因子：
168.9
通讯作者：
Vlahov, D
中科院分区：
文献类型：
--
作者：
Farzadegan, H;Hoover, DR;Vlahov, D
背景 血浆 HIV-1 RNA 测量用于启动抗逆转录病毒治疗，但病毒载量与预后的相关性在女性和男性中是否相似尚不清楚。 方法 我们研究了来自 650 名注射吸毒者 (IDU) 的 812 份样本，这些样本参与了对社区诊所患者的连续观察研究。 HIV-1 载量通过基线访视时 527 名注射吸毒者样本的支链 DNA 进行测量，并通过逆转录酶 PCR 和定量微培养对 3 年后随访的 285 名注射吸毒者样本进行测量。 结果发现，通过支链 DNA 测量，女性的病毒载量中位数低于男性（3365 拷贝/毫升 vs 8907 拷贝/毫升；p=0.001）， 逆转录酶 PCR（45 416 与 93 130 拷贝/mL；p=0.02）和定量微培养（每百万外周血单核细胞 5 与 8 个感染单位；p=0.015）。即使在对过去 6 个月内的 CD4 细胞计数、种族和药物使用进行调整后，这种关联仍然存在。在单变量比例风险模型和调整 CD4 细胞计数的模型中，男性和女性患艾滋病的时间在统计上相似。比例风险模型显示，病毒载量与男性相同的女性患艾滋病的风险高出 1.6 倍（95% CI 1.10-2.32）；或者，同等地，病毒载量只有男性一半的女性与男性患艾滋病的时间相似。 解释 尽管生物学机制尚不清楚，但这些数据表明，目前针对女性启动抗逆转录病毒治疗的 HIV-1 病毒载量阈值的建议应向下修改。
Background Plasma HIV-1 RNA measurements are used for initiation of antiretroviral treatments, Whether the viral-load association with prognosis is similar in women and men is unknown.Methods We studied 812 specimens from 650 injection-drug users (IDUs) participating in a continuous observational study of patients based in a community clinic. HIV-1 load was measured by branched-chain DNA on samples from 527 IDUs from the baseline visit, and by reverse-transcriptase PCR and quantitative microculture on samples from 285 IDUs ai a follow-up visit 3 years later.Findings Women had lower median viral-load measurements than men by branched-chain DNA (3365 vs 8907 copies/mL; p=0.001), reverse-transcriptase PCR (45 416 vs 93 130 copies/mL; p=0.02), and quantitative microculture (5 vs 8 infectious units per million peripheral blood mononuclear cells; p=0.015). This association remained even after adjustment for CD4 cell count, race, and drug use within the previous 6 months. Time to AIDS was statistically similar for men and women in a univariate proportional-hazards model and in a model adjusting for CD4 cell count. Proportional-hazards models showed that women with the same viral load as men had a 1.6-fold higher risk of AIDS (95% CI 1.10-2.32); or, equivalently, that women with half the viral load of men had a similar time to AIDS as men.Interpretation Although a biological mechanism remains unclear, these data suggest that current recommendations for HIV-1 viral-load thresholds to initiate antiretroviral therapy should be revised downwards for women.