机构地区:[1]云南省疾病预防控制中心性病艾滋病防制所,昆明650022
出 处:《中国艾滋病性病》2023年第4期378-382,共5页Chinese Journal of Aids & STD
基 金:国家科技重大专项(2018ZX10715-006)。
摘 要:目的 了解MSM新报告HIV-1感染者在接受ART 48周内总HIV-1 DNA水平变化情况,为评估疾病进展提供数据。方法 连续招募新报告的MSM HIV-1感染者,于ART前(基线,0周)、治疗24周和48周三个时间点分别采集患者样本进行血浆HIV-1新发感染检测(基线)、血浆HIV感染亚型检测(基线)、外周血CD4细胞计数、血浆HIV-1 RNA定量检测和全血HIV-1 DNA定量检测,比较上述指标在ART过程中的变化,分析总HIV-1 DNA水平与传统疾病进展替代标志物(HIV-1 RNA水平和CD4细胞水平)之间的相关性,采用Logistics回归模型分析治疗48周时的总HIV-1 DNA水平的影响因素。结果 共招募到49例调查对象,在基线、治疗24周和48周时的CD4细胞水平分别为263(182,327)、355(287,421)、381(300,483)个/μL,HIV-1 RNA水平分别为4.31(4.06,5.05)、0(0,2.07)、0(0,1.08)log_(10)IU/mL,总HIV-1 DNA水平分别为2.44(1.97,2.89)、2.35(1.90,2.61)、2.16(1.62,2.39)log_(10) copies/106cells。CD4细胞水平与ART时间呈正相关(r_(s)=0.424,P<0.000 1),总HIV-1 RNA水平、HIV-1 DNA水平均与ART时间呈负相关(r_(s)=-0.785,P<0.000 1;r_(s)=-0.238,P=0.004)。基线总HIV-1 DNA水平分别与基线、治疗24周的HIV-1 RNA水平呈正相关(r_(s)=0.304,P=0.034;r_(s)=0.527,P<0.000 1)。治疗48周的总HIV-1 DNA水平与基线CD4细胞水平呈负相关(r_(s)=-0.344,P=0.016)、与基线、治疗48周的HIV-1 RNA水平呈正相关(r_(s)=0.289,P=0.044;r_(s)=0.315,P=0.027)。多因素分析结果显示,在治疗48周时,HIV-1新近感染者较既往感染者的总HIV-1 DNA水平<2.00log_(10) copies/10^(6)cells的概率更高(OR=4.17,95%CI:1.083~16.052)。结论 随着ART进行,CD4细胞水平逐渐升高,HIV-1RNA水平和总HIV-1 DNA水平逐渐降低;基线和治疗48周的总HIV-1 DNA水平与传统疾病进展替代标志物之间存在相关性,治疗前和治疗过程中检测总HIV-1 DNA水平有助于监测疾病进展;及时发现HIV感染者并尽早入组治疗,有助于达到更低的总HIV-1DNA水平。Objective To investigate the changes in total HIV-1 DNA levels in newly reported HIV-1 infected patients in MSM within 48 weeks of receiving ART, and to provide data for the assessment of disease progression.Methods Newly reported MSM HIV-1 infected patients were recruited continuously, and samples were collected from patients at three-time points: before ART(baseline, 0 weeks), 24 weeks, and 48 weeks of treatment for plasma HIV-1 new infection detection(baseline), plasma HIV infection subtype detection(baseline), peripheral blood CD4 cell count, plasma HIV-1 RNA quantitative detection and whole blood HIV-1 DNA quantitative detection. The changes of the above indicators in the ART process were compared and the total HIV-1 has analyzed The correlation between DNA levels and traditional surrogate markers of disease progression(HIV-1 RNA level and CD4 cell level), using the Logistics regression model to analyze the influencing factors of total HIV-1 DNA level at 48 weeks of treatment. Results A total of 49 patients were recruited, and the CD4 cell levels at baseline, 24 weeks, and 48 weeks of treatment were 263(182, 327), 355(287, 421), 381(300, 483)/μL and the levels of HIV-1 RNA were 4.31(4.06, 5.05), 0(0,2.07), 0(0, 1.08) log_(10)IU/mL, respectively. Total HIV-1 DNA levels were 2.44(1.97, 2.89), 2.35(1.90, 2.61),2.16(1.62, 2.39) log_(10) copies/106 cells, respectively. CD4 cell levels were positively correlated with ART time(r_(s)=0.424, P<0.0001), and total HIV-1 RNA levels and HIV-1 DNA levels were negatively correlated with ART time(r_(s)=-0.785, P<0.0001;r_(s)=-0.238, P=0.004). The baseline total HIV-1 DNA level was positively correlated with the HIV-1 RNA level at baseline and 24 weeks of treatment(r_(s)=0.304, P=0.034;r_(s)=0.527, P<0.0001). Total HIV-1 DNA levels at 48 weeks of treatment were negatively correlated with baseline CD4 cell levels(r_(s)=-0.344, P=0.016) and HIV-1 RNA levels at baseline and 48 weeks of treatment(r_(s)=0.289, P=0.044;r_(s)=0.315, P=0.027). Multivariate analysis showed that at 4
关 键 词:男男性行为者 抗病毒治疗 1型艾滋病病毒总脱氧核糖核酸水平
分 类 号:R373.9[医药卫生—病原生物学]
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