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英国剑桥的1860个研究对象中找出的案例：
http://journals.cambridge.org/action/displayAbstract;jsessionid=6C8BEB66C32BA26DB887EE42BFDFFC19.tomcat1?fromPage=online&aid=190633#
美国北卡罗来纳杜克大学的研究：
http://www.aegis.org/conferences/CROI/2006/389.html
重点详述后者
BACKGROUND: Factors influencing time to HIV-1 seroconversion are not well established. Rare case reports describe patients with prolonged periods prior to HIV-1 antibody generation. Such patients may have a rapidly progressive course, but whether this is due to increased viral virulence or to host factors is not known.（影响HIV-1血清转换的时间因素还没有很好的确定。罕见的例子描述了抗体产生的延长的时间段。这样的病人可能是快速进展的阶段，但是是否是增加的病毒毒性，还是宿主的因素还是未知的。）
METHODS: The Duke–University of North Carolina–Emory Acute HIV Research Consortium studies adult patients with symptomatic acute HIV-1 infection diagnosed within 30 days of seroconversion. This prospective cohort enrolled 46 subjects from 1998 to 2004. Associations were sought between initial ELISA status and demographic variables, viral load, nadir CD4 count, and time to seroconversion using Wilcoxon rank-sum and Fisher’s exact tests. We report 1 case in which seroconversion occurred after >1 year.（北卡罗来纳的杜克大学研究的有症状的急性感染成年病人在30天的血清转换期被确诊。其中选取了从1998年到2004年的有名确证的46例研究对象。把最初的酶联结果，和人口统计变量，病毒载量，高峰CD4值，用了Wilcoxon rank-sum and Fisher’s exact tests确定的血清转换时间。我们报道了一例血清转换超过一年的案例。）
RESULTS: At the time of acute HIV-1 diagnosis, 25 of 46 patients had a negative ELISA.（在急性期的诊断时间上，46个当中25个病人有阴的酶联结果。） Median time (25 to 75th quartiles) from symptom onset to first ELISA test: negative ELISA = 7 (4 to 15) days（从症状开始到第一次酶联检测平均时间(25%-75%)，阴性结果是7个。（4到15天））; reactive ELISA = 29 (18 to 42) days（阳性结果有29个（检测在18到42天之间））, p <0.0001. Median initial viral load was higher among negative ELISA patients than reactive ELISA patients (5,649,238 vs 303, 318 copies/mL, p <0.0001).（酶联阴性结果的病人中间开始的病毒载量高于阳性的病人(5,649,238 比 303, 318 copies/mL)） Patients with a negative ELISA were more likely to be non-Caucasian (p = 0.0186)（有阴性结果的病人更可能是非高加索白人。（我理解：可能是和黑人比较的））. Nadir CD4 counts were comparable (median, 413 vs 471, p = ns) as was time to first positive ELISA (median, 26 days vs 29 days, p = ns). A 22-year-old man presented with acute HIV-1 infection (viral load >10 million copies/mL) and had repeatedly negative HIV-1 ELISA tests over the ensuing year, during which he had Pneumocystis carinii pneumonia. He seroconverted only after initiation of effective ART.（一个急性感染的22岁的年轻人（病毒载量大于10万拷贝/毫升），在他感染有间质性浆细胞肺炎的那一年都有酶联阴的结果，他血清转换仅仅发生在他的抗病毒转录治疗开始起作用的时候） Antibody responses to prior tetanus and diphtheria immunization were normal.（对于破伤风和白喉的抗体产生很正常） His HLA type was not one associated with abnormal responses (HLA-B72). （他的组织配对抗原，不和正常的反应一样）Plasma-derived virus (at initial diagnosis) used both CCR5 and CXCR4 co-receptors.
CONCLUSIONS: Subjects diagnosed with acute HIV infection while ELISA-negative had a significantly higher viral load than those who had already seroconverted, but nadir CD4 counts did not differ. Median time to a reactive HIV-1 ELISA from onset of symptoms also did not differ perhaps because timing of ELISA testing was more dependent on non-biological factors such as clinician experience. One patient who rapidly progressed to AIDS did not seroconvert for a full year, despite evidence of functional B cell responses to non-HIV antigens. Virus targeting of HIV-1-specific T cells that augment specific B cell responses may explain this observation.
结论：急性感染期酶联为阴的案例有着相当高的病毒载量，比起那些已经血清转换的人来，但是CD4的峰值并没有不同。
从症状开始到酶联阳性的时间也并没有什么区别。可能因为酶联的检测时间更加以来医生的经验等这些非生物因素。一个长达一年为完成血清转化的病人快速进展为AIDS,尽管有功能性B细胞能够对非HIV抗原起反应。以特异T细胞为靶子的病毒增加了特异B细胞的反应能解释这起观察的例子。 |
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发表于 2009-6-5 20:35
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