PBMC HIV-1 DNA的动态监测在HIV-1感染者抗病毒治疗过程中的临床意义

Clinical significance of PBMC HIV-1 DNA dynamic monitoring for HIV-1 infected patients with ART

目的探讨1型艾滋病病毒(HIV-1)感染者接受抗病毒治疗(ART)过程中,当获得核糖核酸(RNA)病毒学完全抑制后,患者外周血单个核细胞(PBMC)中HIV-1脱氧核糖核酸(DNA)的动态变化及其临床意义。方法分别在HIV-1感染者血浆HIV-1 RNA首次<20拷贝/mL时(定义为转阴)、RNA转阴1年时、RNA转阴2年时检测患者PBMC中HIV-1 DNA的含量,比较三个时间点患者PBMC中HIV-1 DNA含量的动态变化,不同ART方案以及获得RNA病毒学完全抑制所需的时间对HIV-1感染者PBMC中HIV-1 DNA的影响。结果治疗组34例HIV-1感染者接受ART过程中,在血浆HIV-1 RNA首次转阴时、RNA转阴1年时、RNA转阴2年时三个时间点患者PBMC中HIV-1 DNA含量分别为(2.88±0.50)、(2.58±0.47)、(2.57±0.43)Log10拷贝/106个细胞,差异有统计学意义;而未接受ART的对照组15例HIV-1感染者PBMC中HIV-1 DNA含量为(3.26±0.56)Log10拷贝/106个细胞,与ART治疗组比较,差异有统计学意义;含依非韦伦的一线方案和含洛匹那韦/利托那韦的二线方案对患者PBMC中HIV-1 DNA含量的影响无明显统计学差异;HIV-1感染者获得RNA病毒学完全抑制的时间越早,其PBMC中HIV-1 DNA的水平越低。结论在ART获得RNA病毒学完全抑制的HIV-1感染者仍可检出PBMC HIV-1 DNA;随着ART延长,PBMC HIV-1 DNA逐渐消减;PBMC HIV-1 DNA检测有助于判断ART疗效。

Objective To know the clinical significance of HIV-1 DNA in peripheral blood mononuclear cells(PBMC)of HIV-1 infected patients when plasma HIV-1 RNA was effectively inhibited lower than the detection limit during antiretroviral therapy(ART).Methods At the time of plasma HIV-1 RNA of the patients<20 copies/mL for the first time(defined as negative),plasma HIV-1 RNA negative for one and two years,the content of HIV-1 DNA in PBMC was detected by fluorescence quantitative PCR,and the dynamic changes of HIV-1 DNA at the three time points were compared by one-way anova and pairwise comparison.The effects of different ART regimens on PBMC HIV-1 DNA in patients,and that of the different times for plasma HIV-1 RNA effective inhibition below the detection limit were compared too.Results Among the 34 patients receiving ART for a long time,PBMC HIV-1 DNA could be detected.When plasma HIV-1 RNA was negative for the first time,for one year,and for two years,the content of PBMC HIV-1 DNA of the patients was 2.88±0.50 Log10 copies/106 cells,2.58±0.47 Log10 copies/106 cells,and 2.57±0.43 Log10 copies/106 cells.The content of PBMC HIV-1 DNA in three different times was compared.The results showed that there was a statistical difference between the three groups(P<0.05).Among the 15 patients in the control group without ART,the content of HIV-1 DNA in the PBMC of the patients was 3.26±0.56 log10 copies/106 cells.The results showed that compared with the group without ART,the patients with ART for a longer time had a lower content of PBMC HIV-1 DNA,with the difference statistically significant between the two groups.There was no significant difference(P>0.05)between the first-line and second-line regimens on PBMC HIV-1 DNA content.The earlier HIV-1 infected people acquired RNA virologic effective inhibition,the lower the level of HIV-1 DNA in their PBMC.Conclusion PBMC HIV-1 DNA can be detected in HIV-1 infected patients when the plasma HIV-1 RNA is lower than the detection limit during ART.The level of HIV-1 DNA in the PBMC decreases gradually during ART.PBMC HIV-1 DNA test is helpful to judge the efficacy of ART.