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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-03105-4

摘要内容如下：

根据早期开始联合抗逆转录病毒治疗（CART）的儿童治疗后HIV控制的零星报告，我们在此前瞻性研究了284名来自南非夸祖鲁-纳塔尔省的HIV垂直传播后接受早期CART治疗的儿童，以评估病毒血症的控制情况。84%的儿童在CART中达到病毒血症，但仅有32%的儿童病毒血症持续至>36m。我们观察到男性婴儿的基线血浆病毒载量较低（P=0.01）。出乎意料的是，一组男性（n=5）维持了病毒血症，尽管计划外完全停用CART持续3 m-10 m（n=4），或在17 m失访期间间歇性坚持CART（n=1）。我们进一步观察到，在垂直传播的病毒中，I型干扰素（IFN-I）抗性与病毒复制能力（VRC）呈负相关（P<0.0001），男性明显强于女性（IFNα的R=-0.51对R=-0.07）。虽然在整个队列中，传播给雄性胎儿的病毒比传播给雌性胎儿的病毒对IFN-I更敏感且具有更高的VRC（P<0.0001和P=0.0003），但传播给5名维持无病毒血症的雄性胎儿的病毒具有显著较低的复制能力（P<0.0001）。这些数据表明，在早期CART启动后，一些子宫内获得性HIV感染的婴儿可能会出现病毒血症控制，这可能与先天免疫性别差异有关。

英文原文如下：

Abstracts

Following sporadic reports of post-treatment control of HIV in children who initiated combination antiretroviral therapy (cART) early, we here prospectively studied 284 very early cART-treated children from KwaZulu-Natal, South Africa after vertical HIV transmission to assess control of viraemia. 84% of the children achieved aviraemia on cART but aviraemia persisting to >36m was observed in only 32%. We observed that male infants have lower baseline plasma viral loads (p=0.01). Unexpectedly, a subset (n=5) of males maintained aviraemia despite unscheduled complete discontinuation of cART lasting 3m-10m (n=4), or intermittent cART adherence during 17m loss to follow up (n=1). We further observed in vertically transmitted viruses a negative correlation between type I interferon (IFN-I) resistance and viral replication capacity (VRC) (p<0.0001), that was markedly stronger for males than females (r=-0.51 versus r=-0.07 for IFNα). While viruses transmitted to male fetuses were more IFN-I sensitive and of higher VRC than those transmitted to females in the full cohort (p<0.0001 and p=0.0003), the viruses transmitted to the five males maintaining cART-free aviraemia had significantly lower replication capacity (p<0.0001). These data suggest that viraemic control can occur in some infants with in utero acquired HIV infection after early cART initiation, and may be associated with innate immune sex differences.

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