HIV机会性混合感染治疗的研究现状

人类免疫缺陷病毒(HIV)机会性混合感染的诊断、预防及治疗愈来愈引起人们的关注。患者接受高效抗逆转录病毒疗法(HAART)后,生存率有了显著提高。参阅国内外相关文献报道,就HIV感染者潜伏结核病的诊断,HAART引起的免疫重建炎性综合征的诊断,水痘疫苗对HIV感染儿童带状疱疹的预防,HIV感染与社区耐甲氧西林金葡菌(CA-MRSA)相关性,HIV和乙肝病毒(HBV)混合感染的抗病毒治疗,HIV和丙型肝炎病毒(HCV)混合感染的抗病毒治疗以及HAART的临床终点等七方面对HIV机会性混合感染的诊断、预防及抗病毒治疗的研究现状作一综述。     

人类免疫缺陷病毒/获得性免疫缺陷综合征患者高效抗逆转录病毒治疗中发生骨髓抑制相关因素分析

目的:探讨HIV/AIDS患者高效抗逆转录病毒治疗(HAART)过程中出现骨髓抑制的高危因素。方法:回顾性分析432例HIV/AIDS患者HAART治疗资料,分别对患者的性别、年龄、HIV感染途径、体质量、是否肝、肾功能损害、HAART治疗疗程、HAART治疗方案、基线CD4⁺ T淋巴细胞数、是否合并机会性感染、是否联合应用具有骨髓抑制作用药物等与骨髓抑制的发生进行相关性分析。结果:骨髓抑制的发生与患者HIV感染途径、体质量无相关性(P> 0.05);与患者年龄、性别、肝、肾功能损害、HAART治疗疗程、HAART治疗方案、基线CD4⁺ T淋巴细胞数、联合应用具有骨髓抑制作用药物相关(P< 0.05)。结论:老年、女性、肝、肾功能损害者、HAART治疗疗程、HAART治疗方案、基线CD4⁺ T淋巴细胞数、合并机会性感染、联合应用具有骨髓抑制作用药物是患者治疗期间发生骨髓抑制的高危因素。     

抗HIV/AIDS药物:现状与展望

目前已有20余种抗人免疫缺陷病毒(HIV)药物应用于临床,新型抗病毒药物的研制将有助于清除HIV/AIDS患者体内的病毒。高效抗逆转录病毒疗法(HAART)使HIV／AIDS患者的病死率明显下降。     

HIV感染者HAART后EBV变化的研究

目的 了解河南地区HIV感染者EBV再活化的基本状况,以及接受HAART对HIV感染者EBV再活化的影响.方法 应用巢式PCR技术检测73例(HIV感染组)HIV感染者及80例健康人(健康对照组)PBMCs中EBV DNA片段.检测HIV感染者CD4 T淋巴细胞计数及血浆HIV RNA含量.结果 ①HIV感染组和健康对照组PBMCs中EBV DNA检出的频率分别是26/73(35.6%)和4/80(5.0%).HIV感染组显著高于健康对照组.(χ2=22.698,P＜0.01).②将73例HIV感染者,根据HAART后血浆HIV RNA含量进行分组:A组:HIV RNA含量＞1000 copies/ml;B组:HIV RNA含量小于最低栓出限.A组和B组患者PBMCs中EBV DNA检出的频率分别是15/25(60.0%)和11/48(22.9%).A组显著高于B组.(χ2=9.858,P=0.002＜0.05).③比较A组和B组HIV感染者CD4 T淋巴细胞计数的平均值:A组:(147.32±118.58)cell/μl,B组:(231.56±109.79)cell/μl,A组显著低于B组(t=3.024,P=0.003＜0.05).结论 HIV感染者EBV再活化率显著高于健康人群.接受有效的HAART治疗的HIV感染者EBV再活化明显降低,这种降低可能与CD4 T淋巴细胞计数较高有关.     

已进入临床研究阶段的新药

核苷类逆转录酶抑制剂Apricitabine[关键词]核苷类逆转录酶抑制剂;抗HIV药;Apricitabine[中图分类号]R978.7高效抗逆转录病毒疗法(HAART,不少于3种治疗药物的组合,其中至少有2种具抗逆转录病毒活性)可降低HIV感染的发病率和死亡率,能有效降低血液中HIV水平,但其治疗失败造成病毒反弹仍是一个难题,主要原因是HAART的副作用所致顺应性差(导致采用次优化疗法)及耐药性病毒株的迅速产生。据考察,约有30%的病人在使用HAART的6年内对3类抗逆转录病毒药物产生耐药性从而增加了治疗期间艾滋病相关疾病发生的危险。包括拉米夫定、齐多夫定…     

获得性免疫缺陷综合征的抗逆转录病毒治疗

获得性免疫缺陷综合征(AIDS)的临床治疗近年取得了突破性进展,高效抗逆转录病毒治疗(HAART)不仅可提高人免疫缺陷病毒(HIV)感染者的生存率,而且可显著降低HIV相关疾病的病死率.本文简要综述近几年来国内外AIDS抗病毒治疗的进展,包括治疗时机及治疗方案的选择,以及HIV与结核分枝杆菌及其与丙型肝炎共感染的抗逆转录病毒治疗.     

HIV-1疫苗的潜在作用

最近英国伦敦HIV医学皇家自由中心的loes博士报道 ,用高效抗逆转录病毒疗法 (HAART)治疗时期 ,HIV - 1疫苗具有潜在的治疗作用。Loes认为尽管HAART对HIV - 1感染患者的治疗具有重要的进步 ,但短期非依从性会导致抗病毒治疗失败 ,而限制了这些新的治疗方法。另外 ,需要有不同耐药和毒性特性的新抗病毒药以克服抗病毒耐药性、线粒体毒性和脂肪营养不良。对于大多数HIV -1感染的患者 ,治疗费用高并缺少适合的抗病毒治疗方法 ,因此选择新的简便治疗方法是首选。目前已考虑两种形式的治疗疫苗 ,即自体疫苗 (可以使HAART中断和病毒反…     

HIV-1血清阳性者在HAART期间使用MF-59佐剂流感疫苗或传统非佐剂亚单位疫苗的抗体应答及HIV-1负荷[英]／Iorio AM，Francisci D，Camilloni B，et al／／Vaccine

人类免疫缺陷病毒(HIV)感染者如果感染流感可能会延长病程，并使住院率及死亡率上升。虽然对HIV感染者是否应接种流感疫苗存在争议，但近来的研究表明，使用高效逆转录病毒治疗(HAART)能够强烈抑制HIV复制，并能获得较好的疫苗免疫原性，使CD4^ T淋巴细胞数量增加和功能增强。     

HIV潜伏感染激活剂研究进展

艾滋病是由HIV病毒感染引起的一种死亡率较高的获得性免疫缺陷综合症,虽然高效抗逆转录病毒疗法(HAART)能够将血浆内病毒载量降至不可检测水平,但病毒并不能被彻底清除,主要原因是HIV感染后会通过在某些细胞内形成潜伏病毒存在于病毒库中,在停用HAART后潜伏病毒将大量复制。目前研究普遍认为HIV潜伏库是根除HIV感染的主要障碍,随之发展出的一种清除潜伏病毒的新策略为:使用HIV潜伏激活剂诱导潜伏病毒复制及其基因表达,然后通过HAART或自身免疫系统将激活的病毒及其宿主细胞杀灭。因此,寻找高效、安全、可行性高的激活剂成为清除潜伏病毒的关键。迄今为止,HIV潜伏感染激活剂有多种,分别作用于HIV转录的不同阶段并各有优缺点。该文将对潜伏感染的机制及其激活剂的最新研究进展做一介绍。     

HIV感染/AIDS住院患者高效抗逆转录病毒治疗中发生骨髓抑制致死亡的影响因素

目的:探讨人类免疫缺陷病毒(HIV)感染/艾滋病(AIDS)住院患者高效抗逆转录病毒治疗(HAART)中发生骨髓抑制致死亡的影响因素。方法:采用病例对照研究的方法,调查2011年1月—2015年7月南宁市第四人民医院的735例住院HIV感染/AIDS住院患者,通过单因素和多因素非条件Logistic分析筛选出导致患者死亡的危险因素。结果:735例患者中,生存组648例,死亡组87例,病死率为11.8%。单因素Logistic分析显示:男性、老年、总胆红素升高、内生肌酐清除率降低、基线CD4+T淋巴细胞数较低、合并机会性感染较多、联合多种具有骨髓抑制的药物、血小板减少、血红蛋白减少是HAART中死亡的危险因素,而患者HIV感染途径、有齐多夫定的HAART方案、开始HAART时患者的体质量是HAART中死亡的保护性因素;多因素Logistic回归分析显示:男性、老年、总胆红素升高、内生肌酐清除率降低、基线CD4+T淋巴细胞数较低、合并机会性感染较多、联合多种具有骨髓抑制的药物、血小板减少、血红蛋白减少是死亡的危险因素。结论:临床应针对住院HIV感染者/AIDS患者HAART中发生骨髓抑制致死亡的危险因素,采取有针对性的治疗和控制措施,以降低患者病死率。     

Cardiovascular disease and toxicities related to HIV infection and its therapies

Cardiovascular manifestations of HIV vary according to disease stage, treatment regimen and geographical location. Common cardiac complications of HIV disease in patients off highly active antiretroviral therapy (HAART) include dilated cardiomyopathy, myocarditis, pericardial effusion, endocarditis, pulmonary hypertension and non-antiretroviral drug-related cardiotoxicity. However, with the introduction of HAART that has substantially modified the course of HIV disease by lengthening survival, additional cardiovascular consequences are a result of the metabolic syndrome with a propensity toward hyperlipidaemia and atherosclerotic heart disease. Because most of the world's HIV-infected patients have not been treated with HAART, the principal HIV-associated cardiovascular manifestations of patients off HAART are reviewed and new knowledge about the prevalence, pathogenesis and treatment in the HAART era are emphasised in this review. Exercise, a nonpharmacological approach to treating HAART-associated metabolic syndrome, is also discussed.     

Cardiovascular disease and toxicities related to HIV infection and its therapies

Cardiovascular manifestations of HIV vary according to disease stage, treatment regimen and geographical location. Common cardiac complications of HIV disease in patients off highly active antiretroviral therapy (HAART) include dilated cardiomyopathy, myocarditis, pericardial effusion, endocarditis, pulmonary hypertension and non-antiretroviral drug-related cardiotoxicity. However, with the introduction of HAART that has substantially modified the course of HIV disease by lengthening survival, additional cardiovascular consequences are a result of the metabolic syndrome with a propensity toward hyperlipidaemia and atherosclerotic heart disease. Because most of the world’s HIV-infected patients have not been treated with HAART, the principal HIV-associated cardiovascular manifestations of patients off HAART are reviewed and new knowledge about the prevalence, pathogenesis and treatment in the HAART era are emphasised in this review. Exercise, a nonpharmacological approach to treating HAART-associated metabolic syndrome, is also discussed.     

Highly active antiretroviral therapy and the cardiovascular system: the heart of the matter

Highly active antiretroviral therapy (HAART) has prolonged many patients' lives, but many cardiac sequelae of HIV are not affected by HAART and continue to develop even with treatment. In addition, HAART itself causes in a high proportion of patients a metabolic syndrome, characterized by lipodystrophy/lipoatrophy, dyslipidemia and insulin resistance that may be associated with an increase in coronary artery disease and stroke. Careful cardiovascular evaluation in the course of HIV disease can identify cardiac complications early enough to treat. All HIV-infected patients are candidates for antiretroviral therapy and patients already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk according to the available guidelines.     

Highly active antiretroviral therapy and cardiovascular complications in HIV-infected patients

Highly active antiretroviral therapy (HAART) has prolonged many patients' lives, but many cardiac sequelae of HIV are not affected by HAART and continue to develop even with treatment. In addition, HAART itself causes in a high proportion of patients a metabolic syndrome, characterized by lipodystrophy/ lipoatrophy, dyslipidemia and insulin resistance that may be associated with an increase in peripheral artery and coronary artery diseases. Careful cardiovascular evaluation in the course of HIV disease can identify cardiac complications early enough to treat. All HIV-infected patients who are either candidates to antiretroviral therapy or who are already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk with the available guidelines and the interactions between antiretrovirals and drugs commonly used to treat cardiovascular disease.     

Goals and milestones during treatment of HIV-1 infection with antiretroviral therapy: a pathogenesis-based perspective

Highly active antiretroviral therapy (HAART) has reduced the morbidity and mortality related to infection with the human immunodeficiency virus-1 (HIV-1) through its ability to suppress viral replication and preserve and reconstitute specific immune responses in many infected individuals. However, the complete eradication of HIV-1 with current HAART regimens is not considered possible by most experts. Moreover, many current antivirals have metabolic complications and limiting side effects. Consequently, the treatment paradigm has shifted from 'hit hard and early' to delaying the initiation of therapy until later in the course of HIV-1-related disease, with corresponding modifications of consensus treatment guidelines. Factors that need to be considered in deciding when to initiate therapy and with what regimen include the patient's risk of disease progression, the possible adverse drug effects, the patient's ability to adhere to the prescribed therapy, and the need to preserve future therapeutic options. In this article, we discuss the issues surrounding the initiation of HAART, and describe the virologic and immunologic milestones that may be achieved with effective antiretroviral therapy.     

Identification, management, and prevention of adverse effects associated with highly active antiretroviral therapy.

PURPOSE: The adverse effects associated with highly active antiretroviral therapy (HAART), as well as potential options available for management of these complications, are summarized. SUMMARY: Effective treatment of human immunodeficiency virus (HIV) infection requires three or four drug regimens that are complicated and commonly associated with adverse effects. This makes compliance difficult and can result in treatment failures, development of resistance, and loss of future treatment options. In addition, some adverse effects may lead to an increase in morbidity and represent additional risk factors for future complications. Serious adverse events after the initiation of HAART are related to both patient and treatment characteristics. Most organ systems can be affected, depending on the drug or class of drugs being used; therefore, proper identification of adverse effects can be difficult. The most common adverse effects are gastrointestinal, neurologic, metabolic, and cardiovascular, although renal, dermatological, and hematologic events may also be encountered. Adverse-effect management has included treatment interruptions and therapeutic drug monitoring but most commonly involves switching to another drug or class of drugs. This requires a complete understanding of HAART regimens and their associated complications. HIV clinics that have employed clinical pharmacists have been able to successfully prevent or identify adverse effects through suggestions for effective treatment alternatives, medication counseling, and compliance education. CONCLUSION: The identification, management, and prevention of adverse events associated with HAART can be difficult but are integral components of effective treatment. Proper interventions are cost-effective and have resulted in improved quality of life for patients infected with HIV.     

HIV-Related Lung Disorders

Highly active antiretroviral therapy (HAART) has dramatically altered the spectrum of morbidity and mortality in HIV-infected patients. This has been attributed to improvements in the lung microenvironment leading to enhanced pulmonary immunity, either by preventing the progressive loss of immune function or by actually promoting immune restoration. However, these changes have been accompanied by the recognition of new pulmonary complications in HIV-infected subjects, especially those associated with immune reconstitution. In this review we will describe how HIV infection alters the normal pulmonary environment, highlight the effect of HAART on these perturbations, and discuss potential complications of HAART in the lung, focusing on the pulmonary immune reconstitution inflammatory syndrome.