HIV/AIDS病人治疗过程中免疫重建综合征的初步观察

目的 探讨艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人经高效抗逆转录病毒治疗(HAART)后,最初3个月的免疫重建综合征问题. 方法 对收治的HIV/AIDS病人,在抗病毒治疗的前3个月内的临床症状、CD 4 T淋巴细胞计数及病毒载量进行描述. 结果 27例接受HAART的HIV/AIDS病人中,治疗的前3个月CD 4 T淋巴细胞均上升,病毒载量下降有的甚至检测不到,出现免疫重建综合征12例;并发肺炎6例(细菌性4例、霉菌性2例),卡氏肺囊虫肺炎(PCP)3例,巨细胞病毒(CMV)感染1例,结核6例(颈部淋巴结结核3例,肠结核1例,结核性胸膜炎1例,血行播散型结核并脑膜炎1例),带状疱疹1例. 结论 HAART可使免疫重建,包括CD 4 T淋巴细胞功能上升、病毒载量下降和其他的治疗益处,同时也会激活一些接受抗病毒治疗HIV/AIDS病人的炎症反应.     

新疆伊宁市912例HIV-1型病毒载量定量检测结果分析

目的分析新疆伊宁市人民医院抗病毒中心912例HIV感染者HIV-1型病毒载量定量检测结果,了解HIV感染者体内病毒载量、病毒载量与临床指征之间的相互关系,为艾滋病的预防和抗病毒治疗提供基础数据。方法采用分枝DNA信号放大系统(bDNA)技术,利用SIEMENS公司VERSANT-440分子系统,2012年7月～2013年2月检测伊宁市912例HIV感染者HIV-1型病毒载量拷贝数。结果伊宁市912例HIV感染者HIV-1病毒载量分布状况:<500 c/ml 661例(72.4%),501～3 000 c/ml 48例(5.3%),3 001～10 000 c/ml 82例(9.0%),10 001～30 000 c/ml 49例(5.4%),30 000～3 5000 c/ml 6例(0.7%),>35 000 c/ml 66例(7.2%)。结论 HIV-1型病毒载量定量检测是判定HIV感染者疾病进程,评估临床抗病毒治疗的重要指标。     

HIV-1潜伏感染与体外模型的建立

高效抗反转录病毒治疗(HAART)的出现,使得艾滋病病毒(HIV)感染从一种致死性疾病转为慢性感染性疾病,使感染者体内的病毒载量下降至常规方法检测不到的水平。但人们很快发现一旦停止用药,感染者病毒载量很快反弹,这就意味着患者需要终身服用药物。而HAART不能彻底清除HIV-1感染的主要原因是,由于HIV-1在体内潜伏感染,形成病毒储藏库。经过不懈的努力,人们对于HIV-1潜伏的分子机制有了越来越多的认识,并且建立了一系列的体外模型,这些都为攻克HIV潜伏感染,治愈HIV感染奠定了基础。     

中药(XQ-9302)治疗HIV感染者/AIDS患者CD4细胞计数和病毒载量变化的评价

目的　探讨中药 (XQ 930 2 )对艾滋病病毒 (HIV)感染者 /艾滋病 (AIDS)患者的治疗作用。方法　测定XQ 930 2治疗 2 1例HIV感染者 /AIDS患者的CD4细胞计数和病毒载量 ,并与仅进行对症治疗的HIV感染者 /AIDS患者对照组比较。结果　经XQ 930 2治疗后 ,4 2 9%HIV感染者 /AIDS患者的CD4细胞计数上升 >5 1% ,为显效 ;33 3%患者的CD4细胞计数升高 11%～ 5 0 % ,为有效 ,总有效率为 76 2 % ;CD4细胞计数上升 <10 %为无效 ,无效率为 2 3 8%。 5 2 4 %HIV感染者 /AIDS患者的病毒载量下降≥ 1log ,呈显效 ;38 1%的HIV感染者 /AIDS患者病毒载量无变化或下降 <1log ,为有效 ;仅 9 5 %HIV感染者 /AIDS患者病毒载量上升 ,为无效。所有HIV感染者 /AIDS患者的临床症状均获改善。对照组HIV感染者 /AIDS患者病毒载量呈稳定及上升状态 ,临床症状均未获改善 ,呈无效。结论　XQ 930 2对HIV感染者 /AIDS患者的CD4细胞计数上升以及病毒载量下降有效 ,且能改善临床症状。     

益艾康胶囊治疗HIV/AIDS病人60个月CD_4~+T细胞计数和病毒载量临床观察

目的观察益艾康胶囊对艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)CD4+T细胞计数和病毒载量的影响。方法选择1349例HIV/AIDS病人,分为益艾康组口服中成药益艾康胶囊,益艾康+HAART组给予HAART治疗,6个月检测1次CD4+T细胞,1年检测1次病毒载量,连续观察60个月,并对两组进行比较。结果益艾康组434例,口服中成药益艾康胶囊每次5粒,每日3次;益艾康+HAART组治疗915例。治疗60个月后,CD4+T细胞计数两组间差异无统计学意义(P0.05)。以CD4+T计数升降50个/μl为评定值,益艾康组上升者占28.70%;稳定者占17.10%;益艾康+HAART组上升者占46.80%;稳定者占20.50%,组间比较差异有统计学意义(P=0.00)。118例病毒载量下降程度与疗前相比,两组差异均具有统计学意义(P0.05)。益艾康组病毒载量下降率为64.10%,下降和稳定共计85.89%;益艾康+HAART组下降率为57.50%,下降和稳定共计90.00%,两组之间比较差异无统计学意义(P0.05)。结论益艾康胶囊具有提高病人细胞免疫功能或使之保持稳定,并降低或稳定病人病毒载量的作用。     

HAART治疗20例艾滋病患者疗效评估

目的评价高效抗逆转录病毒疗法(Highly active antiretroviral therapy,HAART)对我国艾滋病(AIDS)患者的疗效。方法对20例接受免费HAART治疗1~2年(平均18个月)的HIV-1感染的晚期患者进行横断面调查,检测HIV-RNA病毒载量、CD4 T淋巴细胞绝对计数、HIV特异性细胞毒性T淋巴细胞(CTL)应答、常规生化检验和临床指标观察。结果所有观察对象在HAART治疗1~2年(平均18个月)后,临床症状明显改善:大部分患者病毒复制得到有效抑制,80%患者血浆中HIV-RNA载量在检测水平以下,CD4 T淋巴细胞绝对计数平均356.9±155.7/mm3,其中8例(40%)大于400/mm3;CTL应答频率和效应在每个蛋白区都有应答,对Nef蛋白应答较为突出。结论HAART治疗对我国HIV/AIDS患者疗效显著,能提高HIV-1感染者的生活质量,降低机会性感染,并使部分免疫功能重建,具有较高的安全性和耐受性。     

吸毒成瘾HIV/AIDS患者抗逆转录病毒治疗的初步探讨

目的 评价国产艾滋病抗病毒药物治疗吸毒成瘾艾滋病病毒感染者/病人(HIV/AIDS)的疗效及对治疗时机的探讨. 方法 采用回顾性研究方法,调查随访2004～2007年在北京佑安医院确诊并经抗病毒治疗的吸毒成瘾HIV/AIDS患者114例,按照疾病进展将随访对象分成艾滋病组( AIDS)和HIV感染组(free of AIDS) ,所有患者均用3种抗病毒药物(奈韦拉平 司他夫定 拉米夫定)治疗,疗程48周.常规方法检测患者治疗前后血CD4 T淋巴细胞数,核酸序列扩增技术(NASBA)测定病毒载量. 结果 114例吸毒成瘾HIV/AIDS患者CD4细胞数平均增加(182.39±90.70)个/mm3;其中35例吸毒成瘾HIV/AIDS患者中85.71%病毒载量下降至50 copies/ml以下, 下降2.5个Log数;艾滋病组与HIV感染组治疗后3、6、9和12个月CD4 T淋巴细胞差异有统计学意义(P＜0.05);治疗6个月后,HIV感染组病毒载量下降趋势较艾滋病组明显,但治疗12个月后 HIV感染组病毒载量较艾滋病组有反弹现象. 结论 吸毒成瘾HIV/AIDS患者选用国产艾滋病抗病毒药物奈韦拉平 司他夫定 拉米夫定治疗取得良好效果,并且对艾滋病患者的疗效好于HIV感染者.     

不同HIV-1病毒载量定量检测方法的比较研究

目的 评价不同方法检测Ⅰ型艾滋病病毒(HIV-1)病毒载量的相关性及一致性,探讨国产实时荧光核酸定量检测试剂盒用于临床检测HIV-1病毒载量的可行性.方法 收集61份未治疗的HIV感染者/艾滋病(AIDS)病人血浆标本及57份抗病毒治疗后的血浆标本,使用深圳匹基生物工程股份有限公司实时荧光聚合酶链反应(实时荧光-PCR...     

2005年陕西省HIV耐药监测结果分析

目的 评估陕西省艾滋病高效抗逆转录病毒治疗（HAART）效果，及时发现艾滋病病毒（HIV）耐药毒株。方法 选择26例艾滋病（AIDS）治疗患者和2例待治疗HIV感染者作为监测对象，进行横断面调查，填写调查问卷，采集20ml抗凝血，检测病毒载量、CD4^＋T淋巴细胞计数和基因型耐药变异。结果 26例治疗患者在4种方案HAART治疗2～23个月（平均15个月）后，临床症状明显改善，20例（76．9％）治疗患者病毒复制得到有效控制，11例（42．3％）血浆病毒载量在检测水平以下；CD4^＋T淋巴细胞绝对计数平均为346．8±164．0个／mm^3，其中9例（34％）〉400个／mm^3。28例HIV／AIDS患者均未出现原发性耐药变异。结论 4种治疗方案疗效良好，均可有效抑制HIV-1复制，促进机体免疫重建，改善临床症状，无原发性耐药变异发生，未检出耐药毒株。     

益艾康胶囊治疗HIV/AIDS病人60个月CD4^＋T细胞计数和病毒载量临床观察

目的观察益艾康胶囊对艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）CD4＋T细胞计数和病毒载量的影响。方法选择1349例HIV/AIDS病人,分为益艾康组口服中成药益艾康胶囊,益艾康＋HAART组给予HAART治疗,6个月检测1次CD4＋T细胞,1年检测1次病毒载量,连续观察60个月,并对两组进行比较。结果益艾康组434例,口服中成药益艾康胶囊每次5粒,每日3次;益艾康＋HAART组治疗915例。治疗60个月后,CD4＋T细胞计数两组间差异无统计学意义（P〈0.05）。以CD4＋T计数升降50个/μl为评定值,益艾康组上升者占28.70%;稳定者占17.10%;益艾康＋HAART组上升者占46.80%;稳定者占20.50%,组间比较差异有统计学意义（P=0.00）。118例病毒载量下降程度与疗前相比,两组差异均具有统计学意义（P〉0.05）。益艾康组病毒载量下降率为64.10%,下降和稳定共计85.89%;益艾康＋HAART组下降率为57.50%,下降和稳定共计90.00%,两组之间比较差异无统计学意义（P〉0.05）。结论益艾康胶囊具有提高病人细胞免疫功能或使之保持稳定,并降低或稳定病人病毒载量的作用。     

Effect of influenza vaccination on disease progression among HIV-infected persons

OBJECTIVE: To describe the effect of influenza vaccination on long-term change in CD4 count and HIV RNA level, and on progression to AIDS or death. DESIGN AND SETTING: A longitudinal medical record review set in 113 medical clinics in 10 United States cities. PATIENTS: A total of 36,050 HIV-infected persons aged > or = 13 years in care for HIV infection. MAIN OUTCOME MEASURES: Change in CD4 count and HIV RNA level at follow-up (3-12 months after vaccination); hazard ratios (HR) for association of influenza vaccine with progression from baseline CD4 or HIV RNA level to AIDS and to death. RESULTS: The median CD4 count among all persons decreased 28 cells/year during follow-up, with no difference in change in CD4 count between the 8007 (40%) vaccinated (median = 6 months, vaccine to follow-up CD4 count) and the 11,794 unvaccinated persons. In a viral load subanalysis, median HIV RNA level decreased 90 copies/ml per year among all persons during follow-up; decreases were not different between vaccinated and unvaccinated persons (median = 7 months, vaccine to follow-up HIV RNA level determination). Influenza vaccination was weakly associated with decreased risk of progression to clinical AIDS [HR 0.93; 95% confidence interval (CI), 0.87-0.99], but not associated with time to death (HR, 0.97; CI, 0.93-1.01). CONCLUSIONS: No negative long-term effect of influenza vaccination on CD4 counts, HIV RNA levels, or progression to AIDS or death was found in this HIV-infected population. These data suggest that physicians should not withhold influenza vaccine because of concerns about long-term detrimental effects of increased viral replication.     

Additional evidence for lack of transmission of HIV infection by close interpersonal (casual) contact

To further study the possibility of transmission of HIV infection by close personal but non-sexual, non-parenteral contact we have continued to enroll and evaluate household contacts of adult patients with AIDS. Two hundred and six household contacts of 90 patients with AIDS were evaluated with detailed interviews, physical examinations, and detection of HIV antibodies and p24 antigen from 1984 to 1987; 118 of these contacts were re-evaluated 6-12 months after cessation of household contact or death of the patient. The median duration of household contact from 18 months prior to symptoms in the AIDS patients to last contact was 23 months (range 3-101 months). The median time elapsed from first contact during this period to the last evaluation was 38 months (range 13-66 months). No household contact had signs or symptoms suggesting HIV infection. All 206 were negative for serum antibodies to HIV and HIV p24 antigen, despite extensive sharing of household facilities and items and personal interactions with AIDS patients. This study continues to show that household members without other risks remain at minimal to no risk for HIV transmission (95% confidence interval, 0-1.44) despite prolonged and substantial close non-sexual contact with AIDS patients, and after re-evaluation at a median of 10.9 months after initial evaluation.     

Transfusion-Transmitted AIDS with Blood Negative for Anti-HIV and HIV-Antigen

A four-year-old boy who was diagnosed with Glanzmann's thrombasthenia received supportive treatment and desmopressin for his bleeding episodes. He seldom received blood components, except for platelet concentrates, due to severe bleeding. He was exposed to 18 routine donors and 2 plateletpheresis donors who were negative for human immunodeficiency virus (HIV) antigen and anti-HIV upon screening. At the age of 3 years and 9 months (4.5 months after the transfusion of platelet concentrate), he developed full-blown AIDS and died from circulatory failure 3 months later. The source of HIV transmission was identified as 1 donor who developed anti-HIV 3 months after the last donation. The rather short incubation time of AIDS in this case was attributed to a large inoculum of HIV virus in the ‘window perioD' of infectivity of the newly infected donor. This case illustrates transfusion-transmitted HIV leading to AIDS, even though HIV antigen and anti-HIV screening tests were negative.     

HIV isolation and clinical markers on the seropositive subjects

We investigated 18 anti-HIV seropositive subjects with respect to the isolation of HIV from peripheral blood mononuclear cells (PBMC) and cellular and serologic markers for progression to AIDS. The subjects included homosexuals and recipients of blood products. Three had AIDS, an asymptomatic subject developed AIDS during the study and 14 of the remaining have remained asymptomatic. HIV was isolated from all AIDS patients and 7 asymptomatic subjects. Moreover HIV was detected significantly sooner in symptomatic patients than in asymptomatic subjects. The reductions in CD4 lymphocytes number and CD4/CD8 ratio, as well as anti-HIV core (p24, p17) antigens negativity correlated with deterioration of clinical symptoms and successful HIV isolation. The isolates from AIDS patients and from an asymptomatic subject who 9 months later developed AIDS were infective and cytotoxic to MT-4 cells, however isolates from asymptomatic subjects were not infective. These findings indicate that disease progression correlates with the appearance of variant viruses that are more infective and cytopathic.     

Antibody to HIV in patients with acute hepatitis B in the period 1975-1984

In order to elucidate the time when HIV was introduced into a population of patients with acute hepatitis B, serum samples collected in the period 1975-1984 from 331 patients with hepatitis B were analysed for the presence of antibody to HIV (anti-HIV). Anti-HIV was not detected in any of the serum samples from 97 females. 5/234 serum samples from males (2%) were repeatedly positive. Anti-HIV was first demonstrated in 1978, 3 years before the first patients with AIDS were recognized in Denmark. None of the 4 Danish patients with anti-HIV developed AIDS during a follow-up period of 1-7 years. However, at the time of follow-up in 1985 3 had decreased cell mediated immunity. The hepatitis B infection had an uncomplicated course in 4/5 patients with anti-HIV. One patient had a protracted delta hepatitis and was a HBsAg carrier before as well as after the acute hepatitis. Thus, the HIV infection did not cause any complicated course in this study.     

28例HIV/AIDS与SARS患者同住不受感染的原因探讨

目的　在 2 0 0 3年 2～ 5月 ,有 2 8例艾滋病病毒 (HIV)感染者 /艾滋病 (AIDS)病人与严重急性呼吸综合征 (SARS)病人同时住在一个隔离病区 ,却无人受到感染。查明其原因 ,可能对探讨SARS的发病机理和预防有帮助。方法　对SARS流行期间住院的HIV感染者 /AIDS病人的病情及治疗情况进行分析。结果　 2 8例住院HIV感染者 /AIDS病人 (CD4<2 0 0 /mm3 的占 88 5 % )与SARS病人有近距离接触 ,却无一人受感染。 9例AIDS病人漱口液SARS冠状病毒核酸检测全部阴性。 4 2 3%使用高效抗逆转录病毒治疗 (HAART) ,89 3%使用抗生素治疗。结论　 2 8例HIV感染者 /AIDS病人近距离接触SARS病人后不受感染 ,似乎与抗HIV药物、抗生素使用无明显关系 ,可能与免疫状况或病毒间互相干扰有关。细胞免疫损伤是否是发病的重要机制之一 ,尚待进一步研究。     

23例艾滋病合并结核病患者的临床特点

目的探讨艾滋病合并结核病的临床特点、治疗及预后.方法对1997年～2004年7月间我院收治的23例艾滋病合并结核病的患者进行临床分析.结果 23例患者多为青壮年(94.3%),半年内病死11例(47.8%).人类免疫缺陷病毒(HIV)感染途径以性乱史(15例,占65.2%)为主.持续1个月以上的临床表现有发热、体重下降5～15 kg 者23例(100%),咳嗽15例(65.2%).多并发多种机会性感染.23例患者中以单纯肺结核14例(60.9%)及淋巴结结核8例(34.8%)为主;12例浸润型肺结核患者X线表现为病灶多位于双肺,多为较均匀一致的片絮状阴影,无一例出现空洞.蛋白纯化衍生物(PPD)试验弱阳性2例(8.7%),痰涂片、痰培养查抗酸杆菌仅1例阳性(4.4%).23例患者治疗前CD+4明显低于其他未合并结核病的艾滋病患者(P<0.05);而23例中,病死患者治疗前CD+4也较存活患者明显降低(P<0.05).23例患者的HIV RNA定量值明显高于未合并结核病的艾滋病患者(P<0.05).23例患者中,同时采用抗结核及抗HIV病毒药物治疗的患者,病死率较两种药物均未采用或单用抗结核药物治疗的患者明显降低(P<0.05).结论艾滋病合并结核病患者PPD试验阳性率低,肺结核X线表现不典型,淋巴结结核较多见,病死率高;治疗前CD+4明显降低,且与病死率相关;结核分枝杆菌感染可促进HIV病毒的复制;临床应尽可能同时进行抗结核与抗HIV病毒治疗.     

HIV/AIDS病人结核病可疑症状筛查问卷初探

目的 探讨结核病筛查问卷在HIV/AIDS病人中确诊和排除活动性结核的作用,为基层医生HIV/AIDS中活动性结核的诊断提供参考。 方法 2006年9月至2007年2月,对4个县HIV/AIDS病人进行连续纳入,通过结核病筛查问卷收集了每个患者的结核病可疑症状信息,并对部分患者进行了进一步的临床检查。分析了单一症状,多个症状在活动性结核诊断上的敏感度、特异度、似然比、验后概率。分析采用的金标准是当地艾滋病诊断治疗专家组根据痰检、X线胸片等定诊结果。 结果我国当前采用的HIV/AIDS病人结核病筛查问卷灵敏度为100%,特异度为65.6%。HIV/AIDS病人中可疑症状出现频次排序依次为：咳嗽、咳痰、夜间盗汗、和容易疲劳。出现痰中带血、反复低烧的患者,患活动性结核的概率显著增加。单一症状分析,咳嗽、咳痰在诊断活动性结核上灵敏度最高为92.1%,特异度为73.8%。咳嗽、咳痰阴性是排除活动性结核的有力指标。可疑症状筛查阳性患者中,出现1～3个症状的可疑者占85.4%,发现了78.6%的确诊活动性结核。仅有1个症状可疑者,验后概率为5%,同时,拥有2～5个可疑症状的患者,验后概率均稳定在12%左右,应受到同等重视。 结论 结核病筛查问卷筛查成本低且有效。在资源有限,缺少诸如培养条件地区,简单可行的筛查问卷是发现活动性结核的有力工具。