p53 in fibroblast-like synoviocytes can regulate T helper cell functions in patients with active rheumatoid arthritis

Background  p53 is a tumor suppressor and plays a key role in regulating cell hyperplasia, repairing DNA and inducing apoptosis. This study was to investigate p53 expression in fibroblast-like synoviocytes (FLS) and its effect on CD4⁺ T lymphocytes from patients with active rheumatoid arthritis (RA).

Methods  Human FLS were transfected with p53 siRNA and cocultured with CD4⁺ T lymphocytes from patients with active RA. The expressions of osteoprotegerin and interleukin (IL)-6 were detected in p53 siRNA and scramble siRNA-transfected FLS. In addition, protein levels of interferon (IFN)-γ, IL-17, IL-4 and CD25 as well as mRNAs of IFN-γ, retinoic acid-related orphan receptor (ROR)-γt, IL-17 and Foxp3 in cocultured CD4⁺ T lymphocytes were also measured.

Results  IL-6 decreased in p53-knockdown FLS while osteoprotegerin expression was not altered. FLS with p53 deletion significantly increased the production of IL-17 and IFN-γ by CD4⁺ T cells and upregulated Foxp3 mRNA expression without effects on the proportion of CD4⁺CD25^high T lymphocytes.

Conclusion  p53 in FLS might regulate Th1 and Th17 functions in patients with RA and participate in the pathogenesis of RA.

     

HLA-DR expression on regulatory T cells is closely associated with the global immune activation in HIV-1 infected subjects naïve to antiretroviral therapy

Background  The frequencies of regulatory T cells (Tregs) increased over the HIV infection but its counts actually decreased. We proposed that the decrease of Treg counts may cause the reduction of inhibitory effect and thereby account for the over-activation of Tregs during HIV infection. However, it remains unknown whether Tregs are also over-activated and thereafter the activation induced death may lead to the decrease of Tregs.

Methods  Tregs were defined as CD4⁺CD25⁺CD127^lo/- T cells. Eighty-one HIV-1 infected patients were enrolled in our study, and twenty-two HIV-1 seronegative donors were recruited as the control. The levels of HLA-DR on Tregs were determined by FACSAria flow cytometer.

Results  Compared to HIV-1 seronegative donors, the levels of HLA-DR on CD4⁺CD25⁺CD127^lo/- Tregs were significantly increased in HIV-1 infected patients, and its increase was positively associated with viral loads (r=0.3163, P=0.004) and negatively with CD4 T-cell counts (r=−0.4153, P <0.0001). In addition, significant associations between HLA-DR expression on CD4⁺CD25⁺CD127^lo/- Tregs and the percentages of HLA-DR, CD38, Ki67 expressing CD4⁺ and CD8⁺ T cells were also identified.

Conclusion  HLA-DR on Tregs is a good marker for viral replication and disease progression. The over-activation of Tregs might result in the decrease of Tregs.

     

Endothelial progenitor cells with Alzheimer’s disease

Background  Endothelial dysfunction is thought to be critical events in the pathogenesis of Alzheimer’s disease (AD). Endothelial progenitor cells (EPCs) have provided insight into maintaining and repairing endothelial function. To study the relation between EPCs and AD, we explored the number of circulating EPCs in patients with AD.

Methods  A total of 104 patients were recruited from both the outpatients and inpatients of the geriatric neurology department at General Hospital, Tianjin Medical University. Consecutive patients with newly diagnosed AD (n=30), patients with vascular dementia (VaD, n=34), and healthy elderly control subjects with normal cognition (n=40) were enrolled after matching for age, gender, body mass index, medical history, current medication and Mini Mental State Examination. Middle cerebral artery flow velocity was examined with transcranial Doppler. Endothelial function was evaluated according to the level of EPCs, and peripheral blood EPCs was counted by flow cytometry.

Results  There were no significant statistical differences of clinical data in AD, VaD and control groups (P >0.05). The patients with AD showed decreased CD34-positive (CD34⁺) or CD133-positive (CD133⁺) levels compared to the control subjects, but there were no significant statistical differences in patients with AD. The patients with AD had significantly lower CD34⁺CD133⁺ EPCs (CD34 and CD133 double positive endothelial progenitor cells) than the control subjects (P <0.05). In the patients with AD, a lower CD34⁺CD133⁺ EPCs count was independently associated with a lower Mini-Mental State Examination score (r=0.514,P=0.004). Patients with VaD also showed a significant decrease in CD34⁺CD133⁺ EPCs levels, but this was not evidently associated with the Mini-Mental State Examination score. The changes of middle cerebral artery flow velocity were similar between AD and VaD. Middle cerebral artery flow velocity was decreased in the AD and VaD groups and significantly lower than the normal control group (P <0.01). There was no significant difference of the blood flow velocity between the AD and VaD patients (P >0.05).

Conclusions  The results provided evidence that patients with AD have reduced circulating EPCs. Endothelial function is impaired in patients with AD and vascular factors have a role in the pathogenesis of AD. CD34⁺CD133⁺ EPCs may be a novel biomarker of AD dementia.

     

Correlation between T lymphocyte subsets in peripheral blood lymphocytes and 2-year all-cause mortality in an apparently healthy elderly Chinese cohort

Background  Few data have been acquired on the predictive value of age-related T-lymphocyte subsets among older individuals. The present study has determined the distribution of T-cell phenotypes and their correlation to 2-year mortality in a cohort of Chinese male seniors.

Methods  A total of 101 asymptomatic elderly individuals with laboratory homeostasis were enrolled at baseline. Three age subgroups were categorized as young (65–74 years old), middle (75–84 years old ), and old (≥85 years) for age-related comparison. T-cell subsets in peripheral blood were measured by multi-colored flow cytometry.

Results  At baseline, there was a mild negative correlation by age for total lymphocytes and CD3⁺ T-cells. The frequency of CD28 and CD95 demonstrated a “curved” rather than linear tendency by age. At 2-year follow-up, little change of T-cell distribution was found among those who remained alive (as survivors) comparing the data at baseline to the 2-year time point. Immune risk phenotypes were distinctly demonstrated between survivors and non-survivors.

Conclusions  Since few studies have studied on the distribution of T-lymphocyte subsets in an elderly Chinese population, our results have not only provided reference values of T-subsets for aged Chinese men, but confirmed the immune risk phenotypes among elderly Chinese. The inappropriate age-dependent trajectory of CD28^–/CD8⁺ and CD95^–/CD8⁺ by age, which suggested 85 might be an inflexion point of age during T-cell ageing, warrants further exploration of the underlying mechanisms of T-cell ageing.

     

Chemoresistance of CD133+ cancer stem cells in laryngeal carcinoma

Background  Mounting evidence suggests that tumors are histologically heterogeneous and are maintained by a small population of tumor cells termed cancer stem cells. CD133 has been identified as a candidate marker of cancer stem cells in laryngeal carcinoma. This study aimed to analyze the chemoresistance of CD133⁺ cancer stem cells.

Methods  The response of Hep-2 cells to different chemotherapeutic agents was investigated and the expression of CD133 was studied. Fluorescence-activated cell sorting analysis was used to identify CD133, and the CD133⁺ subset of cells was separated and analyzed in colony formation assays, cell invasion assays, chemotherapy resistance studies, and analyzed for the expression of the drug resistance gene ABCG2.

Results  About 1%–2% of Hep-2 cells were CD133⁺ cells, and the CD133⁺ proportion was enriched by chemotherapy. CD133⁺ cancer stem cells exhibited higher potential for clonogenicity and invasion, and were more resistant to chemotherapy. This resistance was correlated with higher expression of ABCG2.

Conclusions  This study suggested that CD133⁺ cancer stem cells are more resistant to chemotherapy. The expression of ABCG2 could be partially responsible for this. Targeting this small population of CD133⁺ cancer stem cells could be a strategy to develop more effective treatments for laryngeal carcinoma.

     

Cytomegalovirus retinitis associated with acquired immunodeficiency syndrome

Background  Cytomegalovirus (CMV) retinitis is the most severe intraocular complication that results in total retinal destruction and loss of visual acuity in patients with acquired immunodeficiency syndrome (AIDS). This study aimed to investigate the fundus characteristics, systemic manifestations and therapeutic outcomes of CMV retinitis associated with AIDS.

Methods  It was a retrospective case series. CMV retinitis was present in 39 eyes (25 patients). Best corrected visual acuities, anterior segment, fundus features, fundus fluorescence angiography (FFA) and CD4⁺ T-lymphocyte counts of the patients with CMV retinitis associated with AIDS were analyzed. Intravitreal injections of ganciclovir (400 µg) were performed in 4 eyes (2 patients).

Results  Retinal vasculitis, dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface were present in 28 eyes. The vitreous was clear or mildly opaque. Late stage of the retinopathy was demonstrated in 8 eyes characterized as atrophic retina, sclerotic and attenuated vessels, retinal pigment epithelium (RPE) atrophy, and optic nerve atrophy. Retinal detachment was found in 3 eyes. The average CD4⁺ T-lymphocyte count in peripheral blood of the patients with CMV retinitis was (30.6±25.3) ×10⁶/L (range, (0–85) ×10⁶/L). After intravitreal injections of ganciclovir, visual acuity was improved and fundus lesions regressed.

Conclusions  CMV retinitis is the most severe and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis without clear cause, human immunodeficiency virus (HIV) serology should be performed. Routine eye examination is also indicated in HIV positive patients.

     

Abnormal expression of CD43 in patients with systemic lupus erythematosus and its clinical significance

Background  Previous studies indicate that CD43 plays a role in regulating the adhesion of lymphocytes, cell mutation and activation, however, little is known about its effect on systemic lupus erythematousus (SLE). This study was designed to explore the clinical significance of CD43 in SLE patients.

Methods  We used microarray and real-time PCR to detect the mRNA and protein expression of magnetic bead sorted T cells and B cells from peripheral blood mononuclear cells (PBMCs) of SLE patients, and analyzed the relationship between CD43 and the clinical indexes.

Results  Both microarray and real-time PCR results showed that CD43 mRNA was significantly decreased in PBMCs of SLE patients compared with healthy controls (P <0.001). There were no significant differences between lupus nephritis and non-lupus nephritis patients, and neuropsychiatric and non-neuropsychiatric patients. CD43 mRNA expression was significantly reduced in T cells but not in B-cells in SLE patients compared to healthy controls (P <0.01). Compared with healthy controls, the percentage of CD43⁺ cells in the PBMCs of SLE was significantly decreased (P=0.004), and the CD43 fluorescence intensity in CD3⁺/CD43⁺ cells and CD19⁺/CD43⁺ cells was also significantly weaker than in healthy controls (P=0.039 and 0.003). There was no significant difference in the percentage of CD3⁺/CD43⁺ cells, CD19⁺/CD43⁺ cells between the two groups. The CD43 fluorescence intensity in CD3⁺/CD43⁺ cells was inversely correlated with the levels of IgG and IgM (r= –0.8 and –0.6).

Conclusions  Compared to healthy controls, both CD43 mRNA and protein expressions were reduced in T cells from patients with SLE, and were inversely correlated with IgG.

     

In vivo administration of Fms-like tyrosine kinase-3 ligand effectively stimulates lung dendritic cell expansion in mice

Background  Dendritic cells (DCs) are the most important professional antigen presenting cells that play a key role in initiating adaptive immune responses. The depletion and dysfunction of DCs contribute to the development of immunodeficiency or immunoparalysis in some lung diseases. In the present study, we investigated the effects of Fms-like tyrosine kinase-3 ligand (Flt3L) administration in vivo on lung DCs expansion to provide an experimental basis of Flt3L used as a potential therapeutic agent for the related lung disorders.

Methods  Balb/c mice were randomly divided into Flt3L group (n=10) and control group (n=10). Each mouse in the Flt3L group received subcutaneous administration of Flt3L at a dose of 10 μg once daily for nine consecutive days. Lung histology was observed, and CD11c and CD205 were immunologically labeled in lung tissue sections. Low-density lung cells were separated by density gradient centrifugation, and then subsets and MHC-II/I-A^d expression of DCs were analyzed by flow cytometry.  

Results  In the Flt3L group the number and density of DC-like cells were markedly increased compared with the control group, mainly distributed in the alveolar septa. Immunological labeling in situ found that there were significantly higher numbers of CD11c⁺ and CD205⁺ DCs in lung mesenchymal tissue (P <0.05), where they formed a denser reticular formation. Flow cytometry analysis demonstrated that the proportions of myeloid CD11c⁺CD11b⁺ DCs and plasmacytoid CD11c⁺CD45R/B220⁺ DCs in the low-density lung cells in the Flt3L group were significantly higher compared with the control group; showing 3.17- and 3.3-fold increase respectively (P <0.05). The proportion of CD11c⁺ DCs expressing MHC-II/I-A^d+ was significantly increased, with a 2.7-fold increase as compared with the control group (P <0.05).  

Conclusions  Flt3L administration in vivo induces lung DCs expansion, favoring myeloid and plasmacytoid DC subsets, which are phenotypically more mature. Flt3L may be useful in the therapy to augment immune function of the lung.     

Prognostic value of clinical characteristics and immunophenotypic biomarkers in 115 patients with primary central nervous system lymphoma

Background  Clinical outcome in patients with primary central nervous lymphoma (PCNSL) is variable and poorly predictable. This study investigated the association of clinical features and immune markers with prognosis of patients with PCNSL.

Methods  One hundred and fifteen newly diagnosed PCNSL patients at the study institution were considered eligible for this study. Clinical characteristics and biochemical assay data were collected. Immunohistochemical staining of Cyclin D3, Cyclin E, Foxp1, and LMO2 were performed. All cases were followed-up regularly.

Results  The common sites of involvement were frontal lobe (54.8%) and thalamus (16.5%). Diffuse large B-cell lymphoma composed of 96.5% of the cases. The median overall survival was 22 (4–41) months, and the 5-year survival rate was 22.8%. Age >65 years, serum globulin >40 g/L, large size of tumor, lymphocyte count ³1´10⁹/L, and expression of Cyclin D3 and Cyclin E were associated with poor prognosis of PCNSL. Expressions of Foxp1, LMO2, and CD44 were not related to the survival. Expression of Cyclin E, large tumor size, and high serum globulin were independent prognostic factors for PCNSL.

Conclusions  PCNSL prognosis is relatively poor. Age, high tumor burden, higher lymphocyte count, expression of Cyclin D3, and Cyclin E are inferior prognostic factors for PCNSL.

     

Immature CD4+ dendritic cells conditioned with donor kidney antigen prolong renal allograft survival in rats

Background  Allogeneic transplant rejection is currently a major problem encountered during organ transplantation. The dendritic cell (DC) is the most effective powerful known professional antigen-presenting cell, and recent studies have found that DCs can also induce immune tolerance, and avoid or reduce the degree of transplant rejection. The aim of this study was to evaluate the effect of transfused immature CD4⁺ DCs on renal allografts in the rat model.

Methods  In this study, we induced CD4⁺ immature DCs from rat bone marrow cells by a cytokine cocktail. The immature CD4⁺ DCs were identified by morphological analysis and then the suppressive activity of these cells conditioned with donor kidney antigen was evaluated in vitro and in vivo.

Results  Immature CD4⁺ DCs conditioned with donor kidney antigen possessed immunosuppressive activity in vitro and they were able to prolong renal transplant survival in an allograft rat model in vivo.

Conclusions  Our study provides new information on efficacious renal transplantation, which might be useful for understanding the function of immature CD4⁺ DCs in modulating renal transplant rejection and improving clinical outcome in future studies.

     

High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy.

OBJECTIVES--To determine the incidence of active tuberculosis in human immunodeficiency virus (HIV)-seropositive and HIV-seronegative drug injectors with cutaneous anergy and to examine the effectiveness of isoniazid chemoprophylaxis in preventing tuberculosis among drug injectors with positive tuberculin test results. DESIGN AND SETTING--Prospective observational study linked to an ongoing study of HIV infection within a New York City (NY) methadone program; subjects also underwent routine intradermal tuberculin testing and multiple-antigen delayed-type hypersensitivity skin testing. The 31-month study period ended December 31, 1990. METHODS--Anergic subjects and tuberculin reactors who were HIV seropositive were compared by HIV disease status and CD4+ T-lymphocyte levels. Tuberculosis incidence was calculated for anergics (none treated with isoniazid) and for treated and untreated tuberculin reactors, by HIV serological status. RESULTS--Among those seropositive for HIV, anergic subjects had more advanced HIV disease and fewer CD4+ cells (median 0.33 vs 0.56 x 10(9)/L, P less than .01) compared with tuberculin reactors, although neither clinical status nor CD4+ cell counts consistently predicted anergy. Five (7.6%) of 68 anergic subjects who were HIV seropositive and none of 52 anergic subjects who were HIV seronegative (n = 18) or of unknown (n = 34) HIV serological status developed active tuberculosis during the study period (P less than .05). The tuberculosis incidence rate among anergic subjects who were HIV seropositive was 6.6 cases per 100 person-years (95% confidence interval [Cl], 2.1 to 15.3). Of 25 HIV-seropositive tuberculin reactors who did not receive or complete 12 months of isoniazid prophylaxis, tuberculosis incidence was 9.7 cases per 100 person-years (95% Cl, 2.6 to 24.7; P = 0.56, compared with the rate among anergic HIV seropositives); there were no cases of tuberculosis in 53.4 person-years of follow-up for 27 HIV-seropositive tuberculin reactors who received 12 months of prophylaxis (rate difference between treated and untreated groups, 9.7 cases per 100 person-years, 95% Cl, 1.3 to 18.0). CONCLUSION--Drug injectors with cutaneous anergy who are seropositive for HIV are at high risk of active tuberculosis, similar to that among untreated HIV-seropositive tuberculin reactors. A decreased incidence of active tuberculosis was seen in HIV-seropositive tuberculin reactors receiving 12 months of isoniazid chemoprophylaxis, compared with untreated or partially treated subjects. These results support the routine use of delayed-type hypersensitivity testing to accompany tuberculin testing for drug injectors with known or suspected HIV infection, and consideration of isoniazid prophylaxis for anergic as well as tuberculin-reactive subjects who are HIV seropositive, in populations with a high prevalence of coexisting HIV and Mycobacterium tuberculosis infection.     

艾滋病合并耶氏肺孢子菌肺炎及马尔尼菲篮状菌、新型隐球菌播散性感染1例

艾滋病同时合并耶氏肺孢子菌肺炎（Pneumocystis jirovecii pneumonia, PJP）、马尔尼菲篮状菌和新型隐球菌播散性感染少见报道,本文对1例合并多种真菌感染的艾滋病患者的诊疗进行分析总结,以供参考。患者男,79岁,以“大便习惯改变20余天”入院,入院检查：白细胞计数4.57×10⁹/L,中性粒细胞百分数81.8%,CD4⁺淋巴细胞绝对计数 6 个/μL,CD4/CD8比值0.17,经疾控中心确认HIV抗体阳性。脑脊液和肺泡灌洗液新型隐球菌荚膜抗原测定阳性,支气管肺泡灌洗液六胺银染色找到耶氏肺孢子菌,脑脊液培养检出新型隐球菌,血培养同时检出新型隐球菌和马尔尼菲篮状菌。CT示双肺支气管血管束粗多,两肺见斑片状、条索状高密度影,边缘模糊;左肺上叶尖后段见结节状、条索状高密度影,边缘清楚;考虑两肺感染,左肺上叶继发型肺结核。患者入院后因反复发热,先后使用多种抗细菌、真菌药物治疗,效果不佳。患者发热症状等均得不到明显改善,病情持续加重,最终死亡。艾滋病合并细菌、真菌感染,尤其同时合并PJP感染者,病情严重且发展迅速预后差,临床应引起重视。     

109例次HIV/AIDS住院患者临床与实验室检查特征

目的:探讨我院HIV/AIDS患者住院的原因,机会性感染的疾病谱及机会性感染发生与CD4+T淋巴细胞的关系。方法:收集2005年1月²013年8月在我院住院的109例次HIV/AIDS病人,就其临床及实验室资料进行回顾性分析。结果:109例次HIV/AIDS住院患者,因服用抗病毒药物出现严重副反应而住院15例次;因机会性感染而住院83例次。机会性感染以消化系统和呼吸系统的疾病为主,前三位机会性感染为细菌性呼吸系统感染30例次、念珠菌感染28例次、结核菌感染15例次;机会性感染的发生和CD4+T淋巴细胞计数有密切关系;细菌、念珠菌、结核菌在CD4+T淋巴细胞的每个区段都可发生,但CD4T淋巴细胞越低,念珠菌感染越高且重,有时波及胃、肠、皮肤和四肢,而结核菌感染则症状不典型,伴有全身或纵膈淋巴结肿大。PCP仅在CD4+T淋巴细胞<200个/mm3发生。CD4+T淋巴细胞在3502013年8月在我院住院的109例次HIV/AIDS病人,就其临床及实验室资料进行回顾性分析。结果:109例次HIV/AIDS住院患者,因服用抗病毒药物出现严重副反应而住院15例次;因机会性感染而住院83例次。机会性感染以消化系统和呼吸系统的疾病为主,前三位机会性感染为细菌性呼吸系统感染30例次、念珠菌感染28例次、结核菌感染15例次;机会性感染的发生和CD4+T淋巴细胞计数有密切关系;细菌、念珠菌、结核菌在CD4+T淋巴细胞的每个区段都可发生,但CD4T淋巴细胞越低,念珠菌感染越高且重,有时波及胃、肠、皮肤和四肢,而结核菌感染则症状不典型,伴有全身或纵膈淋巴结肿大。PCP仅在CD4+T淋巴细胞<200个/mm3发生。CD4+T淋巴细胞在350⁵00个/mm3之间有机会性感染出现。结论:机会性感染和抗病毒药物副反应是患者就医住院的主要原因;CD4+T淋巴细胞<500个/mm3即应启动抗病毒治疗。     

Ocular manifestations in 321 male consecutive cases of human immunodeficiency virus infection/acquired immunodeficiency syndrome at an HIV-referral centre

Background

Most studies on the ocular manifestations of human immunodeficiency virus (HIV) infection are on cases of acquired immunodeficiency syndrome (AIDS), not including asymptomatic carriers of HIV. With this background, we proceeded to study all the HIV-infected individuals attending our centre, with the aim:a. To study the ocular manifestations of HIV.b. To correlate those manifestations with the CD4+ T-lymphocyte counts.c. To compare our findings with other studies.

Method

A cross-sectional study involving a detailed ocular examination of 321 cases of HIV/AIDS was done. Automated perimetry, digital fundus photography and fundus fluorescein angiography were done for relevant cases. The last 125 cases were subjected to Schirmer's test and tear film break-up time.

Results

We studied 321 male HIV cases (642 eyes), with a mean age of 36.78 years, mean CD4+ count of 276.54 cells/μL, 78.82% of them being on anti-retroviral therapy. Ocular manifestations were seen in 87 out of 321 cases, 72.41% of them being asymptomatic carriers of HIV. The ocular findings seen were conjunctival microvasculopathy, molluscum contagio-sum, dry eye, neuro-ophthalmic manifestations, anterior uveitis, posterior uveitis, and HIV retinopathy, only the last three of which had a significant association with CD4+ counts. The overall prevalence of ocular lesions also had a significant association with CD4+ counts.

Conclusion

Ocular manifestations are common in asymptomatic carriers of HIV. Anterior uveitis, posterior uveitis and HIV retinopathy have a significant association with CD4+ counts and are reliable indicators of low CD4+ count.     

Significance of Tuberculin Testing in HIV Infection: An Indian Perspective

Background

Tuberculin skin testing (TST) is a reliable tool in the diagnosis of tuberculous infection and is important in its control. However, it may be false negative in immunocompromised patients like HIV-infected.

Methods

We examined the pattern of TST results in 523 newly diagnosed HIV-positive patients. CD4, CD8 and absolute lymphocyte counts were done by flowcytometry in 63 of these cases.

Results

56 (44.10%), 15 (11.81%) and 56 (44.10%) of the 127 cases with tuberculosis and 293 (73.99%), 41 (10.35%) and 62 (15.66%) of the 396 cases without any clinical evidence of tuberculosis showed TST results of 0-4, 5-9 and = or > 10 mm respectively. Significantly more (P<0.05) number of cases with TST of = or > 10mm and significantly lesser (P<0.05) number of cases with TST of 0-4 mm are likely to develop tuberculosis. The average CD4+lymphocyte count was found to be significantly lower in cases with nil TST results than with = or >10mm. HIV infected cases associated with tuberculosis with induration on TST had average CD4 counts of 129.5 as compared to 246.3/cmm in those without tuberculosis.

Conclusion

In India where both these diseases are endemic, tuberculosis may develop during early HIV infection, while the body''s immunity is still largely unimpaired and TST shows = or >10mm results in almost 45% of our cases. In another 45% with TST of 0-4mm, the CD4+ lymphocyte count is likely to be lower than 200/cmm. In those with nil induration, TST of 5-9 mm cannot be taken as an independent marker for suspecting tuberculosis in the HIV infected. Hence we recommend that all cases with TST of = or >10mm and cases with nil induratrion with CD4+ count of <200/cmm should be considered as high-risk for developing tuberculosis.Key Words: Tuberculin skin test, HIV infection     

66例艾滋病合并肺结核与单纯肺结核临床对照分析

目的:探讨艾滋病合并肺结核病的临床特征。方法:将诊治的艾滋病合并肺结核病并完成治疗及随访的66例患者作为观察组(A组),以同期住院的HIV(-)单纯肺结核患者72例为对照组(B组)进行回顾性分析。结果:A组痰抗酸杆菌阳性率7例,10.61%,显著低于B组,21例,29.17%(P=0.007);A组发热和体重下降较B组更常见,而咳嗽和咯血较B组少见;A组合并肺外结核较B组多见,A组淋巴系统较B组常发生结核病变,A组全身血液播散性结核病的发病率明显高于B组;肺结核的X线、CT表现为弥漫性浸润或粟粒性阴影的,A组多于B组,而A组影像学空洞率显著低于B组;抗痨疗效A组显著低于B组;外周CD4+T淋巴细胞数与结核严重程度相关。结论:HIV(+)/AIDS患者合并肺结核临床表现不典型,结核分枝杆菌检出率低,肺结核的X线、CT表现不典型,抗痨疗效较差。     

艾滋病合并肺结核CT征象与CD4 T淋巴细胞分级的相关性研究

[摘要] 目的 探讨AIDS合并肺结核CT特征与CD4 T淋巴细胞分级之间相关性。方法 依照CD4 T淋巴细胞数多少分为2级,Ⅰ级：＜100个/mm3、Ⅱ级：≥100个/mm3，对确诊的56例AIDS合并肺结核螺旋CT征象与CD4 T淋巴细胞数分级进行相关性研究。结果 部位：双肺上叶发生率与CD4 T淋巴细胞计数分级之间无明确相关，P＞0.05。右肺中叶及双肺下叶发生率与CD4 T淋巴细胞计数分级之间呈负相关，P＜0.05。影像特征：斑片状和（或）实变影、多发空洞、多发结节、纵隔和（或）腋下淋巴结肿大发生率与CD4 T淋巴细胞计数分级之间呈负相关，P＜0.05。单发空洞发生率与CD4 T淋巴细胞计数分级之间呈正相关，P＜0.05。胸腔积液发生率与CD4 T淋巴细胞计数分级之间无相关，P＞0.05。结论AIDS合并肺结核病变特征与CD4 T淋巴细胞的免疫功能损害有关，CD4 T淋巴细胞计数越低，肺部影像征象越不典型。 [关键词] 获得性免疫缺陷综合征 结核，肺 CD4 T淋巴细胞计数 分级 CT     

混合感染对艾滋病抗病毒治疗CD4的影响

目的探讨结核分枝杆菌（TB）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）等混合感染对艾滋病患者高效抗反转录病毒治疗（HAART）后CD4的影响,以提高艾滋病合并混合感染的诊断治疗水平。方法对43例HIV/TB、11例HIV/TB/HBV、11例HIV/TB/HCV、5例HIV/TB/HBV/HCV及44例HIV患者,进行HAART,比较治疗前、后的CD4计数的变化;比较治疗后不同时间CD4增加值的变化情况。结果经HAART后各感染组CD4计数不同程度增加,呈向上趋势,治疗后的第6个月CD4达到相对高值,并可维持12个月;治疗后12个月比3、9个月治疗效果更好;各感染组之间CD4计数变化情况无差别。结论各感染组患者经HAART后,CD4计数都有不同程度增加,但各组间之间的差别不大。     

Ocular manifestations in 321 male consecutive cases of human immunodeficiency virus infection/acquired immunodeficiency syndrome at an HIV-referral centre

Background

Most studies on the ocular manifestations of human immunodeficiency virus (HIV) infection are on cases of acquired immunodeficiency syndrome (AIDS), not including asymptomatic carriers of HIV. With this background, we proceeded to study all the HIV-infected individuals attending our centre, with the aim:a. To study the ocular manifestations of HIV.b. To correlate those manifestations with the CD4+ T-lymphocyte counts.c. To compare our findings with other studies.

Method

A cross-sectional study involving a detailed ocular examination of 321 cases of HIV/AIDS was done. Automated perimetry, digital fundus photography and fundus fluorescein angiography were done for relevant cases. The last 125 cases were subjected to Schirmer''s test and tear film break-up time.

Results

We studied 321 male HIV cases (642 eyes), with a mean age of 36.78 years, mean CD4+ count of 276.54 cells/μL, 78.82% of them being on anti-retroviral therapy. Ocular manifestations were seen in 87 out of 321 cases, 72.41% of them being asymptomatic carriers of HIV. The ocular findings seen were conjunctival microvasculopathy, molluscum contagio-sum, dry eye, neuro-ophthalmic manifestations, anterior uveitis, posterior uveitis, and HIV retinopathy, only the last three of which had a significant association with CD4+ counts. The overall prevalence of ocular lesions also had a significant association with CD4+ counts.

Conclusion

Ocular manifestations are common in asymptomatic carriers of HIV. Anterior uveitis, posterior uveitis and HIV retinopathy have a significant association with CD4+ counts and are reliable indicators of low CD4+ count.     

A COMPARATIVE STUDY OF CHEST RADIOGRAPHIC FEATURES BETWEEN HIV SEROPOSITIVE AND HIV SERONEGATIVE PATIENTS OF PULMONARY TUBERCULOSIS

Chest radiographic appearance of pulmonary tuberculosis (TB) in Human Immunodeficiency Virus (HIV) positive patients was reviewed. A study group of 50 HIV +ve cases and a control group of 100 HIV -ve cases were analysed. The chest radiographs of HIV seropositive group showed significantly higher incidence of thoracic lymphadenopathy (36% vs 8%, P<.001), pleural effusion (28% vs 10%, P<.01) and miliary pattern (12% vs 2%, P<.05) as compared to the seronegative group. Cavitation was less common in the seropositive group (8% vs 35%, P<.001) than the seronegative group. Upper zone involvement was significantly less common in the study group (38% vs 77%, P<.001) as compared to the control group.KEY WORDS: Chest radiograph, HIV infection, Pulmonary tuberculosis