广西地区HIV合并结核感染及其他因素对HIV复制影响的研究

目的 分析合并结核( tuberculosis,TB)感染及其他因素对广西地区HIV感染者病毒复制的影响.方法 2010年4月至2010年9月间在广西招募到未接受抗病毒治疗、CD4+T细胞数＜350个/μl的HIV/TB感染者61例,单纯HIV感染者34例.收集人口学、流行病学、临床信息,测定HIV病毒载量.结果 HIV/TB双重感染者与单纯HIV感染者血浆病毒载量差异无统计学意义 (5.05±0.93) lg拷贝/ml vs (5.06±0.76) lg拷贝/ml,P=0.94].二元logistic回归分析显示,CRF01_AE亚型较其他亚型HIV感染者血浆病毒复制水平高,OR=8.07 (95％CI 1.07～61.20,P=0.04).年龄、感染途径、CD4+T细胞数,是否合并结核分枝杆菌(MTB)感染及TB临床类型对病毒复制水平的影响均不明显.结论 广西地区CD4+T细胞数较低的HIV感染者中,合并结核感染对病毒复制影响不明显；CRF01_AE亚型HIV-1病毒复制水平较高,在监测和治疗过程中需加强关注.

The influence of Mycobacterium tuberculosis co-infection and other factors on HIV-1 replication in Guangxi, China

Objective To investigate the influence of Mycobacterium tuberculosis (MTB) co-infection and other factors on the HIV replication level in antiretroviral treatment na(i)ve patients.Methods Six hundred TB patients and 465 HIV infectors were recruited between April 2010 and September 2010.TB coinfections were diagnosed in HIV infected cases with chest X-ray,checking TB in sputum with anti-acid staining and culture of the sputum,histopatholo diagnosis and clinical diagnosis.HIV infections were screened in TB patients with the 3rd generation ELISA antibody test.Sixty-one antiretroviral treatment na(i)ve HIV/TB co-infectors and 34 HIV infectors with CD4 T cell count below 350 cells/μl were included in this study.Information about the demography,epidemiology and results of clinical diagnostic tests of HIV and TB was collected through pathography and questionnaires from all participants.HIV viral load were detected with COBAS AmpliPrep/COBAS TaqMan(R) System of Roche Company.Results The viral load of HIV/TB co-infectors was (5.05±0.93) lg copies/ml,while the viral load of HIV infectors was (5.06±0.76) lg copies/ml,after control of age,race,marital status,education,route of HIV infection,HIV clade and CD4 T cell count,there was no significant difference between the two groups (P=0.94).CRF01_AE HIV-1 infection was associated with higher HIV viral load compared with non CRF01_AE (OR=8.07,95％ CI 1.07-61.20,P=0.04).Conclusion No obvious effect of MTB co-infection on HIV replication level of HIV infected cases with relatively low CD4 T cell count in Guangxi region,while the CRF01_AE HIV infected individuals showed higher viral load,we should raise concern on the monitoring and treatment on this population.