Mapping HIV community viral load: space,power and the government of bodies

HIV plasma viral load testing has become more than just a clinical tool to monitor treatment response at the individual level. Increasingly, individual HIV plasma viral load testing is being reported to public health agencies and is used to inform epidemiological surveillance and monitor the presence of the virus collectively using techniques to measure ‘community viral load’. This article seeks to formulate a critique and propose a novel way of theorizing community viral load. Based on the salient work of Michel Foucault, especially the governmentality literature, this article critically examines the use of community viral load as a new strategy of government. Drawing also on the work of Miller and Rose, this article explores the deployment of ‘community’ through the re-configuration of space, the problematization of viral concentrations in specific micro-locales, and the government (in the Foucauldian sense) of specific bodies which are seen as ‘risky’, dangerous and therefore, in need of attention. It also examines community viral load as a necessary precondition – forming the ‘conditions of possibility’ – for the recent shift to high impact prevention tactics that are being scaled up across North America.     

On the analysis of viral load endpoints in HIV vaccine trials

First generation HIV vaccines are not likely to provide complete protection from HIV-1 infection. Therefore, it is important to assess a vaccine's effect on disease progression and infectiousness of infected vaccinees in an efficacy trial; however, direct assessment of such vaccine effects is not feasible within current trial designs. Viral load in HIV-infected individuals correlates with infectiousness and disease progression in a natural history setting, and thus is a reasonable candidate for a surrogate outcome in vaccine efficacy trials. We consider comparisons of viral load of infected vaccinees to that of infected trial participants in the control group. Dramatic differences in viral loads between these groups would suggest a vaccine effect on disease progression. However, modest differences, even if statistically significant, could be consistent with an imperfect vaccine effect on susceptibility to infection and not an effect on disease progression, that is, a selection effect of the vaccine. Thus, the usual statistical tests for no difference between groups do not test the biologically and clinically relevant hypothesis. We propose a model for the possible selective effects of a vaccine and develop several test statistics for assessing a direct effect of the vaccine on viral load given this selection model. Finite sample properties of these tests are evaluated using computer simulations.     

Kinetics of sedimentation rate, viral load and TNF-alpha in relation to HIV co-infection in tuberculosis

The kinetics of potential surrogate markers in HIV-positive (HIV+) and HIV-negative (HIV-), smear-positive tuberculosis (Tb+) patients in Gondar, Ethiopia (n = 60) was investigated. Clinical symptoms, sputum conversion, sedimentation rate (SR), HIV viral load and serum levels of TNF-alpha were determined before and 8 weeks after treatment initiation. The co-infection rate of HIV was 45%. There were significantly higher initial levels of SR and TNF-alpha in HIV+/Tb+ patients (79 +/- 29 mm/h and 13.5 +/- 7.6 pg/ml), than in HIV-/Tb+ patients (60 +/- 23 mm/h and 6.8 +/- 5.9 pg/ml, P<0.001). In HIV-/Tb+ patients, there was a marked decrease in SR compared with co-infected patients (46% [33 +/- 24 mm/h at week 8] vs. 24% [61 +/- 27 mm/h at week 8]). The HIV viral load (4.99 [range 3.70-5.92] to 4.90 [range 3.96-5.78] log10 copies/ml from week 0 to 8) and TNF-alpha (13.5 +/- 7.6 to 12.0 +/- 6.0 pg/ml) remained high in HIV+/Tb+ patients. In Tb patients, SR was significantly increased in HIV+ compared with HIV- patients. Additionally, TNF-alpha and HIV viral load remained elevated in HIV+/Tb+ patients following treatment despite clinical improvement comparable to HIV-/Tb+ patients.     

HCV对HIV感染者免疫功能和体内病毒载量的影响

目的分析探讨HCV对HIV感染者免疫功能和病毒载量的影响,为提高病人的生存质量,指导治疗方案提供思路。方法对单纯感染HIV病毒长期不进展、HIV和HCV共感染、单纯感染HIV病毒正常进展和感染HIV病毒14年以上免疫水平极度低下但身体健康的艾滋病感染者分4组,进行2年的CD_4~+、CD_8~+T淋巴细胞检测和HIV病毒载量检测。结果 HCV有促进CD_4~+T细胞下降和CD_8~+T细胞增加的趋势,而长期不进展者CD_4~+T、CD_8~+T细胞和病毒载量2年来基本稳定,单纯感染HIV病毒正常进展组CD_4~+T细胞略有下降,CD_8~+T细胞基本不变,感染HIV病毒14年以上免疫水平极度低下但身体健康的艾滋病感染者组,CD_4~+T细胞低下≤200个/mm~3,但CD_8~+T细胞≥800个/mm~3,病毒载量水平变化不大。结论 HCV的感染对HIV感染者影响复杂,HCV感染可能加速了病人免疫机能的破坏可能,但感染HIV病毒14年以上免疫水平极度低下但身体健康的艾滋病感染者组,10例中有8例为HCV共感染,提示我们HCV是否促进这些感染者体内出现高水平的CD_8~+T细胞。     

HIV感染者病毒载量和CD_4淋巴细胞计数的意义

[目的 ]　探讨人类免疫缺陷病毒 (HIV)病毒载量和CD4 淋巴细胞计数作为HIV感染者病情演变指征的意义。[方法 ]　对上海地区HIV感染者定期随访HIV病毒载量和CD4 淋巴细胞计数的变化 ,分别采用bDNA和流式细胞仪进行检测 ,所有数据均在计算机上采用SPSS软件统计分析两种指标的趋势和相关性。 [结果 ]　检测 2 82份标本 ,血浆病毒载量界于 <10 2 至 >5× 10 5拷贝数 /mL ,CD4 淋巴细胞计数 8～ 5 0 0个 /mm3;病毒载量和淋巴细胞两者存在明显的相关性 ,呈负相关趋势。 [结论 ]　HIV病毒载量和CD4 淋巴细胞不仅具有明显的相关性 ,而且完全可作为HIV感染者有效的观察疾病演变的指标 ,尤其HIV病毒载量更具有敏感性和广泛的诊断意义     

深圳市HIV阳性人群HPV病毒载量分析

目的 了解深圳市人类免疫缺陷病毒 (HIV)阳性及阴性人群中人乳头瘤病毒 (HPV)感染情况.方法 荧光定量PCR法检测HPV感染情况以及病毒载量.结果 40例HIV阳性组中HPV阳性20例,感染率为50.0%,在HIV阴性组中HPV阳性7例,感染率为17.5%,差异有统计学意义 (P<0.05);HIV阳性组HPV病毒载量比HIV阴性组至少高1个数量级 (P<0.05);检出16种HPV亚型,其中包括11种高危型,5种低危型,感染率最高的为16型 (5例),其次为52型 (4例)、58型 (3例).结论 HIV感染人群中HPV感染率、病毒载量较高,且多型感染情况较严重.     

人类白细胞抗原DRB1*和DQB1*基因多态性与尘肺发病的相关性

目的探讨人类白细胞抗原（HIA）DRB1＊和DQB1＊位点基因多态性与尘肺发病的关系。方法采用1：1配比的病例一对照研究方法。尘肺病例组为113名Ⅰ期尘肺患者，对照组为与尘肺病例组年龄相近、同性别、同民族、同一工作地点、开始接尘时间和累积接尘工龄相差不超过2年的接尘工人。用聚合酶链反应序列特异性引物分析方法检测HIA-DRB1＊和DQB1＊共9个位点的等位基因。用SAS6．12软件进行单因素和多因素分析。结果尘肺病例组的HIA—DRB1＊08等位基因频率高于对照组，差异有统计学意义（P〈0.01），OR值为6．000，95％CI：1．906～18．941：HIA—DRB1＊09、HLA—DQB1＊06等位基因频率低于对照组，差异有统计学意义（P〈0．01），OR值为0．259、0．300，95％CI为：0．115～0．584、0．144～0．627；1：1条件logistic回归分析表明，HIA-DRB1＊08、HIA—DRB1＊09和HIA—DQB1＊06等位基因频率与尘肺有关联，调整OR值分别为：7．804、0．225和0．269，95％CI分别为：2．077—29．307、0．083—0．609和0．117～0．613。生存分析表明，HIA—DRB1＊08等位基因为尘肺潜伏期的危险因素；HIA—DQB1＊06为保护因素。结论HIA—DRB1＊08等位基因可能为尘肺易感的危险因素，HLA—DQB1＊06可能是抗尘肺的保护性的等位基因。     

'HIV is HIV to me': The meanings of treatment,viral load and reinfection for gay men living with HIV

This paper identifies some aspects of the risk management practices of HIV positive gay men in relation to HIV treatments and sexual practice. The paper uses qualitative methods to examine sexual practice and HIV transmission in relation to HIV blood test viral load information. Questions of reinfection with HIV are also examined. Open-ended interviews were conducted with 25 gay and other homosexually active men and analysed for relevant themes. Interviewees spoke of different approaches to risk assessment in relation to viral load and reinfection, drawing on their experiences and advice. This diversity is connected with various risk management 'styles' that reflected positions about HIV transmission risk, the characteristics of the partner and the sexual situation. Some implications for HIV prevention are identified, including the need to address the links between prevention and treatment. HIV prevention strategies will need to address development of education in relation to evolving knowledge about treatment technologies and connections with HIV transmission.     

HIV感染者/AIDS病人CD_4~+T淋巴细胞与HIV病毒载量关联性分析

目的:研究HIV感染者/AIDS病人CD4+T淋巴细胞与HIV病毒载量之间的相互关系。方法:使用NASBA方法(Easy Q)和流式细胞仪绝对计数法检测30名HIV感染者/AIDS病人的HIV病毒载量和CD4+T淋巴细胞数。结果:经过对115对有效数据进行双变量相关分析,结果显示:HIV病毒载量与CD4+T淋巴细胞数二者呈显著性负相关关系(r=-0.184 P=0.049)。结论:研究结果为观察和了解HIV感染者/AIDS病人感染状况或病程发展提供更科学的依据。     

陕西省HIV/AIDS患者接受抗病毒治疗后病毒载量结果及其影响因素分析

目的 分析陕西省艾滋病病毒(human immunodeficiency virus,HIV)感染者/艾滋病(acquired immune deficiency syndrome,AIDS)患者(以下简称为HIV/AIDS患者)接受抗病毒治疗后病毒载量结果及相关影响因素。 方法 对接受抗病毒治疗六个月以上的1 046例HIV/AIDS患者进行病毒载量检测,结合病例流行病学资料分析病毒载量结果及其影响因素。 结果 1 046例HIV/AIDS患者中,≥1 000 copies/ml占9.6%(100/1 046),50~999 copies/ml占9.1%(95/1 046),＜50 copies/ml占25.4%(266/1 046),TND(未检出病毒)占55.9%(585/1 046)。单因素分析显示病毒载量结果＜1 000 copies/ml与≥1 000 copies/ml HIV/AIDS患者在民族(P＜0.05)、教育程度(χ²=10.901,P＜0.05)、感染途径(χ²=14.286, P＜0.05)变量上差异有统计学意义。多因素分析显示教育程度大专及以上是病毒载量≥1 000 copies/ml的保护因素(OR=0.344,95%CI:0.121~0.979),HIV感染途径中注射吸毒是病毒载量≥1 000 copies/ml的危险因素(OR=5.237,95%CI:1.272~21.556)。 结论 陕西省HIV/AIDS患者抗病毒治疗效果较好,但需要提高患者治疗依从性,减少病毒抑制失败。     

MSM人群HIV感染者病毒载量抽样调查缺失数据填补方法研究

目的 探讨不同缺失数据填补法对MSM人群HIV感染者（MSM感染者）病毒载量（VL）缺失数据的填补效果。方法 以2013年中国16个大城市MSM感染者VL抽样检测数据为基础,采用SPSS 17.0软件,模拟完整数据集和5种不同类型的缺失数据集,采用最大期望值法（EM）、回归法、均值填补法、删除法、马尔科夫链蒙特卡罗法（MCMC）对5种VL缺失数据填补处理,从数据分布、准确度、精确度3个方面比较填补效果。结果 VL数据呈偏态非连续分布,难以进行有效正态分布转化;不同填补方法对完全随机缺失数据填补效果均较好;对于其他类型缺失数据,回归法、MCMC较好保留完整数据主要分布特征;EM、回归法、均值填补法、删除法普遍低估数据均值,MCMC多高估数据均值。结论 MCMC可作为首选的VL数据对数转换后缺失数据填补方法。填补数据可作为调查人群VL均值水平估算的参考依据。     

参比校正对中国15个大城市MSM人群HIV感染者病毒载量抽样调查结果的影响

目的 通过对HIV病毒载量（VL）实验室检测方法的参比校正,分析中国MSM人群HIV感染者（MSM感染者）社区VL水平（CVL）。方法 利用国家科技重大专项2014-2015年15个大城市MSM感染者VL抽样调查数据。15个大城市根据各自配置的检测设备、试剂完成VL检测。VL检测方法主要包括RT-PCR、核酸序列依赖性扩增法（NASBA）、分支DNA测定技术（bDNA）、雅培M2000（M2000）4种方法。按照国家HIV参比实验室2013-2015年VL能力验证结果,将EasyQ、bDNA和M2000这3种方法检测的VL值转换成相应的TaqMan 2.0检测的VL值,校正不同检测方法之间的参比关系。采用SPSS 17.0软件对数据进行描述性分析。结果 15个城市CVL对数均值参数校正前后,2014年分别为（2.38±1.47）、（2.99±1.31）,2015年分别为（2.07±1.34）、（2.72±1.19）。分别以VL水平≤ 200拷贝/ml、≤ 400拷贝/ml、≤ 1 000拷贝/ml作为VL成功抑制标准,对参比校正VL值前后比例进行比较发现,以VL水平 ≤ 400拷贝/ml及 ≤ 1 000拷贝/ml标准的参比校正前后数据变化幅度较小。结论 各地区保持统一的检测方法,能增加各年度间VL的可比性;以VL ≤ 400拷贝/ml或 ≤ 1 000拷贝/ml作为人群VL成功抑制标准,进行各地区间VL比较,数据稳定性较好。     

云南省德宏州抗病毒治疗艾滋病患者血浆病毒载量及耐药研究

目的 了解云南省德宏州艾滋病患者接受抗病毒治疗后HIV病毒抑制率及耐药突变情况。方法 对德宏州截止2012年12月31日入组、抗病毒治疗半年以上、年龄≥15岁的全部在治患者进行血浆HIV病毒载量(vL)检测及耐药相关基因位点突变监测。结果 符合入选标准的病例共4390例,其中3964例(90.3%)参加了本研究,2307例(58.2%)研究对象CD4+T淋巴细胞计数在350cells/mm3以上。3169例(79.9%)研究对象血浆VL低于检测下限。其中,瑞丽市、女性、年龄在45岁以上、已婚、异性传播、治疗时间>5年、CD₄⁺T淋巴细胞计数>500cells/mm3的患者中血浆vL低于检测下限者所占比例显著高于其他患者,差异有统计学意义。402例(10.1%)患者血浆vL≥l000copy/ml,其中353例(87.8%)成功进行了耐药相关基因位点突变检测,并有198例(56.1%)检测发现耐药基因突变,以核苷类反转录酶抑制剂(NRTIs)和非核苷类反转录酶抑制剂(M非TIs)耐药为主,分别以M184V和K103N突变最为常见。有12例(3.4%)患者存在蛋白酶抑制剂(PI)耐药基因突变。多因素logistic回归分析显示:治疗时间及初始治疗药物组合对耐药发生率的影响有统计学意义。结论 云南省德宏州艾滋病患者接受抗病毒治疗后,HI抑制率较高,但在病毒抑制效果不好的患者中耐药比例较高,需继续加强抗病毒治疗依从性教育,并及时做好血浆vL检测及耐药监测工作。     

Measures of human immunodeficiency virus (HIV) community viral load and HIV incidence among people who inject drugs

Purpose

To evaluate the measures of community human immunodeficiency virus (HIV) viral load (VL) and the association with HIV incidence among people who inject drugs (PWID).

奥沙利铂、羟基喜树碱、5-氟尿嘧啶及亚叶酸钙联合在晚期胃癌治疗中的临床效果分析

目的探索奥沙利铂、羟基喜树碱、5-氟尿嘧啶及亚叶酸钙联合在晚期胃癌治疗中的临床应用价值。方法选择2007年1月～2008年12月某科就诊的70例晚期胃癌患者,机械抽样随机将其中44例分为观察组,采取HLOF方案;余者26例分为对照组,采取HLPF方案。结果观察组患者的完全缓解率(36.4%)显著高于对照组的(11.5%)(P﹤0.05),进展率(4.5%)显著低于对照组(30.7%)(P﹤0.05)。观察组患者的进展时间[(5.3±1.4)月]及生存时间[(21.8±3.2)月]比对照组的[(4.2±1.7)月]及生存时间[(14.5±1.4)月]显著长(P﹤0.05)。观察组和对照组不良反应情况对照显示,中性粒细胞减少、腹泻、神经毒性及口腔黏膜炎的发生率差异无统计学意义(P﹥0.05)。结论奥沙利铂、羟基喜树碱、5-氟尿嘧啶及亚叶酸钙联合应用于晚期胃癌的治疗,疗效确切,不良反应轻,值得临床中推广应用。     

Segmental modeling of viral load changes for HIV longitudinal data with skewness and detection limits

Although it is a common practice to analyze complex HIV longitudinal data using nonlinear mixed‐effects or nonparametric mixed‐effects models in literature, the following issues may standout. (i) In clinical practice, the profile of each subject's viral response may follow a ‘broken‐stick’‐like trajectory, indicating multiple phases of decline and increase in response. Such multiple phases (change points) may be an important indicator to help quantify treatment effect and improve management of patient care. To estimate change points, nonlinear mixed‐effects or nonparametric mixed‐effects models become a challenge because of complicated structures of model formulations. (ii) The commonly assumed distribution for model random errors is normal, but this assumption may unrealistically obscure important features of subject variations. (iii) The response observations (viral load) may be subject to left censoring due to a limit of detection. Inferential procedures can be complicated dramatically when data with asymmetric (skewed) characteristics and left censoring are observed in conjunction with change points as unknown parameters into models. There is relatively little work concerning all these features simultaneously. This article proposes segmental mixed‐effects models with skew distributions for the response process (with left censoring) under a Bayesian framework. A real data example is used to illustrate the proposed methods. Copyright © 2012 John Wiley & Sons, Ltd.     

Association of genetic polymorphisms in CYP2E1, MPO,NQO1, GSTM1, and GSTT1 genes with benzene poisoning

Metabolic enzymes involved in benzene activation or detoxification, including NAD(P)H, quinone oxidoreductase 1 (NQO1), cytochrome P450 2E1 (CYP2E1), myeloperoxidase (MPO), glutathione-S-transferase mu-1 (GSTM1), and glutathione-S-transferase theta-1 (GSTT1), were studied for their roles in human susceptibility to benzene poisoning. The potential interactions of these metabolic enzymes with lifestyle factors such as cigarette smoking and alcohol consumption were also explored. We studied 156 benzene-poisoning patients and 152 workers occupationally exposed to benzene in South China. Sequencing, denaturing HPLC, restriction fragment-length polymorphism, and polymerase chain reaction were used to detect polymorphisms on the promoters and complete coding regions of NQO1, CYP2E1, MPO, and the null genotypes of GSTM1 and GSTT1. Seventeen single nucleotide polymorphisms (SNPs) were identified in NQO1, CYP2E1, and MPO genes, including 6 novel SNPs in CYP2E1 and MPO. Of the subjects who smoked and drank alcohol, an 8.15-fold [95% confidence interval (CI), 1.43-46.50] and a 21.50-fold (95% CI, 2.79-165.79) increased risk of benzene poisoning, respectively, were observed among the subjects with two copies of NQO1 with a C-to-T substitution in cDNA at nucleotide 609 (c.609 C>T variation; i.e., NQO1 c.609 T/T) compared to those with the heterozygous or wild (NQO1 c.609 C/T and c.609 C/C) genotypes. Our data also indicated that individuals with CYP2E1 c.-1293 C/C and c.-1293 G/C, and NQO1 c.609 T/T, and GSTT1 null genotypes tended to be more susceptible to benzene toxicity. Our results suggest that the combined effect of polymorphisms in NQO1, CYP2E1, and GSTT1 genes and lifestyle factors might contribute to benzene poisoning.     

TSC1、TSC2基因多态性和儿童孤独症的家系研究

目的 探讨结节性硬化症(tuberous sclerosis complex,TSC)相关基因TSC1、TSC2基因多态性与儿童孤独症之间的关联。 方法 利用SNaPshot基因分型技术,在97例孤独症核心家系中,对TSC1、TSC2基因上的8个标签SNP,即rs3761840、rs2809244、rs1050700、rs739441、rs2074968、rs2074969、rs2072314、rs8063461进行分型;通过FBAT软件及Haploview软件进行基于家系的单倍型分析。 结果 1)基于家系的关联分析发现8个SNPs等位基因中有2个SNPs的等位基因倾向于过传递(rs1050700 A:Z=2.708,P=0.006769;rs2074968 G:Z=3.244,P=0.001180),并且经过FDR校正后,2个SNPs仍显示出与孤独症之间存在显著关联性(校正P值分别为0.027,0.014)。2)rs3761840-rs2809244基因型的单体型A-C显示出显著的传递不平衡,双亲较少传递给子女(Z=-2.297,P=0.021629)。rs2074968-rs2072314基因型的2种单体型即 G-C及C-C均显示出显著的传递不平衡,单体型G-C能从双亲过传递给子女(Z=2.596,P=0.009444),单体型C-C则相反(Z=-3.657,P=0.000256)。 结论 TSC1、TSC2基因可能与儿童孤独症的发生存在关联。     

CYP1A1和CYP1B1基因多态性与RPL易感性

目的 探讨CYP1A1、CYP1B1基因多态性与复发性流产(RPL)遗传易感性关系,为预防和治疗该病提供新靶点。方法 本研究采用等位基因特异性PCR(As-PCR)和聚合酶链反应-限制性片断长度多态性(PCR-RFLP)方法,针对CYP1A1基因MspΙ酶切位点和CYP1B1 L432V多态位点,检测81例患有原因不明RPL病例组和98名有生育史健康女性对照组之间差异。结果 RPL组和对照组CYP1A1 MspΙ位点3种基因型m1/m1、m1/m2、m2/m2分布频率差异无统计学意义(χ²=0.335,P>0.05);CYP1B1 L432V多态位点3种基因型C/C、C/G、G/G在病例组和对照组分布差异有统计学意义(χ²=7.467,P<0.05);2组间C、G等位基因分布差异有统计学意义(χ²=9.129,P=0.003);G/G、C/G基因型与C/C基因型比较,RPL危险度分别提高2.620、1.954倍;等位基因G使RPL危险性增加2.038倍。结论 CYP1B1 L432V突变基因型增加RPL发病风险,尚不能认为CYP1A1基因MspI位点多态性与RPL易感性有关。