艾滋病患者抗逆转录病毒治疗的肝毒性特点分析

目的分析包含非核苷类逆转录酶抑制剂联合抗逆转录病毒治疗（HAART）的肝毒性特点。方法回顾研究75例接受包含奈韦拉平或依非韦仑的联合抗逆转录病毒治疗的HIV／AIDs患者,对出现肝毒性者进行肝毒性分级,分析性别、年龄、HBV和／或HCV感染、其他肝毒性药物及NNRTIs种类对肝毒性发生的影响。结果75例接受HAART的HIV／AIDs患者中,45例（60.0％）发生至少1次肝毒性,其中肝毒性1级26例（57.8％）,2级16例（35.6％）,3级2例（4.4％）,4级1例（2.2％）;男性31例（68.9％）,女性14例（31.1％）,差异无统计学意义（X^2=0.658,P=0.428）;肝毒性组患者平均年龄（39±9）岁,无肝毒性组平均年龄（38±12）岁,差异无统计学意义（t=73,P=0.511）;合并HBV和／或HCV感染肝毒性组29例（64.4％）、无肝毒性组11例（36.7％）,差异有统计学意义（X^2=5.581,P=0.018）;应用基于NVP的HAART方案者肝毒性发生率为88.9％（32／36）：应用基于EFV的HAART方案者肝毒性发生率为33.3％（13／39）,差异有统计学意义（X^2=24.07,P=0.000）;同时应用抗结核药物或复方新诺明肝毒性组30例（66.7％）、无肝毒性组12例（40％）,差异有统计学意义（X^2=5.195,P=0.023）。结论包含NNRTIs的联合抗逆转录病毒治疗所致的肝毒性多为轻到中度,合并感染HBV和／或HCV、应用包含NVP的治疗方案和同时应用其他肝毒性药物的患者容易出现肝毒性,需要密切监测。     

Prevalence of and risk factors for HIV-associated neuropathy in Melbourne, Australia 1993-2006

OBJECTIVES: The aim of the study was to describe the prevalence of and risk factors for HIV-associated sensory neuropathy (HIV-SN) in 2006 [the era of stavudine, didanosine and zalcitabine (dNRTI)-sparing highly active antiretroviral therapy (HAART)] and to compare our findings with data obtained in the same clinic in 1993 (pre-HAART) and 2001 (frequent use of dNRTI-containing HAART). METHODS: This was a cross-sectional comparative study using convenience sampling. HIV-positive adults attending a tertiary referral clinic over a 2-week period were screened for HIV-SN using the AIDS Clinical Trials Group screening tool. HIV-SN was defined as present if the patient had both neuropathic symptoms and abnormal signs. Demographic, clinical, laboratory and treatment data were considered as possible risk factors for HIV-SN, and results were compared with data obtained in the same clinic in 1993 and 2001. RESULTS: One hundred patients were screened. The prevalence of HIV-SN was 42%, which was unchanged since 2001 (44%) despite a significant reduction in the use of dNRTIs. HIV-SN remained much more common than in 1993 (42% vs 13%; P<0.0001). The only independent associations with HIV-SN in 2006 were increasing patient age and a history of exposure to either stavudine or indinavir. This compares with 1993 when neuropathy was increased in those with Mycobacterium avium complex infection, and 2001 when patient age and use of stavudine and didanosine were the independent associations with HIV-SN in this clinic. CONCLUSIONS: HIV-SN remained common among ambulatory patients in 2006 (42% prevalence) despite a significant reduction in the use of dNRTIs. In addition to patient age and stavudine exposure, indinavir use may be a risk factor for HIV-SN.     

重组人肿瘤坏死因子调节端粒酶活性的体外研究

目的：研究重组人肿瘤坏死因子（rhTNF)对端粒酶活性的调节作用,方法：将不同浓度rhTNF加入肝癌细胞株HepG2和HepG1-6细胞,以TRAP－ELISA方法测定其端粒酶活性,采用Liofect脂质体转染法将携带端粒酶催化亚单位一端酶逆转录酶（hTERT)启动力质粒转染至肝癌细胞株HepG2细胞,2h后加入不同浓度的rhTNF,孵育48h后,分别检测其报告基因萤虫素酶活性,结果：在10－1000IU／ml浓度范围内,rhTNF可抑制端粒酶活性,同时在浓度范围内,rhTNF可显著抑hTERT启动子的表达,其抑制作用与rhTNF剂量呈正相关,结论：rhTNF杀伤肿瘤细胞的机制可能与其抑hTERT的表达有关。     

德宏地区艾滋病病人ART后的耐药性观察

目的了解德宏地区艾滋病（AIDS）病人在进行抗反转录病毒治疗（ART）后,发生耐药的情况。方法为德宏地区进行ART的病人检测CD4＋T淋巴细胞计数、病毒载量及基因型耐药性,以SPSS 17.0分析病人的耐药数据。结果 78例病人中,男49例,女29例,以汉族（41.0%）和景颇族（34.6%）病人为多,农民占71.8%。随访地点主要在陇川（43.6%）和潞西（37.2%）。性传播、静脉吸毒传播和母婴垂直传播分别占53.8%（42/78）、30.8%（24/78）和15.4%（12/78）。ART 24个月后最常见的核苷类反转录酶抑制剂的耐药突变是M184I/V、D67N/S、T69F和T215F/Y,非核苷类反转录酶抑制剂耐药突变中K101E/I/Q、K103N/R/S/V、Y181C和G190A/S发生率最高,蛋白酶抑制剂耐药突变较少。结论德宏地区AIDS病人ART后出现较多反转录酶耐药位点,ART规范应加强并提高服药依从性。     

高效抗反转录病毒治疗相关性脂肪代谢综合征

自1996年高效抗反转录病毒治疗(HAART)应用于临床以来,艾滋病的发病率和死亡率已经大大降低。但HAART治疗需长期或终身服药,因此,药物的毒副作用容易导致患者的依从性下降。其中脂肪代谢综合征就是HAART用药过程中的一个比较常见的远期不良反应之一。HAART药物中与脂肪代谢有关的主要是蛋白酶抑制剂(PIs)和核苷类逆转录酶抑制剂(NRTIs),可以引起各种代谢异常和内分泌紊乱综合征。其具体的发病机制目前尚不清楚。本文就脂肪代谢综合征的发病机制、检测及治疗进行了阐述。