HIV/AIDS相关机会性感染研究进展

【摘要】 机会性感染是人类免疫缺陷病毒（HIV）感染者进入艾滋病期的重要标准，也是HIV感染者主要的不良临床事件，严重影响患者预后。了解HIV/AIDS相关机会性感染的主要种类，识别机会性感染发生的危险因素，掌握机会性感染的诊疗原则，可以有效预防其发生，控制其进展；也是提高HIV患者生存质量，降低死亡率的关键。通过尽早启动抗逆转录病毒治疗（ART）来恢复细胞免疫功能是预防机会性感染的最佳手段；而根据患者CD4细胞计数，适时启动预防性抗菌药物治疗也有非常重要的作用。总之，在HIV感染者，尤其细胞免疫被严重抑制的患者中，应定期筛查机会性感染，做到早期诊断、早期治疗，才能改善预后。本文就HIV/AIDS相关机会性感染研究进展作一综述。     

HIV／HCV合并感染的流行病学、发病机制与治疗

随着人类免疫缺陷病毒（HIV）感染者和艾滋病（AIDS）病人不断增加，高效抗逆转录病毒治疗（HAART）的广泛使用，AIDS产生的机会性感染已相对减少，而由HIV与其它病原体引起的合并感染越来越引起人们的重视。丙型肝炎病毒（HCV）感染导致的肝脏疾病现在已成为发达国家HIV感染者死亡的主要原因之一。本文综述了HIV和HCV合并感染的流行病学、临床特点与治疗的研究进展。     

维生素D对HIV感染者免疫功能调节的研究进展

抗逆转录病毒治疗（ART）虽然能快速有效的控制人类免疫缺陷病毒（HIV）的感染，但迄今为止仍无法实现完全地清除人体内的HIV。HIV感染者比HIV阴性人群更易出现非艾滋病（AIDS）相关的疾病，而维生素D作为一种人体生命中不可缺少的营养素，在调节免疫功能和辅助治疗非AIDS相关疾病中具有显著作用。补充维生素D能有效减少HIV感染者炎症因子水平，抑制其免疫细胞的异常激活或衰竭，改善HIV感染者ART期间的免疫功能，减少HIV感染导致的机体损伤，降低全因死亡率。本文将阐述维生素D对HIV感染者免疫功能调节的研究进展。     

HIV感染合并结核感染150例临床诊治分析

结核病是人类免疫缺陷病毒（HIV）感染者和获得性免疫缺陷综合征（AIDS）患者最常见的机会性感染和最主要的死亡原因,约1/3的AIDS患者死于结核病,AIDS也是促使结核发展的重要因素。     

获得性免疫缺陷综合征抗病毒治疗及预防的研究进展

获得性免疫缺陷综合征(AIDS)是人免疫缺陷病毒(HIV)引起的全球流行的传染性疾病。近40年来,全球感染HIV患者数量不断增加,大部分患者因AIDS相关疾病死亡。抗反转录病毒治疗(ART)是最有效的治疗AIDS的方法,由于HIV细胞潜伏库的存在,ART不能彻底清除HIV,但能有效抑制HIV复制,改善预后,提高患者生存质量,减少HIV传播。随着抗病毒治疗药物的不断更新、治疗时机提前、治疗方案的优化,AIDS治疗及预防有了巨大进展,使AIDS成为一种可控制的慢性传染性疾病。     

艾滋病合并丙型肝炎的护理

人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）感染途经相似,HIV感染者和艾滋病患者（AIDS）常合并丙肝。HIV阳性的丙型肝炎的特征是HCV相关性肝病（肝硬化和代偿性肝病、肝癌）发生率明显增加,病情急速加剧,给治疗和护理带来了一定的难度,预后较差。大量研究表明,HIV感染者和艾滋病患者合并丙肝的死亡率明显高于单纯患艾滋病或单纯丙肝。因此对该病的早期诊断、积极治疗、采取有效的护理措施对改善预后极为重要。现将我院2005年至2007年收治的28例AIDS合并HCV的临床护理报告如下。     

AIDS的实验诊断

获得性免疫缺陷综合征（Acquired Immunoddiciencv Syndrome）又称艾滋病（AIDS）。已成为危害全球的一种严重传染性疾病。是由人类免疫缺陷病毒（Human Immunodeficiency Virus．HIV）引起的。艾滋病在我国的流行已经进入快速增长期，预防和控制艾滋病已经刻不容缓。因此对HIV抗原抗体的检测，尽早发现感染者控制其传播是非常重要的。目前临床检测内容主要有P24抗原、HIV抗体、HIV病毒载量和CD4^＋T淋巴细胞计数等。现就HIV的实验诊断方法作如下简述。     

CMV感染对HIV感染者预后影响的研究进展

巨细胞病毒(CMV)与人类免疫缺陷病毒(HIV)的共感染率极高,当伴有活动性CMV感染时,将加速HIV感染者向获得性免疫缺陷综合征(AIDS)的进展。虽抗反转录病毒治疗后,CMV终末器官疾病的发生率大大降低,但是CMV感染仍然是HIV感染者远期非AIDS相关死亡以及导致免疫衰老的一个重要因素。CMV感染对HIV感染者抗反转录病毒治疗后的免疫重建、异常免疫激活、炎症、心脑血管疾病、免疫衰老、HIV储存库的大小均有重要影响,而CMV特异性的T细胞与B细胞免疫在其中发挥重要作用。阐明相关机制并寻求可行的预防性治疗策略,如开发CMV疫苗,将有助于更好地临床管理CMV与HIV共感染患者。     

艾滋病高效抗逆转录病毒治疗

艾滋病（AIDS）的治疗包括抗逆转录病毒治疗（ART）和机会性感染的治疗。ART的研究经历了多个阶段。1987年第1个抗逆转录病毒药物（ARV）齐多夫定（zidovudine，ZDV或AZT）问世，开始使用单一的核苷类逆转录酶抑制剂（NRTIs）治疗人类免疫缺陷病毒（HIV）感染者和艾滋病患者，为第1个阶段。第2个阶段为自上世纪90年代早中期开始使用2种NRTIs治疗患者。第1、2阶段的治疗，抑制病毒效果均不令人满意。     

艾滋病流行形势与艾滋病健康教育

艾滋病医学全称获得性免疫缺陷综合征（Acquire immuno-deficiency syndrome，AIDS），是由于人体感染人类免疫缺陷病毒（Human immuno-deficiency virus，HIV）而引起的一种病死率极高的恶性传染病。艾滋病的传播途径有三种：性接触传播、血液传播和母婴传播。人类对HIV普遍易感，机体感染HIV后可以在长达5～10年的潜伏期内不发病，即为HIV感染者。     

Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China

Objective To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus (HIV) infection epidemics.
Methods A prospective cohort study of newly registered patients in tuberculosis (TB) dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis.
Results Of 19,103 newly registered pulmonary TB patients, 925 (4.8%) were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322 (1.7%) deaths that occurred during TB treatment, 85 (26%) of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio (aOR) 7.86]. Other significant mortality risk factors included presentation with miliary TB (aOR 4.10; 95% confidence interval: 2.14-7.88), ≥35 years of age (aOR 3.04), non-Han ethnicity (aOR 1.67), and farming as an occupation (aOR 1.59). For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death (aOR 5.48). A low CD4 count (≤200 cells/μL) (aOR 3.27) at the time of TB treatment initiation and a lack of antiretroviral therapy (ART) administration (aOR 3.78) were also correlated with an increased risk of death.
Conclusion Infection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths.     

Prevention and control of HIV/AIDS in China: lessons from the past three decades

In the past 37 years, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has undergone various major transmission routes in China, with the world most complex co-circulating HIV-1 subtypes, even the prevalence is still low. In response to the first epidemic outbreak of HIV in injecting drug users and the second one by illegal commercial blood collection, China issued the Anti-Drug Law and launched the Blood Donation Act and nationwide nucleic acid testing, which has avoided 98,232 to 211,200 estimated infections and almost ended the blood product-related infection. China has been providing free antiretroviral therapy (ART) since 2003, which covered >80% of the identified patients and achieved a viral suppression rate of 91%. To bend the curve of increasing the disease burden of HIV and finally end the epidemic, China should consider constraining HIV spread through sexual transmission, narrowing the gaps in identifying HIV cases, and the long-term effectiveness and safety of ART in the future.     

广西HIV/AIDS患者合并巨细胞病毒感染特征与影响因素分析

目的调查HIV/AIDS患者巨细胞病毒(CMV)感染情况,比较不同标本(血液、尿液)在HIV合并CMV感染早期筛查的应用价值,分析HIV合并CMV感染的影响因素。方法收集2018年1月—2020年12月南宁市第四人民医院诊治的848例HIV/AIDS患者的性别、年龄、CD4^(^(+))T细胞计数、抗逆转录病毒治疗(ART)等资料信息,采用荧光PCR(FQ-PCR)检测血液/尿液CMV-DNA载量。采用卡方检验、Fisher确切概率法分析感染的差异,以二项Logistic回归分析HIV合并CMV感染的危险因素。结果848例HIV/AIDS患者中,有205例(24.17%)CMV-DNA阳性。尿液CMV-DNA检出率20.03%(142/709)高于血液CMV-DNA检出率12.04%(102/847)。多因素二项Logistic回归分析显示男性合并CMV感染的危险是女性2.30倍(95%CI:1.43~3.71),年龄30~<50岁和≥50岁合并CMV感染危险是年龄<30岁的2.43和2.32倍(95%CI分别为:1.20~4.91,1.15~4.65)、CD4^(+)T<50个/μL合并CMV感染的危险是CD4^(+)T≥100个/μL的3.88倍(95%CI:2.50~6.03),ART治疗患者合并CMV感染的危险比非ART治疗下降89%(OR=0.11,95%CI:0.05~0.24)。结论尿液在CMV感染的早期筛查比血液准确度更高,应重视CD4^(+)T计数较低、中年以上男性,加强其CMV感染的早期筛查和抗病毒治疗。     

中国获得性免疫缺陷综合症的中医治疗：机遇、进展及挑战

Chinese medicine(CM) has been used in the treatment of human immunodeficiency virus(HIV) infection and acquired immunodeficiency syndrome (AIDS) for 30 years and the demonstrated therapeutic effects of CM,such as reducing plasma HIV viral load,increasing CD4~+T cell counts,promoting immunity reconstitution,ameliorating symptoms and signs,improving the health related quality of life(HRQOL) and counteracting against the effects of anti-retroviral drugs,were summarized and reviewed in this article.The authors point out that it had been a good opportunity to use CM for the treatment of HIV infection and AIDS in the past and also there are huge challenges ahead for CM research and clinicians to discover more effective CM and its underlying mechanisms for treatment of AIDS.     

The outcome of prevention of mother-to-child transmission of HIV infection at King Abdulaziz University Hospital,Western Region of Saudi Arabia: A Descriptive Study

Objectives:To describe the effectiveness of HIV guidelines in prevention of mother-to-child transmission (PMTCT).Methods:A retrospective review from January 2009 to December 2018 at the King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. The main outcome measures were characteristics of HIV-exposed patients and transmission rate.Results:A total of 18 HIV-positive mothers and their 26 infants were included. The mean age of mothers at delivery was 31.69 years, and 50% were under 30 years old. All mothers received lifelong ART, except one who was not diagnosed until the 27th week of gestation. Among the mothers, 83% complied with treatment regimens, and 11% had ART resistance. Human immunodeficiency virus polymerase chain reaction (PCR) was undetectable in 19 pregnancies. Seven mothers had opportunistic infections and treatment was immediately initiated. After reviewing the infants’ HIV PCR tests, the transmission rates of HIV were 0% for both spontaneous vaginal delivery and cesarean section.Conclusion:Many challenges face the efforts to decrease vertical HIV transmission, and a particular focus on the transitions between stages of care is needed. We believe that early screening, counseling, and regular follow-up have contributed to MTCT elimination.     

Premature atherosclerosis in patients with acquired immunodeficiency syndrome

Background Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus （HIV）infection since highly active antiretroviral therapy （HAART） has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients.Methods One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients （41HAART-treated and 41 antiretroviral therapy （ART） naive patients） and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity （PWV） was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage.Results A higher PWV （（1358.3±117.8） cm/s vs. （1270.2±189.2） cm/s, P=0.010） was found in ART na（i）ve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART na（i）ve patients （（1283.8±181.4） cm/s vs. （1358.0±117.8） cm/s, P=0.033）. Multiple regression analysis revealed that age （B=5.218, 95% confidence interval （CI） 1.420-9.016, P=0.008）, current smoking （B=-74.671, 95% CI -147.003 to -2.339, P=0.043） and HAART （92.7% patients on a protease inhibitor-free regimen） （B=-169.169, 95% CI-272.508 to -65.831, P=0.010） were associated with reduced PWV in HIV-infected patients.Conclusions Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.     

Antiretroviral therapy: Shifting sands

HIV/AIDS has been an extremely difficult pandemic to control. However, with the advent of antiretroviral therapy (ART), HIV has now been transformed into a chronic illness in patients who have continued treatment access and excellent long-term adherence. Existing indications for ART initiation in asymptomatic patients were based on CD4 levels; however, recent evidence has broken the shackles of CD4 levels. Early initiation of ART in HIV patients irrespective of CD4 counts can have profound positive impact on morbidity and mortality. Early initiation of ART has been found not only beneficial for patients but also to community as it reduces the risk of transmission. There have been few financial concerns about providing ART to all HIV-positive people but various studies have proven that early initiation of ART not only proves to be cost-effective but also contributes to economic and social growth of community. A novel multidisciplinary approach with early initiation and availability of ART at its heart can turn the tide in our favor in future. Effective preexposure prophylaxis and postexposure prophylaxis can also lower transmission risk of HIV in community. New understanding of HIV pathogenesis is opening new vistas to cure and prevention. Various promising candidate vaccines and drugs are undergoing aggressive clinical trials, raising optimism for an ever-elusive cure for HIV. This review describes various facets of tectonic shift in management of HIV.     

陕西省TB与HIV/AIDS双向筛查及TB/HIV患者抗结核治疗转归队列分析

目的 了解陕西省TB/HIV (结核分枝杆菌 /艾滋病病毒)双重感染防治工作。提高TB/HIV发现、治疗和管理力度,控制结核病和艾滋病的进一步传播,保护公众健康。方法 收集整理和分析2010—2017年陕西省各地上报的《TB/HIV 双重感染防治管理工作年度报表》。结果 2010—2017年,累计接受HIV抗体检测的结核病患者43 304例,检测率25.10%,HIV检测阳性数16例,阳性检出率0.04%;同期,HIV /AIDS患者中,新检出的HIV/AIDS中接受X线胸片或查痰9 666人,结核病检查率76.81%;诊断TB/HIV双重感染患者224人,结核病患者检出率2.32%;既往的HIV/AIDS中接受X线胸片或查痰24 277人次,结核病检查率80.43%;诊断TB/HIV双重感染患者105人,结核病患者检出率0.43%;结核中筛HIV/AIDS,新检出HIV/AIDS中筛结核,既往HIV/AIDS中筛结核,三组检出率两两进行对比,差别均有统计学意义（P<0.001）;共进行抗结核治疗263例,抗结核治疗率76.23%;进行抗病毒治疗256例,抗病毒治疗率74.20%;抗结核治疗的TB/HIV患者中治愈35例（17.59%）,完成疗程率141例（70.85%）,结核死亡1例（0.50%）,非结核死亡15例（7.54%）,丢失2例（1.00%）,其他5例（2.51%）。结论 双向筛查是切实有效的早期发现TB/HIV的方法,有利于提高TB/HIV的早期发现,并能提高TB/HIV双重感染患者结核病的治疗成功率、降低结核病死亡率,有效的控制TB/HIV双重感染疫情。     

Effect of Traditional Chinese Medicine for Treating Human Immunodeficiency Virus Infections and Acquired Immune Deficiency Syndrome: Boosting Immune and Alleviating Symptoms

To respond to the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic in China, the integration of antiretroviral therapy (ART) and traditional Chinese medicine (TCM) has important implications in health outcomes, especially in China where the use of TCM is widespread. The National Free TCM Pilot Program for HIV Infected People began in 5 provinces (Henan, Hebei, Anhui, Hubei, and Guangdong) in 2004, and quickly scaled up to 19 provinces, autonomous regions, and municipalities in China including some places with high prevalence, 26,276 adults have been treated thus far. Usually, people with HIV infection seek TCM for four main reasons: to enhance immune function, to treat symptoms, to improve quality of life, and to reduce side effects related to medications. Evidences from randomized controlled clinical trials suggested some beneficial effects of use of traditional Chinese herbal medicine for HIV infections and AIDS. More proofs from large, well-designed, rigorous trials is needed to give firm support. Challenges include interaction between herbs and antiretroviral drugs, stigma and discrimination. The Free TCM Program has made considerable progress in providing the necessary alternative care and treatment for HIV-infected people in China, and has strong government support for continued improvement and expansion, establishing and improving a work mechanism integrating Chinese and Western medicines.