艾滋病并发新型隐球菌脑膜炎1例

艾滋病（AIDS）是获得性免疫缺陷综合征的简称,是由人免疫缺陷病病毒（HIV）所引起的致命性慢性传染病。艾滋病病毒主要侵犯和破坏辅助性T淋巴细胞（CD4^＋T细胞）,使机体细胞免疫功能受损,最后并发各种严重的机会性感染和肿瘤。艾滋病临床表现复杂,可引起肺部、胃肠系统、神经系统、皮肤黏膜、眼部等感染。现将本院艾滋病并发新型隐球菌脑膜炎1例报道如下。     

人类免疫缺陷病毒感染者和获得性免疫缺陷综合征患者眼部病变相关的基础与临床研究

  目的  总结北京协和医院眼科诊治的人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者和获得性免疫缺陷综合征(acquired immunodeficiency syndrome, AIDS)患者眼部病变的发病率及其临床特征、治疗效果和房水、泪液病毒学检测结果。  方法  回顾性分析2001年1月至2015年12月在北京协和医院眼科诊治的223例HIV/AIDS患者的眼部并发症的临床特征和治疗效果。其中男性157例, 女性66例; 平均年龄(39.2±9.7)岁(8.0~78.0岁)。对所有患者的感染方式、眼部并发症的临床表现、检查、治疗等进行回顾性分析。  结果  223例HIV/AIDS患者中, 有眼部并发症者99例(44.4%), 共156只眼, 其中并发巨细胞病毒(cytomegalovirus, CMV)视网膜炎64只眼(40例), HIV视网膜病变54只眼(35例), HIV/梅毒双重感染合并眼底病变20只眼(13例), 免疫重建炎症综合征(immune reconstitution inflammatory syndrome, IRIS)16只眼(10例), 慢性泪腺炎2只眼(1例)。CD4⁺T淋巴细胞计数小于50/mm³的HIV/AIDS患者泪液分泌低于正常人(P=0.008)。在行高效抗逆转录酶病毒疗法(highly active antiretroviral therapy, HAART)治疗有效且血浆HIV检测为阴性的16例HIV/AIDS患者的泪液中发现HIV-1病毒, 中位病毒载量为2291(519, 6667)拷贝/ml。  结论  在HIV/AIDS患者眼部病变中, CMV视网膜炎是AIDS晚期最常见的机会性感染, 早期发现和及时给予全身及眼部治疗, 可改善患者的视力预后。患者血液HIV检测阴性时, 房水和泪液HIV仍持续阳性, 提示防止HIV病毒播散, 采取有效的预防措施至关重要。     

人类免疫缺陷病毒感染者及艾滋病患者免疫功能与病毒载量之间的关系

目的探讨人类免疫缺陷病毒（HIV）感染者和艾滋病（AIDS）患者机体的免疫功能与病毒载量的关系、以此判断疾病的进展，评价抗病毒治疗效果和评估预后情况。方法对226例已确诊的HIV感染血样进行CD4^＋T淋巴细胞绝对计数、CD4／CD8比值和血浆病毒载量的检测。结果226例HIV感染者或AIDS患者体内CD4^＋T淋巴细胞绝对数与病毒载量的对数值呈负相关，变化趋势相反，但与CD4／CD8比值呈正相关。结论CD4^＋T淋巴细胞绝对数是HIV感染者或AIDS患者免疫系统中的“金指标”，流式细胞术单平台法是检测CD4^＋T淋巴细胞绝对数的标准方法，病毒载量则主要是衡量AIDS患者药物疗效必不可少的方法之一。     

外周血淋巴细胞监测人类免疫缺陷病毒和获得性免疫缺陷综合症疗效评价

目的研究人类免疫缺陷病毒（HIV）感染者和获得性免疫缺陷综合症（AIDS）患者CD4^＋T淋巴细胞数变化（ΔCD4^＋T）和外周血淋巴细胞总数变化（ΔTLC）的相关性。探讨用ΔTLC预测ΔCD4^＋T在监测HIV/AIDS患者疾病进展以及高效抗逆转录病毒治疗（HAART）疗效的价值。方法回顾性分析20052008年确诊的91例HIV/AIDS患者的临床资料。结果ΔTLC与ΔCD4^＋T呈直线正相关（r=0.809,P〈0.01）,好于TLC与CD4^＋T的相关性（r=0.712,P〈0.01）。分别用ΔTLC170、330、630、910个/μL细胞预测ΔCD4^＋T50、100、200、300个/μL细胞时具有较好的预测价值,各项评价指标符合率基本达到90%以上,显著高于相同时间下用TLC预测CD4^＋T计数的价值。结论应用ΔTLC预测ΔCD4^＋T,可比TLC更加直观、准确的反映HIV感染者疾病进展和评价AIDS患者HAART的疗效。     

HIV相关的风湿综合征

人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染所致的疾病称为获得性免疫缺陷综合征（acquired immunodeficiency syndrome，AIDS），简称艾滋病。HIV感染的主要靶细胞是CD4^＋T细胞，它在数量和功能上出现质和量的缺陷，即可造成宿主免疫功能的全面障碍，乃至免疫功能全面丧失。     

巨细胞病毒性视网膜炎误诊一例

目的 探讨巨细胞病毒性视网膜炎(cytomegalovirus retinitis,CMVR)的临床特点、误诊原因及其防范措施,提高对该病认识.方法 对我院收治的1例CMVR误诊病例的临床资料进行回顾性分析.结果 患者为19岁学生,因突发左眼视力下降15 d入院.当地医院诊断为“视盘水肿”予相关治疗无效,视力损害加重入我院.眼底检查视盘区及后极部隆起,视网膜静脉周围金黄色或白色鞘膜形成,后极部奶酪加番茄酱样改变;HIV抗体、获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)蛋白印迹确认试验、巨细胞病毒(CMV)-IgG及CMV-IgM均(+).确诊左眼CMVR,AIDS.患者转入相关医院行进一步治疗,后失访.结论 临床医生应提高对CMVR的认识,遇及眼底出现典型“奶酪加番茄酱样视网膜炎”改变患者,要考虑到AIDS并发CMVR,进一步行HIV相关检查,以防止误诊、误治.     

高效抗逆转录病毒治疗联合白细胞介素2对艾滋病患者免疫重建的观察

目前公认的艾滋病（AIDS）特征是人免疫缺陷病毒（HIV）特异性侵犯CD4＋ T淋巴细胞,引起CD4＋ T淋巴细胞数量进行性减少和功能性破坏以及全身异常的免疫激活,     

男性HIV/AIDS患者中HIV病毒载量、CD4^+T淋巴细胞数目与CMV感染的相关性

获得性免疫缺陷综合征(AIDS)是一种危害极大的传染病[1],由人类免疫缺陷病毒(HIV)引起,主要表现为体内CD4^+T细胞数量减少,机体免疫力降低,免疫细胞亚群异常活化,诱导器官或系统损伤,最终由于继发感染或肿瘤导致患者死亡[2-4]。巨细胞病毒(CMV)感染是一种典型的继发性感染[5]。CMV属于疱疹病毒,是最常见的感染病毒,对正常人无显著影响,但对免疫功能缺陷者会造成严重的后果。如器官移植后免疫抑制剂的使用或是HIV入侵宿主免疫系统,都会使机体免疫系统受到抑制,此时人体内的CMV被再次激活,从而导致一系列的症状,严重者可导致死亡[6]。我们旨在探究AIDS合并CMV感染的男性患者中CD4^+T细胞数目变化与CMV感染和HIV病毒载量是否具有相关性,以及CMV感染在AIDS中的意义。     

艾滋病痴呆复合征抗病毒治疗研究进展

获得性免疫缺陷综合征（acquired immune deficiency syndrome,AIDS）是人类免疫缺陷病毒（human immunodeficiency virus,HIV）特异性感染辅助性T淋巴细胞,破坏免疫系统,造成以机会性感染和恶性肿瘤为主要临床表现的综合征,日前已成为世界上首要的社会公共卫生问题。截至2007年底,全世界已有HIV／AIDS患者4000余万,其中我国70余万人^[1]。     

武汉地区婴儿肝病综合征病原分析及细胞免疫研究

目的探讨武汉地区婴儿肝病综合征的主要致病因素及相应的细胞免疫特征。方法采用酶联免疫吸附法检测132例肝病综合征患儿血清病毒抗体,测定项目包括乙型肝炎病毒（HBV）、巨细胞病毒（CMV）、EB病毒、单纯疱疹病毒（HSV）以及风疹病毒（RV）,同时采用流式细胞仪免疫荧光法检测患儿T淋巴细胞亚群,结果与患儿ALT值进行相关分析。结果病原学检查以巨细胞感染最多见,占26．5％,其次是HSV感染,占1．5％;CMV—IgM（＋）患儿中ALT值异常（ALT〉40U／L）者占91．4％,且其CD4^＋淋巴细胞绝对数升高而百分比降低,CD8^＋淋巴细胞绝对数和百分比均升高,CD3^＋淋巴细胞绝对数升高,CD4^＋／CD8^＋比值显著降低,与同龄健康婴儿及CMV—IgM（-）组比较,均P〈0．05,差异有统计学显著性意义。结论巨细胞病毒是婴儿肝病综合征的重要致病因子,小儿感染CMV肝炎后细胞免疫功能处于相对抑制状态,T淋巴细胞亚群测定可作为判断病情轻重及预后的辅助指标。     

Ophthalmic manifestations of HIV: an update.

A variety of ocular disease processes have been identified in HIV-antibody positive persons, especially in people with AIDS. The most common sight-threatening disease in this population is cytomegalovirus (CMV) retinitis. Effective therapies are available to treat CMV retinitis. However, such therapies carry potentially challenging toxicities. Highly active antiretroviral therapy (HAART) has improved immune system functioning in many of its adherents, decreasing the incidence and improving the clinical course of CMV retinitis. However, a recent phenomenon associated with HAART, immune recovery uveitis (IRU), has been noted with additional, often problematic ocular manifestations in many persons with CMV retinitis. Periodic ophthalmic examination is prudent for all persons with HIV and especially for people with AIDS.     

Cytomegalovirus retinitis in patients with AIDS: pathophysiology and nursing care

Cytomegalovirus (CMV) is a particular threat to the patient with AIDS. Retinitis that may progress to blindness is one of the most distressing manifestations of CMV. DHPG (Ganciclovir) has been used with some success in the treatment of CMV retinitis. This article discusses the pathophysiology of CMV in patients with AIDS, current protocols for DHPG therapy, problems experienced by the patient with CMV retinitis, and nursing actions in response to these problems.     

The prognosis of CMV retinitis among patients with AIDS in Serbia.

BACKGROUND: Cytomegalovirus (CMV) end-organ diseases, including CMV retinitis, are major opportunistic events in terminal AIDS patients. METHODS: A retrospective study of 30 AIDS patients with CMV retinitis treated between 1997 and 2007 in Serbia was conducted to examine the prognosis and factors associated with survival. RESULTS: Eighteen (60%) patients survived the mean follow-up period of 46.4+/-36 months. Patients' sex, mode of HIV transmission or previous AIDS diagnosis did not affect survival. Bilateral CMV retinitis predicted dissemination of CMV disease and poor prognosis (OR 7.8, 95% CI 1.3-47.0, P=0.012), but was not associated with blindness (P=0.33). Among patients treated with HAART and CMV therapy the probability of surviving 10 years was 70%, while in those on CMV therapy alone, the median survival was 10 months (log rank P=0.00). However, HAART itself was not sufficient to prevent blindness and the major predictor of blindness was a baseline CD4 cell count of less than 50/muL (OR 6.8, 95% CI 1.1-41.8, P=0.03). After CMV disease, most patients suffered other opportunistic events regardless of HAART introduction. CONCLUSION: Even in the HAART era patients with advanced immunodeficiency and CMV retinitis may not escape from the high risk mortality group, while survivors commonly lose sight.     

Immune predispositions for cytomegalovirus retinitis in AIDS. The HNRC Group.

CMV retinitis develops in approximately 28-35% of all AIDS patients at later stages of disease, often leading to blindness. To determine whether the subset of AIDS patients who developed CMV retinitis (CMV-R) were immunologically predisposed, T cell proliferation responses to CMV were examined prospectively in an HIV infected, HLA typed, longitudinal study population. Individuals who developed CMV-R had significantly lower T cell proliferation responses to CMV, both early and late in disease, compared to CD4 matched controls who have not developed CMV-R. Since HLA proteins influence T-cell recognition, phenotypes of 21 CMV-R patients were examined to determine whether certain HLA alleles were associated with low immune response and predisposed AIDS patients to CMV-R. HLA DR7 and B44 were at increased (nearly twice the expected) frequency in those with CMV-R. The combined association of either B44, 51 or DR7 with CMV-R was highly significant (P = .008, relative risk of CMV-R = 15) with correction for multiple comparisons. Low immune responses were twice as frequent in those with (61%) compared to those without (30%) predisposing alleles. Thus, AIDS patients with immunogenetically related hyporesponsiveness to CMV antigens may be at increased risk of retinitis.     

Cytomegalovirus-induced osteomyelitis in a patient with the acquired immunodeficiency syndrome

A 43-year-old man with AIDS had a periodontal abscess, no fever, and normal findings on funduscopic examination. Three months later, the abscess area was debrided, and histologic examination of the tissue revealed osteomyelitis of the mandible. Within the area of osteomyelitis were numerous cells with inclusions typical of cytomegalovirus (CMV) infected cells. Funduscopic examination at that time revealed extensive CMV retinitis. Osteomyelitis should be added to the list of infections caused by CMV in patients with AIDS.     

The utility of clinical and radiographic features in the diagnosis of cytomegalovirus central nervous system disease in AIDS patients.

BACKGROUND: Polymerase chain reaction (PCR) assays of cerebrospinal fluid (CSF) for cytomegalovirus (CMV) DNA have facilitated the diagnosis of CMV-associated central nervous system disease in AIDS patients. We attempt to correlate clinical and radiographic features that are associated with CMV PCR- positivity in CSF from AIDS patients with neurologic disease. METHODS AND RESULTS: A retrospective case controlled comparison was made of CMV PCR-positive and PCR-negative patients. RESULTS: CMV PCR-positive patients were significantly more likely to have nystagmus, prior CMV retinitis, and CSF protein levels.90 mg/dL. Of patients with 0, 1, and $2 of these features, 5.6%, 55.2%, and 88.9%, respectively, were PCR-positive. Ependymal enhancement was present by magnetic resonance imaging in 9 of 12 PCR-positive, and in 8 of 30 PCR-negative patients. CONCLUSION: These clinical and radiographic features may serve as useful adjuncts toward the establishment of the diagnosis of CMV-associated neurologic disease in AIDS patients.     

Failure of adjunctive cytomegalovirus intravenous immune globulin to improve efficacy of ganciclovir in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis: a phase 1 study.

Six men with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis, treated with combined ganciclovir induction therapy and hyperimmune globulin (CMV-IGIV) for 10 days followed by CMV-IGIV alone, had a median time to retinitis progression shorter (7 days) than had eight historical controls given ganciclovir maintenance therapy (54 days; P = 0.06) and similar to that in eight controls given ganciclovir for 10 days only (19 days; P = 0.97). CMV-IGIV, which also failed to inhibit CMV replication in blood and urine, did not appear to add markedly to the efficacy of ganciclovir in acquired immunodeficiency syndrome-associated CMV retinitis.     

Massive upper gastrointestinal hemorrhage due to cytomegalovirus infection in two patients with acquired immunodeficiency syndrome

Massive upper gastrointestinal (GI) hemorrhage is a rare manifestation of GI cytomegalovirus (CMV) infection. A review of the English language literature yielded 21 well-documented cases of gastric ulcers due to CMV, and 7 of these 21 cases were complicated by significant GI bleeding. This report describes two cases of massive upper GI hemorrhage due to CMV infection in patients with acquired immunodeficiency syndrome (AIDS).     

A brighter future for the AIDS patient

This article explores the etiology, medical and surgical treatment, and care of the acquired immune deficiency syndrome (AIDS) patient with cytomegalovirus (CMV) retinitis. CMV retinitis is the most common intraocular infection as well as the leading cause of vision loss in people with AIDS. CMV, part of the herpesvirus group, is an opportunistic pathogen that is transmitted through body fluids. Both the human immunodeficiency virus (HIV) and the herpesvirus are factors in predisposing retinal tissue to CMV. CMV usually remains dormant in a healthy immune system. However, in people who are immunosuppressed, the virus can become active and cause infections in the GI tract, lungs, and central nervous system, as well as in the eyes.     

High levels of circulating cytomegalovirus DNA reflect visceral organ disease in viremic immunosuppressed patients other than marrow recipients.

Although viremia is a hallmark of disseminated cytomegalovirus (CMV) infection, not all viremic patients have visceral organ CMV disease. We used blot hybridization with a cloned subgenomic probe to quantitate viral DNA in blood leukocytes of 60 viremic patients (25 with solid organ transplants, 20 with AIDS, and 15 marrow recipients) who had different clinical manifestations of CMV infection. The results are expressed as pg of viral DNA/10 micrograms of leukocyte DNA. Patients with AIDS or with solid organ transplants who had CMV visceral organ disease had the largest amounts of viral DNA in their granulocytes (median 632 and 237 pg, respectively). These amounts were significantly greater than those in similar viremic patients without CMV visceral disease (17 and 21 pg; P < 0.005 and 0.002, respectively). All patients in the study with > 150 pg of CMV DNA in their granulocytes had visceral CMV disease. The amounts of viral DNA in granulocytes of AIDS and organ transplant patients with CMV retinitis were low (median 22 pg). Marrow transplant patients were unique in that the amounts of CMV DNA in granulocytes were low whether CMV visceral organ disease was present (17 pg) or absent (14 pg). We conclude that high levels of circulating CMV DNA in viremic AIDS and solid organ transplant patients reflect viral involvement of visceral organs but not the retina. In marrow recipients, the severity of CMV disease, even when fatal, is not reflected quantitatively in peripheral blood leukocytes.