常规拔牙病人艾滋病病毒污染情况调查及防护

目的:对常规拔牙术中艾滋病病毒污染情况进行调查,进一步控制医源性感染。方法:随机抽取200例门诊拔牙病人的术中止血棉球,浸入盛有1ml生理盐水的无菌试管内,其浸出液用3种方法进行艾滋病病毒检测。结果:200例标本中查出1例HIV抗体阳性(0.5%)。结论:迫切要求口腔医务工作者要加强职业防护,有效防止艾滋病通过口腔科诊疗传播。     

重组HIV抗原和多表位抗原的研究

目的研究重组HIV病毒系列抗原,以满足HIV各种抗体检测试荆研究的需要。方法从HIV-1／2不同抗原中精选出优势抗原片段,分别用PCR方法从编码全长HIV-1基因的pBHIOR2／HIV质粒中扩增出HIV-1／gpl20、HIV-1／GP41及HIV-1／“M”优势抗原表位,用基因合成法,合成HIV-1／“0”和HIV-2／gp36基因,将获得的各基因片段插入到pBVIL1载体,使其在HB101中表达。利用载体pBVILl具有使小分子肽基因间可方便连接的特点,选择优势抗原表位进行连接和嵌合表达。结果与结论所克隆的单片段及嵌合抗原均在大肠杆菌中获得了高效的表达,纯化的单片段及多表位嵌合抗原经用间接EIA法对HIV阴性和阳性血清测定,表明抗原已满足抗体检测试剂盒的要求。得到的单片段抗原可用于LIA测定,而多表位嵌合抗原,可用于EIA筛检试剂。     

河南省暗娼人群艾滋病哨点监测分析

目的 了解河南省暗娼人群中艾滋病病毒(HIV)感染状况和行为特征.方法 用重复横断面调查的方法对河南省部分市县的暗娼人群进行行为学和血清学监测.结果 2003-2006年各暗娼哨点HIV抗体阳性率均低于1%,与客人每次都用安全套的比例仍较低.结论 河南省暗娼人群HIV感染率较低,但疫情呈蔓延扩散趋势,需要加大对该人群的干预力度.     

Determination of HIV tropism and its use in the clinical practice

Assessment of HIV coreceptor tropism assay is recommended before starting therapy with CCR5 coreceptor antagonists. So far, only maraviroc (MVC) has been approved for clinical use and a tropism assay is mandatory for patients with virological failure or patients in which MVC is considered into future treatment options. Viral tropism can be assessed with either genotypic or phenotypic methods and to this aim different techniques have been developed. However, it is unclear which assay is more appropriate for routine testing. In fact, although phenotypic assays are considered the gold standard as they directly measure the viral tropism and current versions allow detection of a lower threshold of minor CXCR4-dependent variants, the genotypic assays present major practical advantages for their use in the clinical setting.     

2006年下半年苏州市戒毒人员艾滋病、丙型肝炎、梅毒监测报告

目的 了解苏州市吸毒人群艾滋病的感染状况,为预防控制艾滋病的流行提供科学依据.方法 对苏州市戒毒所2006年下半年新入所戒毒人员艾滋病哨点监测资料进行分析.结果 494名戒毒人员中,检出艾滋病病毒(HIV)感染者12例,感染率为2.43%;酶联免疫吸附试验梅毒感染阳性率为3.44%,丙型肝炎(丙肝)感染阳性率为21.05%.12名HIV感染者均有共用注射器静脉吸毒史.注射吸毒人员的丙肝感染率49.3%万,显著高于非注射吸毒人员的丙肝感染率5.92%(x2=126.31,P＜0.005).共用过注射器或针头人员占静脉吸毒人员的61.27%.戒毒人员中4.25%通过钱或毒品交易与他人发生性行为,只有14.29%每次都用安全套.结论 苏州市吸毒人群中HIV、丙肝病毒(HCV)感染率居于全国平均水平,静脉吸毒和共用针具吸毒是HIV和HCV传播的高危因素,不洁性行为增加了HIV、HCV、梅毒由吸毒人员向其他人群传播的危险性.     

Disruption of HIV-1 co-receptors CCR5 and CXCR4 in primary human T cells and hematopoietic stem and progenitor cells using base editing

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我国237例未接受抗病毒治疗的HIV/AIDS患者中原发性基因型耐药监测和病毒亚型分析

目的 分析237例HIV/AIDS患者中原发性耐药的发生率和病毒亚型分布情况.方法 从河南、云南、上海等20个地区采集237例未经抗病毒治疗的HIV/AIDS患者血浆HIV-1进行基因测序,通过病毒亚型分析软件REGA HIV-1 Subtyping Tool确定测序样本的HIV-1亚型,并与斯坦福大学HIV耐药数据库比对确定测序样本HIV-1耐药相关突变位点.采用b-DNA方法检测患者血浆病毒载量,采用流式细胞仪检测CD4+ T淋巴细胞计数.结果 237例未接受抗病毒治疗的HIV/AIDS患者感染的HIV-1毒株分布为A1、B、C、CRF01-AE、CRF02-AG、CRY7-BC、CRF08-BC、CRF12-BF、G等9个不同亚型,可能的感染时间分布在1990-2006年.237例患者中仅有3例分别对核苷类逆转录酶抑制剂高度耐药、蛋白酶类抑制剂低度耐药和非核苷类逆转录酶抑制剂高度耐药,原发性耐药的发生率为1.3%(3/237).结论我国部分地区未经抗病毒治疗的HIV/AIDS患者中HIV-1原发性基因型耐药的发生比例处于较低水平,病毒亚型分布在9个亚型.     

Comparison of non-radioactive DNA hybridization probes to detect human immunodeficiency virus nucleic acid

Simple and sensitive methods to directly detect the human immunodeficiency virus (HIV) are needed for routine use in the clinical laboratory. In this study, we compared DNA probes prepared by: (1) nick translation with biotinylated dATP; (2) direct covalent biotinylation with photobiotin; (3) direct covalent reaction with 2-acetylaminofluorene (AAF); and (4) a standard radioactive (32P) nick translation procedure. These four DNA probes were hybridized with dilutions of purified target HIV DNA blotted onto nitrocellulose strips. Hybridization was detected using a complex of strepavidin-alkaline phosphatase [for (1) and (2)], alkaline phosphatase-tagged antibodies [for (3)] and by autoradiography [for (4)]. Alkaline phosphatase was detected colorimetrically using nitroblue tetrazolium and 5-bromo-4-chloro-3-indolyl phosphate. After 1 h, AAF probes were most sensitive (amount detected less than 5 pg), followed by biotin (10 pg), photobiotinylated probes (20 pg) and the radioactive probe (10 pg). The AAF probes were then used to detect HIV DNA in infected CEM cells. We conclude that non-radioactive DNA labelling methods can be used to directly detect HIV DNA under conditions compatible with present clinical laboratory procedures.     

Universal HIV Screening in Ambulatory Care Settings

Statistics reveal that clinicians are not offering or recommending routine HIV screening in almost all health care settings, despite strongly recommended clinical guidelines published in 2006 and 2013. The Centers for Disease Control and Prevention estimates that less than half of the US population aged 18–64 years has ever been tested for HIV.^1,2 To increase HIV screening rates, it is crucial to provide education on the guidelines and a mechanism for readily available testing to increase HIV screening rates. Employing evidence-based universal screening will potentially identify new HIV diagnoses earlier. Timely identification decreases the spread of HIV, reduces the complications from living with HIV, and provides significant cost savings. Undiagnosed persons living with HIV pose a substantial epidemiologic risk. Without increased HIV screening and linkage to care, ending the HIV epidemic within the United States will be unattainable.     

Video as an Effective Method to Deliver Pretest Information for Rapid Human Immunodeficiency Testing

Objectives: Video‐based delivery of human immunodeficiency virus (HIV) pretest information might assist in streamlining HIV screening and testing efforts in the emergency department (ED). The objectives of this study were to determine if the video “Do you know about rapid HIV testing?” is an acceptable alternative to an in‐person information session on rapid HIV pretest information, in regard to comprehension of rapid HIV pretest fundamentals, and to identify patients who might have difficulties in comprehending pretest information. Methods: This was a noninferiority trial of 574 participants in an ED opt‐in rapid HIV screening program who were randomly assigned to receive identical pretest information from either an animated and live‐action 9.5‐minute video or an in‐person information session. Pretest information comprehension was assessed using a questionnaire. The video would be accepted as not inferior to the in‐person information session if the 95% confidence interval (CI) of the difference (Δ) in mean scores on the questionnaire between the two information groups was less than a 10% decrease in the in‐person information session arm’s mean score. Linear regression models were constructed to identify patients with lower mean scores based upon study arm assignment, demographic characteristics, and history of prior HIV testing. Results: The questionnaire mean scores were 20.1 (95% CI = 19.7 to 20.5) for the video arm and 20.8 (95% CI = 20.4 to 21.2) for the in‐person information session arm. The difference in mean scores compared to the mean score for the in‐person information session met the noninferiority criterion for this investigation (Δ = 0.68; 95% CI = 0.18 to 1.26). In a multivariable linear regression model, Blacks/African Americans, Hispanics, and those with Medicare and Medicaid insurance exhibited slightly lower mean scores, regardless of the pretest information delivery format. There was a strong relationship between fewer years of formal education and lower mean scores on the questionnaire. Age, gender, type of insurance, partner/marital status, and history of prior HIV testing were not predictive of scores on the questionnaire. Conclusions: In terms of patient comprehension of rapid HIV pretest information fundamentals, the video was an acceptable substitute to pretest information delivered by an HIV test counselor. Both the video and the in‐person information session were less effective in providing pretest information for patients with fewer years of formal education.     

HIV-慢病毒载体有效转导人肺动脉平滑肌细胞的实验研究

目的使用不同的HIV-载体感染人肺动脉平滑肌细胞,并使用HIV慢病毒载体将外源基因转入人肺动脉平滑肌细胞。方法应用ADA/Luc、HXB2/Luc、VSV-G/Luc和VSV-G/GFP感染人肺动脉平滑肌细胞U87.CD4.CCR5和U87.CD4.CX-CR4。结果ADA/Luc和HXB2/Luc均能感染具有相应复合受体的U87.CD4,但不能感染人肺动脉平滑肌细胞。VSV-G/Luc和VSV-G/GFP能有效转导至人肺动脉平滑肌细胞中,于感染第3天,表达VSV-G/GFP的人肺动脉平滑肌细胞的阳性率为18%。结论应用HIV慢病毒载体能够向人肺动脉平滑肌细胞中导入外源基因。     

Respiratory infections after lung cancer resection

The advent of highly active antiretroviral therapy has facilitated the virtual elimination of mother-to-child transmission of HIV infection in developed countries, reducing transmission rates to approximately 1 to 2%. In these settings, highly active antiretroviral therapy has also transformed pediatric HIV infection into a chronic disease; although there are associated costs in terms of side effects and the heavy pill burden. In less developed settings, easier-to-use adaptations of antiretroviral therapy regimens, such as short-course and single-dose antiretroviral strategies or neonatal postexposure prophylaxis can also substantially prevent mother-to-child transmission, although to a lesser degree than highly active antiretroviral therapy. However, postnatal transmission of infection through breastfeeding significantly reduces the longer-term efficacy of these strategies. Ongoing research is focusing on the use of antiretroviral therapy in the breastfeeding period.     

Prevalence and characteristics of occult hepatitis B virus infection in Japanese human immunodeficiency virus-infected patients

Occult hepatitis B virus (HBV) infection (OBI) is hepatitis B surface antigen (HBsAg) negative but with detectable HBV DNA. Although HIV infection has been reported to be a risk factor for OBI, the prevalence and clinical features of OBI in Japanese HIV infected patients have not been documented. This retrospective, single-center study was conducted to determine the prevalence and characteristic of OBI in Japanese antiretroviral therapy (ART) naïve HIV infected patients. OBI was defined as the presence of serum HBV DNA but without detectable HBsAg. Of the 147 ART naïve HIV infected patients, OBI was detected in 9 (6.1%) patients; 2 (4.3%) of 47 with both anti-HBs and anti-HBc positive, 6 (27.3%) of 22 with anti-HBc alone, and 1 (2.0%) of 50 with both anti-HBs and anti-HBc negative. The mean HBV DNA level was low at 28.7 ± 18.2 IU/mL. The proportion of OBI patients with anti-HBc alone was significantly higher than that of non-OBI patients (66.7% vs 14.5%, P = 0.001). In addition, the prevalence of AIDS (acquired immunodeficiency syndrome)-defining illnesses in the OBI group was significantly higher than in the non-OBI group (77.8% vs 35.5%, P = 0.001). No significant difference was found in the CD4 count or alanine aminotransferase levels of these two groups. This is the first study to reveal the prevalence and clinical features of OBI in Japanese HIV-infected patients. The persistence of anti-HBc alone and AIDS-defining illnesses were associated with the occurrence of OBI in these patients.     

A Model for Increasing Access to Preexposure Prophylaxis (PrEP) Services in the Substance Use Population

In 2017, a low-resource substance use treatment center in Baltimore, Maryland, noted that at least 38% of patients, ranging from 18 to 76 years old, with substance use disorders (SUD) met the criteria for preexposure prophylaxis (PrEP) therapy. PrEP therapy consists of a daily medication to prevent transmission of human immunodeficiency virus. A conceptual framework model was developed linking eligible patients with SUD to PrEP services based on current Centers for Disease Control and Prevention PrEP recommendations. Three tools were developed for PrEP service planning, implementation, and evaluation. The focus of this report is to increase access to and uptake of comprehensive PrEP services in those with SUD who are at risk for acquiring human immunodeficiency virus.     

HIV阳性垂体瘤患者的围手术期循证护理

目的探讨HIV阳性垂体瘤患者的围手术期循证护理。方法根据循证护理模式,对1例HIV阳性垂体瘤患者进行围手术期的循证护理,包括4个连续的过程:循证问题、循证支持、循证观察、循证应用。为此举办有关艾滋病护理培训;组织护士进行专题循证护理学习。了解到HIV感染主要是通过性接触、血液、体液暴露和母婴垂直传播,不会通过日常接触传播,因此,直接护理的基本技巧与护理其他疾病没有显著区别,特殊措施包括消毒隔离及管理问题。结果通过医、护、患的共同努力,病人手术成功痊愈出院。结论通过循证护理,减轻了病人的痛苦,提高了医疗质量,使病人获得最佳的护理。     

Pulmonary nocardiosis caused by <Emphasis Type="Italic">Nocardia exalbida</Emphasis> complicating <Emphasis Type="Italic">Pneumocystis</Emphasis> pneumonia in an HIV-infected patient

A 47-year-old man with optimally controlled type-2 diabetes mellitus and chronic hepatitis B was admitted to a local hospital because of a 1-week history of cough and high-grade fever. He was diagnosed with Pneumocystis pneumonia (PCP) and Klebsiella pneumonia from a chest radiograph and sputum. Simultaneously, he was found to have HIV infection with a CD4 count of 76/μl. Despite alteration of treatment secondary to the development of allergic reaction to trimethoprim–sulfamethoxazole (TMP–SMX), the patient was able to complete a 3-week therapy for PCP after being switched to pentamidine isetionate. After the treatment of PCP, he was referred to our hospital for the initiation of anti-HIV therapy. He presented with recurrent high-grade fever of a few days’ duration prior to his initial visit, which subsequently led to his admission. Chest computed tomography (CT) showed the enlargement of a previously identified infiltrate in the left upper lung field, and the sputum culture upon admission was positive for Gram-positive branching rods; the organism was later identified as Nocardia exalbida. Due to his allergy to sulfonamide, the patient was treated with imipenem (IMP) and amikacin (AMK) given intravenously for 17 days, followed by garenoxacin (GRNX) taken orally for 6 months, without any adverse effects. The chest infiltrate resolved completely, and he remains stable without relapse 8 months after the completion of the therapy. Pulmonary nocardiosis should be considered as a differential diagnosis of recurring pneumonia in immunocompromised patients, especially in HIV-infected individuals. Oral administration of GRNX following IMP and AMK can be used as an alternative to TMP–SMX therapy in cases of pulmonary nocardiosis caused by N. exalbida.