抗-R7V研究现状

近年有研究发现，人类免疫缺陷病毒（HIV）不进展者体内一种名为抗-R7V的抗体含量很高，并且临床资料显示抗-R7V对HIV感染者具有一定的保护作用，使病情进展延缓或长期停留在无症状期，可以作为疾病进展的一个标志，为人们希望通过自身机体免疫控制HIV感染带来了曙光。对这类患者的研究有利于进一步阐明影响病毒复制的因素，也有助于制定治疗HIV／AIDS患者的新方案。含有R7V肽的酶联免疫吸附试验（ELISA）可以检测到HIV感染者体内的抗-R7V，与CDd计数和病毒载量联合应用，有助于医生决定治疗开始的时机。     

抗-R7V抗体与HIV感染后疾病进展关系的初步研究

目的初步了解人类免疫缺陷病毒（HIV）感染者血清抗-R7V抗体阳性与疾病进展之间的相关性。方法检测HIV感染者的抗-R7V抗体,根据结果分为阳性、阴性和灰区3组。跟踪随访,观察各组病例的CD4^＋T细胞计数和病毒载量变化,以及进行高效抗逆转录病毒治疗（HAART）的情况,进行组间比较。结果44例感染者中,发现9例抗-R7V阳性,阳性率为20．45％。其中7例感染HIV均超过10年。经过平均28．5个月随访,阳性组CD4计数下降幅度和开始HAART治疗的患者比例均显著低于阴性组。结论HIV感染者中抗R7V阳性率为20．45％,该抗体阳性和HIV感染后疾病缓慢进展之间存在着较高的相关性。     

抗-R7V研究现状

近年有研究发现,人类免疫缺陷病毒(HIV)不进展者体内一种名为抗-R7V的抗体含量很高,并且临床资料显示抗-R7V对HIV感染者具有一定的保护作用,使病情进展延缓或长期停留在无症状期,可以作为疾病进展的一个标志,为人们希望通过自身机体免疫控制HIV感染带来了曙光。对这类患者的研究有利于进一步阐明影响病毒复制的因素,也有助于制定治疗HIV/AIDS患者的新方案。含有R7V肽的酶联免疫吸附试验(ELISA)可以检测到HIV感染者体内的抗-R7V,与CD4计数和病毒载量联合应用,有助于医生决定治疗开始的时机。     

不同病期HIV-1感染者的血浆中和抗体研究

目的了解HIV-1感染者体内中和抗体状况,探讨HIV-1感染的病理机制.方法病毒的分离和培养采用共培养(co-culture)方法,从29例HIV-1感染者的外周血淋巴细胞(PBMC)分离了29株HIV-1原代病毒,中和实验采用病例血浆中和分离的相应病毒株,再感染经PHA刺激活化后的正常人PBMC,培养5天检测其HIV-1 p24抗原含量以判断中和效果.结果29例研究时象中,24例是无症状感染者,5例为AIDS患者.我们发现17例无症状感染者的ID50≥8,其中10例ID90≥8,4例产生高滴度中和抗体ID90≥64,交叉中和实验结果表明这4例感染者的血浆对异体病毒均有不同程度的中和效应,其中尤以s7,s28作用最强.而AIDS患者中仅2例ID50≥8,其中1例ID90≥8,无1例产生高滴度中和抗体.结论通过对HIV-1感染者血浆中和效应的观察,表明多数感染者对自身同血源病毒的中和抗体滴度较低,但也有少数感染者能产生较高滴度的中和抗体,有必要深入研究其广泛的中和病毒效应;此外,早期无症状的感染者似比晚期有症状者对自体病毒的中和效应强,提示抗病毒治疗应于感染早期进行,以免机体体液免疫反应的进一步恶化.     

长期不进展者抗HIV-1相关机制的研究进展

临床实践调查发现,Ⅰ型艾滋病病毒（HIV-1）感染存在不同的病程进展模式,长期不进展者（LTNPs）是指,在HIV-1感染者中,小部分未接受抗病毒治疗而保持病程长期不进展的个体。然而是什么机制使得这些HIV-1感染者疾病长期不进展？近年来有关LTNPs抗HIV-1的作用机制受到越来越多的关注。文章收集了有关LTNPs最近的研究进展,着重从机体免疫学、宿主遗传学、病毒生物学三方面进行综述。     

不同病期HIV—1感染者的血浆中和抗体研究

目的：了解HIV－1感染者体内中和抗体状况，探讨HIV－1感染的病理机制，方法：病毒的分离和培养采用共培养（co-culture)方法，从29例HIV－1感染者的外周血淋巴细胞（PBMC）分离了29株HIV－1原代病毒，中和实验采用病例血浆中和分离的相应病毒株，再感染经PHA刺激活化后的正常人PBMC，培养5天检测其HIV－1 p24抗原含量以判断中和效果。结果：29例研究中，24例是无症状感染者，5例为AIDS患者，我们发现17例无症状感染者的ID50≥8，其中10例ID90≥8，4例产生高滴度中和抗体ID90≥64，交叉中和实验结果表明这4例感染者的血浆对异体 病毒均有不同程度的中和效应，其中尤以s7,s28作用最强，而AIDS患者中仅2例ID50≥8，其中1例ID90≥8，无1例产生高滴度中和抗体。结果：通过对HIV－1感染者血浆中和效应的观察，表明多数感染者对自身同血源病毒的中和抗体滴度较低，但也有少数感染者能产生较高滴度的中和抗体，有必要深入研究其广泛的中和病毒效应，此外，早期无症状的感染者似比晚期有症状者对自体病毒的中和效应强，提示抗病毒治疗应于感染早期进行，以免机体体液免疫反应的进一步恶化。     

HIV-1 B′亚型毒株感染者广谱中和活性样本不同时间点env基因变异研究

目的探讨具有广谱中和活性的艾滋病病毒-1型(HIV-1)B′亚型毒株感染者,连续五个时间点样本的膜蛋白基因(env)序列的特征。方法采用单基因组扩增法扩增env基因。分析不同时间点env基因序列的特征及代表性广谱中和抗体(bNAbs)表位的变异。结果 env基因系统进化分析发现,感染者体内包含优势和劣势两个不同株系的病毒,优势株系毒株可变区多样性随时间增大,尤以V1V2环序列长度和糖基化位点变异程度最高;优势和劣势株系病毒的顶端四肽分别为GQGR和GPGK,辅助受体均为CCR5。代表性广谱中和抗体表位分析显示,2G12和PG9/PG16识别的关键位点存在变异。结论 B′亚型毒株感染者体内包含优势和劣势两个不同株系的病毒,优势株系病毒在中和选择压力下不断进化;单抗表位变异分析表明,感染者体内可能存在2G12和PG9/PG16样抗体。     

HIV-1 Gag和Env蛋白特异性ADCC反应与AIDS病程进展的关系

目的了解艾滋病病毒I型（HIV-1）Gag和Env蛋白特异性抗体依赖性细胞介导的细胞毒作用（ADCC）反应,与艾滋病（AIDS）疾病进展的相关性。方法采集58份未经抗病毒治疗的、感染时间1年以内的男男性行为人群（MSM）标本,利用HIV-1特异性肽库刺激和流式细胞染色技术进行ADCC检测。结果病毒载量与HIV-1Gag特异性CD＋2IFN-γ＋细胞占CD-3细胞的比例呈显著的正相关（r=0.2919,P=0.0339）;而01_AE亚型感染者的病毒载量与HIV-1Env特异性CD＋2CD107a＋细胞占CD-3细胞的比例呈显著负相关（r=-0.3454,P=0.0454）。结论在HIV-1感染早期,感染者体内可以产生Gag蛋白特异性的ADCC反应,其中Env蛋白特异性的ADCC反应具有控制疾病进展的作用。     

滤泡辅助T细胞与HIV感染者中和抗体的相关研究进展

滤泡辅助T细胞(Tfh)是最近发现的一群具有辅助B细胞功能的辅助T细胞,在机体体液免疫中具有重要作用。最近研究发现,滤泡辅助T细胞与艾滋病病毒(HIV)感染者的中和抗体有关,Tfh细胞表达量越高,相对应的HIV-1感染者的中和抗体的活性越明显,该发现极大地推动了艾滋病疫苗的研究。对Tfh细胞进行深入研究,将为刺激机体产生如HIV-1自然感染过程中产生的广谱中和抗体的艾滋病疫苗研究提供新途径。该文即对滤泡辅助T细胞和HIV感染者的中和抗体间的相关研究进展进行综述。     

MSM HIV感染者外周血中ADCC反应水平与HIV-1感染早期病毒载量的关系

目的在艾滋病病毒（HIV）感染早期,观察HIV-1特异性抗体依赖的细胞毒性作用（ADCC）与病程进展的关系。方法利用HIV-1特异性多肽刺激和多色流式技术,对前期采集的、感染时间在1年以内的男男性行为人群（MSM）标本进行ADCC检测。结果共采集HIV-1感染者标本58份,CD4＋T淋病细胞计数与外周血病毒载量呈明显负相关（r=-0.281 6,P=0.032 3）。ADCC检测结果显示,病毒载量与HIV-1Pol特异性CD2＋IFN-γ＋细胞占CD3-细胞的比例呈显著的正相关（r=0.260 7,P=0.046 2）;而病毒载量与HIV-1Gp120特异性CD2＋CD107a＋细胞占CD3-[A1]细胞的比例呈显著负相关（r=-0.342 9,P=0.009 0）。结论在HIV-1感染早期,感染者体内即可产生针对Pol和Env蛋白的ADCC反应,其中针对Gp120蛋白的ADCC反应具有控制病程进展的作用。     

艾滋病15例临床分析

目的　提高对艾滋病 (AIDS)的认识 ,为AIDS及时诊断提供基础资料。方法　分析经免疫印迹检测证实的 15例AIDS病人的临床资料。结果　本组病人 80 0 %经性接触感染 ;73 3 %以呼吸道感染起病 ,表现为持续发热、慢性咳嗽 ,严重者气急紫绀 ;2 6 7%以长程腹泻起病。可伴有体重进行性下降 (80 0 % )。病人从起病至确诊的时间较长。多为多种病原体混合性感染 ,单纯针对细菌治疗疗效常不理想 ,酌情采用综合治疗有66 7%的病人好转。结论　加强对AIDS的警惕性 ,对反复发热、慢性咳嗽、长程腹泻的病人应尽早行抗 HIV检查 ;尽早诊断、综合治疗是病情稳定之关键     

Effect of influenza vaccination on disease progression among HIV-infected persons

OBJECTIVE: To describe the effect of influenza vaccination on long-term change in CD4 count and HIV RNA level, and on progression to AIDS or death. DESIGN AND SETTING: A longitudinal medical record review set in 113 medical clinics in 10 United States cities. PATIENTS: A total of 36,050 HIV-infected persons aged > or = 13 years in care for HIV infection. MAIN OUTCOME MEASURES: Change in CD4 count and HIV RNA level at follow-up (3-12 months after vaccination); hazard ratios (HR) for association of influenza vaccine with progression from baseline CD4 or HIV RNA level to AIDS and to death. RESULTS: The median CD4 count among all persons decreased 28 cells/year during follow-up, with no difference in change in CD4 count between the 8007 (40%) vaccinated (median = 6 months, vaccine to follow-up CD4 count) and the 11,794 unvaccinated persons. In a viral load subanalysis, median HIV RNA level decreased 90 copies/ml per year among all persons during follow-up; decreases were not different between vaccinated and unvaccinated persons (median = 7 months, vaccine to follow-up HIV RNA level determination). Influenza vaccination was weakly associated with decreased risk of progression to clinical AIDS [HR 0.93; 95% confidence interval (CI), 0.87-0.99], but not associated with time to death (HR, 0.97; CI, 0.93-1.01). CONCLUSIONS: No negative long-term effect of influenza vaccination on CD4 counts, HIV RNA levels, or progression to AIDS or death was found in this HIV-infected population. These data suggest that physicians should not withhold influenza vaccine because of concerns about long-term detrimental effects of increased viral replication.     

Identification of IL7RA risk alleles for rapid progression during HIV-1 infection: a comprehensive study in the GRIV cohort

Interleukin 7 (IL7) is a critical factor for lymphocyte homeostasis. A dysfunction of the IL7/IL7R pathway has previously been described in HIV-1 infection, and promising results were observed in recent analyses of IL7 for therapeutic use in HIV infected individuals. However, further investigations are still warranted to understand the possible roles of this cytokine. Here, we explored whether the IL7 and IL7RA genetic polymorphisms were associated with the progression of HIV infection. We extensively genotyped the IL7 and IL7RA genes in the GRIV (Genomics of Resistance to Immunodeficiency Virus) cohort, composed of patients with extreme progression profiles - long-term non (LTNP) and rapid (RP) progressors--, and in a healthy control group (CTR). Statistical case-control analyses were performed using the Fisher's exact test, comparing either LTNP vs CTR or RP vs CTR. Three IL7RA SNPs (single nucleotide polymorphisms--rs7701176, rs987106 and rs10491434), but no IL7 SNPs, were significantly associated with rapid disease progression (P < 0.01). In a multi-marker analysis focusing on functional variants, a strong association between an IL7RA haplotype and rapid progression was observed (P = 5.59 x 10(-3)). In summary, our comprehensive genetic study revealed three SNPs and a risk of haplotype associated with rapid progression to AIDS in the IL7RA gene. Interestingly, the haplotype is composed of SNPs previously identified in other inflammatory diseases (e.g., multiple sclerosis) by GWAS and by functional studies. Our results contribute to the growing understanding of the role of IL7/IL7R in HIV disease progression, and more widely, in CD4+ T cell homeostasis.     

云南省HIV/AIDS预测

目的 预测未来10年云南省HIV/AIDS流行趋势。方法 定性与定量相结合,数学模型、现患率趋势估计及经验分布函数相结合的方法。结果 用9种方案描述云南省未来10年HIV/AIDS流行趋势,指标包括未来各年HIV感染人数、新增人数和累计人数,及AIDS现患人数、新增人数和累计人数。我们估计目前云南省HIV感染人数为5.2～5.4万,到2005年时增加到8～20万,到2010年时再增加到11～62万。目前AIDS患者累计人数为 5 000～8 000人,到 2010年将增加到 6～12万。结论 未来 10年云南省 HIV仍以在吸毒人群中流行为主,但通过其它途径感染HIV的人数占总HIV感染人数的比例也会不断增加,同时艾滋病将会造成未来孤儿数不断增加,估计2000年云南省艾滋病孤儿为2千人,到2010年为2万人。本文还讨论了非安全注射问题,这是一个可能导致艾滋病流行的不可忽视的潜在因素。     

Reducing barriers to care and improving quality of life for rural persons with HIV

Rural persons living with HIV disease is a patient group rapidly increasing in size and one that will present America's health-care system with daunting challenges. As the HIV epidemic increasingly affects rural America, it is clear there are many significant barriers to providing adequate care for persons with HIV and AIDS in these smaller communities. The study surveyed 57 attendees of the National Rural AIDS Conference held in early 1995, St. Cloud, MN, to assist in the identification of barriers to care and to examine strategies that may improve their quality of life. Health care professionals were more likely to believe the following circumstances made living with HIV/AIDS in a rural community difficult: long distances to medical facilities and personnel, lack of employment opportunities and unsupportive work environments, and a shortage of psychologists, social workers, and mental health counselors. Health care and nonhealth care personnel also showed high levels of agreement regarding ways to improve the quality of life among rural persons with AIDS. Quality of life strategies rated as most promising included ensuring that instrumental support and daily assistance is readily available, teaching HIV-affected persons coping and problem-solving skills, and conducting weekly face-to-face support groups for persons living with HIV/AIDS. These findings provide useful information for strategies to improve the life circumstances of persons living with HIV/AIDS in rural areas.     

中国城市妇女AIDS知识 态度 行为情况调查

目的　了解中国城市妇女对艾滋病 (AIDS)知识、态度及行为现况 ,为制定中国妇女预防与控制AIDS的工作方针与策略提供依据。方法　随机选择 8个AIDS流行率不同的省 ,采取分层整群抽样方式 ,每省抽取 1个城市的 15～ 49岁城市妇女 10 0人 ,共计 80 0人。主要了解中国城市妇女AIDS相关知识、态度、行为的现况 ,AIDS流行及潜在的危险行为因素等。结果　有效表 792份 ( 99 0 % )。 ( 1) 90 %以上的调查对象对性交和输血途径传播AIDS有正确认识 ,而 2 0 %调查对象对母婴传播途径缺乏认识 ;近 1/ 2的调查对象对蚊虫叮咬、干吻等非传播途径存在错误认识 ;( 2 )对艾滋病病毒感染者 (HIV)是否需要隔离 ,是否应继续学习或工作 ,回答正确率仅为 2 7 1%和5 5 3 % ,表明人们对AIDS存在歧视甚至恐惧认识 ;( 3 ) 6 9%的调查对象认为少量毒品对人无危害 ;11 9%的调查对象周围有朋友吸毒 ;0 4%的调查对象明确表示吸毒 ;0 7%的调查对象有吸毒史 (其中 0 0 8%静脉吸毒 ) ;0 7%调查对象的丈夫有吸毒史 (其中 0 0 4%为静脉吸毒 ) ;( 4) 1 1%的调查对象有婚外性伴侣 ;2 5 %拒绝回答该问题 ;( 5 )有 77 7%的调查对象采取宫内节育器及结扎等避孕措施 ,仅 6 2 %调查对象每次性生活都用安全套 ;( 6) 10 8%的调查对象存在生     

Changing trends in human immunodeficiency virus and acquired immunodeficiency syndrome in the population aged 50 and older

OBJECTIVES: To alert persons in the public and private healthcare professions to the increasing trends in higher proportions of persons aged 50 and older who are newly diagnosed with human immunodeficiency virus (HIV) and who are living with HIV and acquired immunodeficiency syndrome (AIDS). DESIGN: Data from the period 1992 through 2004 from the HIV/AIDS Reporting System (HARS) were analyzed. SETTING: New Jersey is the eleventh-most-populous state, with the highest density of persons per square mile. It also has the fifth-highest number of AIDS cases. PARTICIPANTS: All persons residing in New Jersey and reported to HARS with HIV infection or who are considered to have AIDS. MEASUREMENTS: Trends in persons aged 50 and older were compared with those in the population younger than 50 during 1992 through 2004 for the numbers of persons living with HIV/AIDS and the number of persons newly diagnosed with HIV infection. RESULTS: The proportion of all persons aged 50 and older living with HIV/AIDS in 2004 was significantly greater than the comparable proportion of persons in 1992. Proportionally, more persons were newly diagnosed with HIV who were aged 50 and older according to sex and for each of the three major race or ethnicity groups (white non-Hispanic, black non-Hispanic, and Hispanic) than were persons younger than 50. Each of these increases was statistically significant. CONCLUSION: HIV/AIDS social marketing campaigns should include images and issues related to older persons in educational and prevention efforts. New methods that reach older populations should be considered. Physicians and other healthcare providers should be made aware of their role in prevention and education about HIV. Testing of older populations with risk factors should be encouraged.     

影响地方领导开展艾滋病防治工作的相关因素及领导力建设模式研究

目的了解影响地方多部门领导开展艾滋病防治工作的相关因素,探索适合中国国情的防治艾滋病领导力建设的可行性模式。方法采用定性研究的方法,对2省15县市地方领导共47人,分为卫生和非卫生部门两组进行个人深入访谈及专题小组讨论。结果影响地方领导开展艾滋病防治工作的相关因素包括外部和内部两方面。外部影响因素分为部门共同及特殊影响因素两类,如主要领导的重视程度、政策的可操作性和实效性等;内部影响因素两组的共性是,因缺乏明确的针对个人和部门的考核评估机制而导致的自我激励机制的缺乏等,2个省情况基本一致。防治艾滋病领导力建设的培训,应针对不同性质的领导在培训内容、方法和时间上区别对待,突出艾滋病与执政的关系。防治艾滋病领导力建设的模式,除通过目前培训的短期行为外,还需配合实施和评估等长期综合措施。结论地方领导开展艾滋病防治工作在不同程度上受到内外多种因素的影响和制约。防治艾滋病领导力建设的培训可采用"目的分层"的策略。领导力建设的模式应建立培训-实施-评估的长效机制。     

Impact of accelerated progression to AIDS on public health monitoring of late HIV diagnosis

Some patients develop AIDS within a year of HIV infection ("accelerated progression"). Classifying such cases as late HIV diagnosis may lead to inaccurate evaluation of HIV testing efforts. We sought to determine this group's contribution to overall late diagnosis rates. To identify cases of accelerated progression (development of AIDS within 12 months of a negative HIV test), we reviewed published HIV seroconverter cohort studies and used New York City's (NYC) HIV/AIDS surveillance registry. From the literature review, three seroconverter cohort studies revealed that 1.0-3.6% of participants had accelerated progression to AIDS. Applying this frequency estimate to the number of new infections in NYC (4762) for 2006 calculated by the Centers for Diseases Control and Prevention's incidence formula, we estimated that 3.6-13.0% of 1317 NYC HIV cases who are diagnosed with AIDS within 12 months of HIV diagnosis are accelerated progressors, not persons HIV infected for many years who did not test and present with AIDS (i.e., delayed diagnosis). In addition, our analysis of the 2006 NYC surveillance registry confirmed the occurrence of accelerated progression in a population-based setting; 67 accelerated progressors were reported and 9 (13%) could be confirmed through follow-up medical record review. With increased HIV testing initiatives, the irreducible proportion of AIDS cases with accelerated progression must be considered when interpreting late diagnosis data.     

517名外训军人HIV/AIDS感染监测分析

目的 了解军队外训人员HIV感染状况,防止AIDS传入部队。方法 外训军人进入我军部队1周内抽血,抗-HIV检测分初筛和确认两步进行。结果 517名外训人员中检出7例抗-HIV阳性(1.35％),其中6例来自赞比亚,1例来自坦桑尼亚。结论 应加强对外训人员抗-HIV检测,控制AIDS传入部队。