Lactic acidosis in HIV patients receiving highly active antiretroviral therapy

Exposure to highly active antiretroviral therapy (HAART) may lead to adverse effects related to mitochondrial toxicity such as lactic acidosis. We describe two cases of severe lactic acidosis in HIV-positive patients to illustrate the clinical symptoms and abnormal laboratory results associated with this condition. There is a lack of awareness about the risk factors for developing severe lactic acidosis and recognition of its onset with dire consequences.     

高效抗逆转录病毒治疗时代的免疫重建问题

HIV感染引起以细胞免疫缺陷为主的免疫损伤。抗HIV治疗的最终日标是产生特异性的抗病毒免疫反应以清除病毒。高效抗逆转录病毒治疗(HAART)改变了HIV感染的进程，改善了患者的生活质量和预后。但HAART在多大程度上恢复了患者的免疫功能，以及在应用HAART的条件下如何促进免疫重建，均是亟待深入研究的问题。     

Cytomegalovirus retinitis in the era of highly active antiretroviral therapy

A number of striking changes have occurred recently in the presentation and course of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) who are receiving highly active antiretroviral therapy (HAART). Before the use of HAART, CMV retinitis was the most common intraocular infection in patients with AIDS, occurring in up to 40% of patients, typically when CD4+ cell counts have decreased to less than 0.10 x 10(9)/L. By studying CMV retinitis, clinicians can investigate whether the rejuvenated immune system that results from HAART can effectively control opportunistic infections in patients with AIDS. In some patients, retinitis has not progressed when specific anti-CMV therapy was discontinued, but a number of patients have developed substantial intraocular inflammation, which has resulted in decreased visual acuity. Anterior uveitis, cataract, vitritis, cystoid macular edema, epiretinal membrane, and disc edema may occur in patients with CMV retinitis who have experienced HAART-associated elevation in CD4+ cell counts. Since immune recovery uveitis does not occur in eyes without CMV retinitis, the ocular inflammation appears to be related to the CMV infection. Anti-CMV maintenance therapy likely can be safely discontinued in some patients with CMV retinitis if CD4+ cell counts are stable or increasing and have been higher than 0.10 x 10(9)/L for at least 3 months. Immune recovery in patients receiving HAART has been effective in controlling opportunistic infections, but it may also result in intraocular inflammation, which can have adverse effects on the eye.     

高效抗逆转录病毒治疗HIV感染女性围产期及妊娠结局分析

目的 了解经高效抗逆转录病毒治疗HIV产妇围产期合并症、并发症及预后情况.方法 收集2016年1月一2020年1月合浦县人民医院(69例)、广西壮族自治区妇幼保健院妇产科(36例)收治的105例经高效抗逆转录病毒治疗≥1年HIV孕妇的临床基本资料,另外随机选择同时期两家医院(合浦县人民医院70例,广西壮族自治区妇幼保健...     

Ten years of highly active antiretroviral therapy for HIV infection

Over the past 10 years, the management of HIV infection has been transformed by an increased number of effective antiretrovirals (ARVs), with more convenient dosing and improved tolerability. Optimal management of HIV infection includes at least three effective ARVs; from at least two different drug classes. Current strategies and drugs can effectively control HIV and significantly reduce morbidity and mortality. However, no cure is yet possible. Appropriate use of ARVs leads to suppression of virological replication (to below the limit of detection using commercial assays to measure HIV in plasma) and an increase in CD4(+) T cells with few adverse effects. Greater than 95% adherence to drug therapy is required for effective viral suppression and immunological improvement. Monotherapy, two-drug combinations, sequential ARVs, drug "cycling", and treatment interruptions are ineffective management strategies and lead to earlier disease progression and emergence of drug resistance. Drug-drug interactions are common and caution is required when prescribing ARVs that inhibit or induce the cytochrome P450 pathway.     

HAART治疗儿童的HIV-1基因型耐药变异情况

目的研究我国某地区HAART治疗的儿童HIV-1基因型耐药变异情况,为临床治疗HIV-1感染儿童提供参考实验室参考数据。方法利用RT-PCR和套式PCR从20例HAART治疗失败的HIV-1感染儿童的血浆中提取的病毒RNA扩增HIV-1逆转录酶基因（RT）第40-250位氨基酸,直接将PCR产物进行序列测定分析,利用斯坦福大学网站提供的HIVdb数据库分析该两个区域的耐药基因变异情况。结果（1）20例患儿根据RT区基因分型结果显示均为B亚型;（2）分别有20、15、13例患儿对NVP、DLV和EFV产生了高度耐药;分别有7例、5例患儿对AZT产生了高、中度耐药;有5例患儿对3TC产生了从潜在低度一中度耐药突变,而有11例患儿出现了高度耐药突变;针对d4T、ddI的中、高度耐药共占11／20;此外,19例患儿出现了针对从未服用的ABC的不同程度的耐药突变,12例患儿出现了针对TDF的不同程度的耐药突变。结论HIV-1耐药突变株的出现是儿童抗病毒治疗失败的主要原因之一。对于正在抗病毒治疗中的HIV-1患儿,应及时进行耐药变异监测,及早发现耐药变异。及时改变抗病毒治疗药物以达到真正的病毒抑制效果。     

重庆市男男性行为人群艾滋病患者抗病毒治疗效果分析

目的：了解重庆市男男性行为（MSM）人群艾滋病患者抗病毒治疗基本情况,评估不同基线CD4＋T淋巴细胞数水平的抗病毒治疗效果。方法在国家艾滋病综合防治信息系统中收集资料,以患者开始治疗时基线CD4＋T淋巴细胞数水平分类,采用回顾性队列研究方法观察和评估治疗效果,数据运用SPSS18．0软件进行统计分析。结果1758例治疗患者平均年龄（33．5±11．1）岁,CD4＋T＜50个／μL、50～199个／μL、200～350个／μL、＞350个／μL者分别占7．7％、27．6％、54．9％、9．7％,治疗12个月后CD4＋T值分别维持在150～250个／μL、250～350个／μL、350～450个／μL、450～550个／μL,治疗6个月后病毒载量抑制比例分别为70．2％、81．7％、84．2％、83．3％,治疗36个月生存率分别为0．81、0．93、0．98、1．00。结论MSM人群艾滋病抗病毒治疗取得显著效果,早期治疗更有利于该人群免疫功能恢复,降低艾滋病病死率,控制疫情。     

24个月抗艾滋病病毒治疗效果的初步评价

目的观察人类免疫缺陷病毒1型（HIV-1）感染者经24个月高效抗逆转录病毒治疗（HAART）的抗病毒效果、免疫重建效果和毒副反应。方法27例HIV-1感染者以去羟肌苷、司他夫定和奈韦拉平治疗24个月,分别在治疗前,治疗后3、6、12、18和24个月时采血检测血浆HIVRNA病毒载量,检测外周血CD3^＋CD4^＋、CD3^＋CD8^＋淋巴细胞数,CD4^＋CD45RA^＋CD62L^＋纯真细胞数,CD4^＋CD45RO^＋记忆细胞数,CD8^＋CD38^＋激活淋巴细胞数和CD8^＋CD38^＋／CD3^＋CD8^＋百分比;并观察药物的毒副反应、血常规和主要生化指标的变化,以及发生的不良事件。结果27例HIV-1感染者在24个月的治疗中,病毒学和各项免疫学指标均有明显改善,其变化以3或6个月时较显著,24个月时上述各项检测指标均未达到正常对照组数值。其中19例感染者先后出现过消化道反应、周围神经炎、皮疹、腹痛、头痛、发热和脱发等毒副反应,有21例感染者发生过血相异常、肝功能或肾功能变化、血脂异常以及γ-谷氨酰转肽酶和淀粉酶升高等。有3例感染者先后因Ⅲ级外周神经炎和疑为乳酸中毒而改药。结论HIV-1感染者经去羟肌苷、司他夫定和奈韦拉平治疗24个月,显示了较好的抗病毒效果和免疫重建效果。但药物的副反应较多。     

Cardiovascular disease risk factors among HIV-infected Nigerians receiving highly active antiretroviral therapy

Background:

Highly active antiretroviral therapy (HAART) has become more accessible to Human immunodeficiency virus infection/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients worldwide. There is growing concern that the metabolic complications associated with HIV and HAART may increase cardiovascular risk and lead to cardiovascular diseases. We, therefore, set out to describe the cardiovascular risk profile of HIV/AIDS patients receiving HAART at a health facility in northern part of Nigeria.

Materials and Methods:

This cross-sectional study was conducted at the Aminu Kano Teaching Hospital, Kano, Nigeria. Consenting patients, who had been receiving HAART, were compared with age and sex matched HAART-naive subjects. Questionnaire interview, electrocardiography, anthropometric and blood pressure measurements were conducted under standard conditions. Blood samples were obtained for the determination of plasma glucose, uric acid and lipid levels.

Results:

Two hundred subjects were studied, 100 were on HAART (group 1) and the other 100 (group 2) were HAART-naive. Subjects’ mean age for all the participants was 32.5 (7.6) years. The prevalence of hypertension was 17% in group 1 and 2% in group 2 (P < 0.001). Similarly, 11% and 21% of group 1 subjects were obese or had metabolic syndrome compared with 2% and 9% of group 2 patients (P < 0.05 for both).

Conclusion:

HAART treatment was associated with significantly higher prevalences of hypertension, obesity and metabolic syndrome.     

高效抗逆转录病毒治疗对AIDS患者MCP-1和MSP水平的影响

目的:研究高效抗逆转录病毒治疗(HAART)对AIDS患者血清中MCP-1、MSP水平的影响。方法:采用ELISA法检测40例经HAART3个月的国内AIDS患者及84例经HAART3至6年的德国患者血清MCP-1、MSP的水平,荧光定量PCR测定HIV-RNA滴度,流式细胞术检测CD4 T细胞计数。结果:HIV-1感染者血清MCP-1的水平显著高于正常人群(P<0.01),MSP则显著低于正常人群(P<0.01);经短期HAART(3月)后,MCP-1水平下降(P<0.01),MSP无明显改变;长期HAART(3至6年)后MCP-1水平显著升高(P<0.01),而MSP显著下降(P<0.01),MCP-1和MSP水平的变化呈负相关(r=-0.99,P=0.029)。结论:MCP-1、MSP与AIDS病程进展有密切关系,HAART对AIDS患者MCP-1、MSP水平有显著的改变,进而改善患者病程进展。     

Spontaneous regression of HIV associated T-cell non-Hodgkin's lymphoma with highly active antiretroviral therapy

A subcutaneous, T-phenotypic anaplastic large cell lymphoma (CD30/Ki1-positive, EBV positive) was diagnosed in a HIV-infected bisexual man. Without chemotherapy the patient had a sustained long-term remission of this tumor (more than three years) after the initiation of highly active antiretroviral therapy. By PCR analysis of T-cell receptor beta gene rearrangements the tumor was found to be oligoclonal. Improvement of cellular immune function by antiretroviral therapy is the only recognizable factor which may have led to tumor remission. This hypothesis is supported by parallels to EBV associated polyclonal lymphoproliferation in allogeneic transplantat recipients where regression of lymphoma can be induced by reducing immunosuppressive therapy.     

高效联合抗反转录病毒治疗艾滋病失访患者访谈分析

目的 探讨影响艾滋病抗病毒治疗患者失访发生的相关因素,为管理HIV/AIDS患者提供依据.方法 以2018年1月-2018年12月在南宁市第四人民医院进行艾滋病抗病毒治疗失访患者为研究对象,采用自行设计的问卷,以半结构化访谈的方式对失访患者的艾滋病药物/艾滋病治疗的相关知识、按时服药的信心以及失访的原因三个维度进行调查...     

艾滋病患者抗艾滋病毒治疗免疫学和病毒学失败情况分析

摘要：目的了解河北省艾滋病患者抗病毒治疗过程中病毒学失败和免疫学失败情况,为开展二线药物治疗工作提供依据。方法对河北省接受免费抗病毒治疗的病人进行免疫学和病毒学随访检测,分析其病毒学失败率,免疫学失败率和相关影响因素。结果63例病人中免疫学失败率为46．03％,病毒学失败率为58．73％,免疫学和病毒学均失败率33．33％。结论各级卫生部门应加强对艾滋病病人的随访和耐药检测,通过及时优化治疗方案、提高病人服药依从性等措施,进一步提高抗病毒治疗效果。     

湖南省衡阳市2004-2009年艾滋病抗病毒治疗情况分析

目的评估和预测湖南省艾滋病抗病毒治疗状况和治疗效果。方法 2010年6月对衡阳市接受艾滋病抗病毒治疗的病人进行调查,除去因各种原因无法做调查者外,共调查到223人,均为抗病毒治疗12个月以上且仍在治疗的病人。对其进行病毒载量检测和CD4+T淋巴细胞计数,并对结果进行分析。结果按患者开始治疗的年份将患者分为6组(2004-2009年治疗组),比较各组在不同CD4+T淋巴细胞水平(<200个/μl、200~350个/μl、>350个/μl)及病毒载量水平(<103拷贝/μl、103~104拷贝/μl、>104拷贝/μl)时的患者比例。结果显示:2004-2009年各组患者CD4+T淋巴细胞水平<200个/μl的人数比例分别为0、5.9%、10.0%、15.0%、29.9%和28.6%,治疗时间越长,CD4+T淋巴细胞水平<200个/μl的患者人数比例越低;但2004-2009年各治疗组患者在不同病毒滴度时人数比例的差异无统计学意义。病毒载量较低(<103拷贝/μl)的感染者中,CD4+T淋巴细胞>350个/μl人数比例较高(104,52.0%),而随着病毒载量水平的上升,CD4+T淋巴细胞<200个/μl的患者比...