HIV p24抗原的检测及意义

艾滋病 (ＡｃｑｕｉｒｅｄＩｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙＳｙｎｄｒｏｍｅ ,ＡＩＤＳ)在全球广泛流行 ,亚洲是继北美、非洲之后成为全球ＨＩＶ (ＨｕｍａｎＩｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙＶｉｒｕｓ)感染上升最迅速、流行最严重的地区之一。我国ＡＩＤＳ也呈加速流行的趋势 ,截止到 2 0 0 0年 9月 ,共报告ＨＩＶ感染者 2 0 711例。据专家估算 ,我国实际感染人数超过 60万人。ＨＩＶ主要通过性、母婴和血液三种途径传播。为监控流行情况 ,评价新的疫苗和药物 ,建立简便、灵敏、特异的检测方法特别关键。理想的检测试剂应该是拥有一套…     

Early diagnosis of vertical HIV infection in infants by rapid detection of immune complex-dissociated HIV p24 antigen

Conventional HIV antibody detection was problematic for diagnosis of HIV infection in young infants < 18 months of age who were born to HIV-infected mothers. The HIV p24 antigen (Ag) is mainly bound to the antibody as an immune complex which causes underdetection by conventional methods. Attempts were made to dissociate these immune complexes to release free p24 Ag for detection. The current study's objective was to evaluate the rapid assays for detection of immune complex-dissociated p24 Ag (ICD p24 Ag) for early identification of HIV-infected infants as compared to the detection of HIV RNA by polymerase chain reaction (PCR) assay. The ICD was performed by acid dissociation and heat-denatured dissociation, and then the released ICD p24 Ag were detected. Tested were 41 HIV-infected children who acquired the infection perinatally and who had positive PCR and 30 HIV noninfected children with negative PCR. The overall sensitivity of the ICD p24 Ag detection after acid- and heat-denatured dissociation in the infected children was 85.4% and 87.8%, respectively, compared to 34.2% of p24 Ag without pretreatment for dissociation of the serum samples. The specificity of nonimmune complex dissociation and both methods of immune complex dissociation test were 100%. The sensitivity of ICD-p24 Ag test using these two methods showed excellent agreement (K = 0.893). Besides the relatively high sensitivity and specificity of the ICD p24 Ag test, its advantages include simplicity, rapidity, and relatively low cost--indicating ICD p24 Ag detection as a promising method for early diagnosis of vertical HIV infection in infants.     

Acceptance of HIV Testing by Substance-Abusing Individuals

Routine HIV (human immunodeficiency virus) testing of high-risk groups (i.e., substance-abusing individuals) could help decrease the spread of AIDS (acquired immune deficiency syndrome). Such a policy, however, could deter individuals from entering treatment, paradoxically increasing the likelihood of the disease being spread. The authors examined the willingness of substance-abusing individuals to consent to HIV testing by randomly assigning patients entering either a drug-free outpatient program or a methadone maintenance program to one of three informed consent conditions differing in degree of perceived coerciveness. Overall, 69% of the patients agreed to testing. As hypothesized, the proportion of agreement was highest under the most coercive informed consent condition. Although the results tend to support continuation of voluntary testing programs, only 5.5% of patients asked indicated that mandatory testing would have deterred them from entering treatment.     

Bone Changes and Fracture Risk in Individuals Infected With HIV

The life expectancy of individuals infected with HIV has improved greatly since the institution of combination antiretroviral therapy. However, many metabolic derangements have been discovered with long-term combination antiretroviral treatment, including lipodystrophy; insulin resistance; and, more recently, abnormal bone metabolism. It is well-documented that bone mineral density (BMD) in HIV-positive patients is lower compared with the expected BMD in non–HIV-positive patients. The underlying cause of lower BMD is unknown but is thought to be a multifactorial process. Conflicting evidence exists regarding the effect of antiretroviral exposure and duration of treatment, antiretroviral type, and cumulative HIV viral exposure on bone health. Here we review the bone changes that occur with HIV infection and treatment.     

HPTN 062: A Feasibility and Acceptability Pilot Intervention to Reduce HIV Transmission Risk Behaviors Among Individuals with Acute and Early HIV Infection in Lilongwe,Malawi

Acute HIV infection (AHI) is a relatively brief period of time when individuals are highly infectious and the opportunity to intervene to prevent forward transmission is extremely limited. HPTN 062 partnered with CHAVI 001 to evaluate the feasibility and acceptability of a motivational interviewing (MI)-based counseling intervention to reduce HIV-transmission risk behaviors among individuals with acute and early HIV infection in Lilongwe, Malawi. Participants were randomized to receive either (1) brief education sessions about HIV and AHI; or (2) the same brief education sessions plus an MI-based counseling intervention called Uphungu Wanga. Although Uphungu Wanga was determined to be feasible and acceptable, few major differences existed between the two arms with regard to acceptability, feasibility, and self-reported sexual behaviors. We therefore conclude that an additional MI-based counseling intervention may not be needed during the short period of AHI. Instead, we recommend that individuals with AHI receive frequent, but brief, counseling immediately after diagnosis and then transition to receiving counseling at less frequent intervals until they can initiate antiretroviral therapy. Other recommendations are provided.     

Comparing Immune Responses to Inactivated Vaccines against SARS-CoV-2 between People Living with HIV and HIV-Negative Individuals: A Cross-Sectional Study in China

This study compared the immunogenicity of inactivated SARS-CoV-2 vaccines between people living with HIV (PLWH) and HIV-negative individuals. We recruited 120 PLWH and 53 HIV-negative individuals aged 18–59 years who had received an inactivated SARS-CoV-2 vaccine in two Chinese cities between April and June 2021. Blood samples were tested for immunogenicity of the inactivated SARS-CoV-2 vaccines. The prevalence and severity of adverse events associated with SARS-CoV-2 vaccines were similar between PLWH and HIV-negative individuals. The seropositivity of neutralizing activity against authentic SARS-CoV-2, of the total amount of antibody (total antibody) and of S-IgG were 71.3%, 81.9%, and 92.6%, respectively, among fully vaccinated PLWH. Among all participants, PLWH had lower neutralizing activity, total antibody, S-IgG, and T-cell-specific immune response levels, compared to HIV-negative individuals, after controlling for types of vaccine, time interval between first and second dose, time after receiving the second dose, and sociodemographic factors. PLWH with a longer interval since HIV diagnosis, who received their second dose 15–28 days prior to study commencement, and who had an interval of ≥21 days between first and second dose had higher neutralizing activity levels. The immunogenicity of the inactivated SARS-CoV-2 vaccines was lower among PLWH as compared to HIV-negative individuals. Vaccination guideline specific for PLWH should be developed.     

对山东省艾滋病病毒感染者管理工作的探讨

对HIV感染者的管理是艾滋病防制工作的重要组成部分.山东省在对HIV感染者的管理中,实施了健康教育、健康咨询、定点医疗服务和血清监测等措施,积累了一定的经验,发现了不少问题.我们认为加强立法,充分发挥政府的督导作用以增进多部门间的协作是实施对HIV感染者有效管理的重要环节,有效的健康教育能增强公众的预防意识,减少对HIV感染者的歧视,必要的保密措施和良好的医患关系均有利于对HIV感染者的管理.     

Prevalence and Persistence of TT Virus DNA in HIV1-Infected Individuals

Background: TT virus (TTV) is a recently discovered virus with a high DNA prevalence in different populations. Its role in pathogenesis is uncertain, particularly in immunocompromised patients.Patients and Methods: Prevalence of TTV-DNA was evaluated in a cohort of HIV-infected patients and in blood donors by nested PCR, using two different primer sets: T primers, derived from the open reading frame ORF1 region N22; B primers, derived from the untranslated region (UTR). Samples positive using T primers were also tested for TTVDNA in peripheral blood mononuclear cells (PBMC) and followed up every 4 months.Results: The overall prevalence of TTV-DNA in HIV-infected patients was 37/376 (9.8%) using T primers and 223/333 (67%) using B primers; prevalence was higher in males (167/237, 70.5% vs 56/96, 58.3%; p = 0.033) and sub- Saharan Africans (22/23, 95.6% vs 201/310, 64.8% in other areas). Discordance was also observed in blood donors: 3.8% prevalence using T primers and 51.4% using B primers (also higher in males: 57% vs 37%, p = 0.056). TTV-DNA was detected in PBMC in 20/23 (87%) TTV-positive sera. Twothirds of the serum samples remained positive over a 2-year follow-up period.Conclusion: TTV-DNA prevalence is higher when detected with primers derived from the UTR region and was highest in male and HIV-infected sub-Saharan Africans. TTV-DNA is frequently isolated in PBMC and chronic infection is common.     

A Relationship-Based Framework of Spirituality for Individuals with HIV

Twenty HIV-positive individuals (10 male, 10 female) participated in interviews on their spiritual life. Interview themes suggest that the HIV diagnosis facilitated a relationship-based framework of spirituality. Relationships that formed this framework were: relationship with God/Higher Power, renewed engagement with life, and relationship with family. Within ‘‘relationship with God/Higher Power,’’ subthemes included gratitude for God's benevolent influence, spiritual struggles, and building connections with their Higher Power. Self care, transformation of life goals, and accepting mortality were subthemes for ‘‘renewed engagement with life.’’ Subthemes within ‘‘relationship with family’’ included finding a sense of purpose, finding support through families, and families as a source of strain. Overall, results suggest that interventions that integrate spirituality need to consider a notion of spirituality that goes beyond church attendance, prayer, and Bible reading. These interventions must include the positive aspects of spirituality and spiritual struggles that individuals with HIV may experience.     

Strategies Used in the Detection of Acute/Early HIV Infections. The NIMH Multisite Acute HIV Infection Study: I

Acute/early HIV infection plays a critical role in onward HIV transmission. Detection of HIV infections during this period provides an important early opportunity to offer interventions which may prevent further transmission. In six US cities, persons with acute/early HIV infection were identified using either HIV RNA testing of pooled sera from persons screened HIV antibody negative or through clinical referral of persons with acute or early infections. Fifty-one cases were identified and 34 (68%) were enrolled into the study; 28 (82%) were acute infections and 6 (18%) were early infections. Of those enrolled, 13 (38%) were identified through HIV pooled testing of 7,633 HIV antibody negative sera and 21 (62%) through referral. Both strategies identified cases that would have been missed under current HIV testing and counseling protocols. Efforts to identify newly infected persons should target specific populations and geographic areas based on knowledge of the local epidemiology of incident infections.     

Suppression of HIV p24 antigen and induction of HIV anti-p24 antibody by alpha interferon in patients with chronic hepatitis B

Five HIV p24 antigen (p24Ag)-positive patients received alpha interferon during trials of therapy for hepatitis B. Four of these showed marked falls in p24Ag during treatment. One of the two patients who became p24Ag-negative [corrected] developed anti-p24 antibodies (anti-p24). Five out of nine p24Ag-negative HIV-antibody-positive patients showed a rise in anti-p24 titres during interferon therapy, whereas only two out of six untreated controls showed a similar rise. This study provides evidence that alpha interferon has anti-HIV activity in vivo.     

Anti-p53 antibodies and p53 protein expression in cholangiocarcinoma

BACKGROUND/AIMS: Mutations of p53 are found in the majority of human malignancies. The accumulated mutant p53 can be detected in tumor sections by immunohistochemical methods. The abnormal accumulation of the defective p53 protein can induce the host to develop anti-p53 antibodies in sera of cancer patients. This study aimed to investigate the presence of anti-p53 antibodies in sera of patients with cholangiocarcinoma and to evaluate the correlation between such antibodies and p53 protein accumulation. METHODOLOGY: The presence of serum anti-p53 antibodies in 49 patients with cholangiocarcinoma was determined by ELISA kit (Pharma Cell, France). Immunohistochemical detection of p53 protein expression was examined in available tissue samples of 36 patients. RESULTS: Serum anti-p53 antibodies were detected in 6 of 49 patients with cholangiocarcinoma (12.2%). Immunostaining of p53 was found in 15 of 36 patients (41.6%) and 4 of these 15 patients (26.7%) were positive for anti-p53 antibodies. The association between anti-p53 antibodies and p53 protein expression was statistically significant (P=0.023). No correlation was found between the presence of anti-p53 antibodies and sex, age, histological grade, site and stage of tumor (P>0.05). CONCLUSIONS: The majority of serum anti-p53 antibodies detected in cholangiocarcinoma were specifically associated with the accumulation of p53 protein in tumor tissues. However, antibody generation against the p53 protein is a relatively uncommon event in cholangiocarcinoma.     

Therapist's Expectations of Psychotherapy Duration for Individuals Living with HIV

Abstract

Data were collected from 102 psychotherapists providing mental health care to individuals living with HIV at a mental health clinic in the Southeastern United States, for the purpose of assessing the perceptions of therapists with regard to necessary therapy duration for a range of mental health issues and disorders. Analyses were conducted to explore the extent to which therapists perceived the need for different therapy durations for individuals living with HIV rather than those who had not received such a diagnosis. Across all mental health issues assessed, therapists indicated a greater need for therapy duration when an HIV diagnosis was also present, and this generally was consistent without regard to therapist education, demographics, or therapeutic orientation. Given the extent to which mental health care is often a routine component of the HIV social services infrastructure, the findings of this study have important implications for mental health providers, mental health training programs, and the staff and volunteers of other HIV-related organizations.     

Genetic Testing for Early Detection of Individuals at Risk of Coronary Heart Disease and Monitoring Response to Therapy: Challenges and Promises

Coronary heart disease (CHD) often presents suddenly with little warning. Traditional risk factors are inadequate to identify the asymptomatic high-risk individuals. Early identification of patients with subclinical coronary artery disease using noninvasive imaging modalities would allow the early adoption of aggressive preventative interventions. Currently, it is impractical to screen the entire population with noninvasive coronary imaging tools. The use of relatively simple and inexpensive genetic markers of increased CHD risk can identify a population subgroup in which benefit of atherosclerotic imaging modalities would be increased despite nominal cost and radiation exposure. Additionally, genetic markers are fixed and need only be measured once in a patient's lifetime, can help guide therapy selection, and may be of utility in family counseling.     

Detection of HIV in haemopoietic progenitors

Peripheral blood cytopenias present a major problem in the management of patients with HIV infection. Their pathophysiology is likely to be multifactorial, although there is controversy as to whether haemopoietic progenitors are a target for HIV. In order to investigate the haemopoietic defect in HIV infection, we looked at bone marrow culture characteristics of marrow from eight HIV+ patients compared to normal controls. We performed long-term liquid culture (LTC) and colony forming assays for granulocyte-macrophage (CFU-GM) and granulocyte, erythroid, megakaryocyte, macrophage (CFU-GEMM). In LTC we found normal stromal appearance and haemopoietic focus formation. There was no difference in colony assays of CFU-GM and CFU-GEMM between HIV+ and normal controls. Colonies taken from CFU-GM and CFU-GEMM were analysed for HIV DNA sequences, and we were able to detect HIV DNA in colonies from all HIV+ patients. Our results indicate that despite infection of haemopoietic progenitor cells by HIV, bone marrow function is preserved. This suggests that HIV-related cytopenias may be due to alternative mechanisms not present in our in vitro system.     

Prognostic significance of quantitative levels of HIV p24 binding capacity in HIV infection

Human immunodeficiency virus, type 1 (HIV-1), produces a chronic infection with a long latency before clinical disease. We followed 214 untreated subjects for 12-42 months to study the natural history of HIV infection: 110 were classified as asymptomatic, 11 as AIDS-related complex (ARC), 15 as AIDS with Kaposi's sarcoma (KS), 31 as AIDS with opportunistic infections (AIDS/OI), and 47 were HIV-seronegative controls. The quantitative capacity of serum to complex HIV p24 antigen, termed the p24 binding capacity (p24 BC), and quantitative levels of HIV p24 antigen in serum were determined at regular intervals. For people in all diagnostic groups, a p24 BC below 31 ng/ml was more closely associated with progression to AIDS/OI than was p24 antigen positivity; 94% of AIDS/OI, 86% of ARC, 56% of AIDS/KS, and 19% of asymptomatic subjects had p24 BC less than 31 ng/ml during the study period, while 67% of AIDS/OI, 27% of ARC, 61% of AIDS/KS, and 20% of asymptomatic subjects were p24 antigenemic. Prospective analysis of 47 asymptomatic seropositive men followed for 3 years, who showed actuarial progression rates to ARC at 4%, 13%, and 23% and to AIDS at 5%, 8%, and 8% at 1, 2, and 3 years, indicated that entry levels of p24 BC below 31 ng/ml were as strongly associated with progression to ARC/AIDS as was p24 antigenemia (p = 0.0003 vs. p = 0.008). The p24 binding capacity assay is a new and convenient methodology to measure immunocomplexing antibody to HIV p24 and is a powerful indicator of progressive HIV disease.     

Detection of circulating p24 antigen-positive CD4+ cells during HIV infection by flow cytometry.

OBJECTIVES: To determine the amount of circulating CD4+ cells positive for intracellular p24 antigen during HIV infection, and to correlate the results with clinical, virological and therapeutic parameters. METHODS: Data were obtained from 24 anti-HIV-negative subjects (controls) and 47 anti-HIV-positive patients classified according to clinical diagnosis, serum p24-antigen assay results, and antiretroviral treatment with zidovudine, using a modified flow cytometric assay for the detection of intracellular HIV p24 antigen (p24-FCA) in circulating CD4+ lymphocytes. RESULTS: The proportion of CD4+ lymphocytes positive for p24-FCA correlated well with HIV infection (1.685 +/- 1.902 versus 0.160 +/- 0.152 in controls; P < 0.001) and clinical progression [Centers for Disease Control (CDC) stage II: 1.310 +/- 1.187; CDC stage III 1.145 +/- 1.442; CDC stage IVA/C2: 2.335 +/- 2.112; CDC stage IVC1: 2.066 +/- 2.420]. The percentage of CD4+ cells positive for HIV p24-FCA was inversely correlated with an absolute peripheral blood CD4+ lymphocyte count (Spearman's rank correlation = -0.324; P < 0.05). However, there was no statistically significant difference between patients in presence (n = 27; 1.938 +/- 2.095) or absence (n = 20; 1.343 +/- 1.594) of serum p24 Ag. The variable linked most strongly to the detection of intracellular p24 in anti-HIV-positive patients was zidovudine treatment: the proportion of p24-FCA-positive CD4+ lymphocytes was significantly lower (0.825 +/- 0.910) in the treated patients (n = 25) than in the untreated patients (n = 22; 2.662 +/- 2.248; P < 0.001). CONCLUSIONS: Our results suggest that CD4+ p24 Ag-FCA is a rapid and easy test for the identification of the proportion of CD4+ lymphocytes with intracellular p24 Ag, and that it could be more appropriate than serum p24 Ag assay in evaluating disease progression and efficacy of antiretroviral treatment.