人类免疫缺陷病毒感染相关皮肤病及其治疗

人类免疫缺陷病毒(HIV)为RNA逆转录病毒,主要感染CD4⁺细胞,导致免疫功能破坏,产生机会性感染、恶性肿瘤等,当CD4⁺细胞计数每mm³低于200个或出现某些临床疾病时,感染者进展为艾滋病(AIDS).HIV感染并发皮肤病主要包括感染性疾病(病毒、细菌、真菌感染)和非感染性疾病及肿瘤等,治疗HIV感染本身也会发生皮肤表现^[1],其中部分皮肤病仅见于HIV阳性个体,为早期诊断HIV感染提供第一线索,而另一些皮肤病可作为疾病进展的标志,与HIV感染相关的皮肤病通常表现较为严重或不典型、或治疗困难.高效抗逆转录病毒治疗(HAART)可明显减少一些皮肤病的发生,但也引起皮肤不良反应.     

免疫缺陷性皮肤病

T细胞第二信号受体-CD28分子在HIV／AIDS患者中的异常改变；腺病毒介导反义RNA抑制HIV-1辅助受体CCR5和CXCR4表达；中国HIV暴露未感者CD4^＋T淋巴细胞的体外抗HTV活性；我国HIV／AIDS患者外周血CD4^＋T淋巴细胞凋亡与疾病进展的相关性分析；高效抗逆转录病毒治疗间断过程中中药对CD4^＋T淋巴细胞和病毒载量的影响；     

广西某综合医院住院HIV/AIDS患者的皮肤黏膜表现和临床流行病学特征的回顾性分析

目的:了解某院住院的免疫缺陷病毒(HIV)感染者和艾滋病(AIDS)患者的临床流行病学特征和皮肤黏膜表现,及其与CD4~+T淋巴细胞计数的关系,为临床医生和相关领域的AIDS防治提供参考信息。方法:回顾性分析2000年1月—2014年12月间在该院住院的1162例HIV/AIDS患者的流行病学资料、临床特点及实验室检查数据等,将资料数值用EXCEL建立数据库,用SPSS统计软件进行统计学分析。结果:1162例HIV/AIDS患者以男性为主,中青年患者数最多(占60.07%),高龄感染者也有较高的比例(50岁以上患者占37.26%);患者来源地涉及广西的所有市、县,呈弥漫性不均匀分布,有明显的聚集性;疾病在流动务工人员中传播,农村传播较以往更加明显;性传播为主要传染途径,传播范围从高危人群向普通人群扩散;15年间住院患者数呈逐渐递增趋势,壮、汉族患者比例差异无统计学意义。患者CD4~+T淋巴细胞计数水平与皮肤病发病率呈负相关,随着CD4~+T淋巴细胞计数水平降低,皮肤病的发病率和并发皮肤病的数量增多。结论:广西综合医院住院HIV/AIDS患者以男性为主,中老年组占的比重日趋加大;性传播为主要传播途径;随着CD4~+T淋巴细胞计数水平降低,皮肤病的发病率和并发皮肤病的数量增多。     

HIV^＋／AIDS相关的皮肤粘膜损害

艾滋病（AIDS）是由人类免疫缺陷病毒（HIV）感染所致的传染病。HIV是一种逆转录病毒,能选择性结合CD4分子并侵入表达CD4的宿主细胞（主要是辅助性T淋巴细胞及树突状细胞）,导致机体免疫功能缺陷及免疫紊乱,出现机会性感染和恶性肿瘤。特别是表皮中树突状细胞（即郎格罕细胞）减少,抗原递呈功能受损,是导致皮肤黏膜损害的重要原因之一。感染HIV者普遍存在皮肤黏膜损害（90％可出现皮肤损害）,许多HIV^＋／AIDS患者以皮肤损害为首发症状,皮肤损害可作为HIV^＋／AIDS诊断的重要线索,也是免疫状况观察的重要指标。HIV^＋／AIDS相关皮肤黏膜损害可分为感染性皮肤病、肿瘤性皮肤病和炎症性皮肤病,简述如下。     

HIV感染相关的皮肤细菌及螺旋体感染

皮肤细菌感染可发生于HIV感染的任何阶段,是最常见的机会性感染之一,据报道HIV感染后有48.6%可以合并细菌感染,其中皮肤细菌感染占13.3%[1]。播散性细菌感染及脓毒血症是HIV/AIDS患者常见的死因之一,HIV/AIDS患者合并细菌感染性皮肤病的流行病学特征、临床进程及临床表现与非HIV/AIDS患者不同,HIV/AIDS患者合并皮肤细菌感染皮损受累面积广,非好发部位也可累及,病情重,进展迅速,治疗效果差,迁延难愈,易复发。     

河南、山西2164例经血传播HIV/AIDS患者的皮肤表现分析

目的:观察和统计经血感染HIV/AIDS患者各种皮肤病的发生率.方法:通过回顾性分析,对河南、山西两地2164例经单采血浆或输血传播的HIV/AIDS住院和门诊患者皮肤病的发病情况进行总结.用流式细胞仪测定CD4T细胞计数.并将CD4T细胞计数和皮炎湿疹类疾病及念珠菌感染等进行相关性分析.结果:这一人群中皮肤病的发病率高达90%以上,最常见为皮炎湿疹类皮肤病,其次为口腔念珠菌感染和浅部真菌病.结论:HIV感染/AIDS患者皮肤病高发,河南、山西两地经血传播HIV人群中以皮炎湿疹类皮肤病及真菌感染最为多见.     

赣州市2010-2014年新发HIV/AIDS病例首次CD4~+ T淋巴细胞检测结果分析

目的了解赣州市HIV/AIDS患者免疫水平及疾病进展情况,为其抗病毒治疗提供参考依据。方法将入选的564例HIV/AIDS病例首次血液标本采用流式细胞仪(FACScont)进行CD4~+T淋巴细胞绝对值检测。结果 564例HIV/AIDS患者的CD4~+T淋巴细胞中位数(四分位数间距)为256.00(277.75)个/μl,CD4~+T淋巴细胞绝对值≤200个/μL者占35.28%,201~350个/μL者占32.09%,351~500个/μL者占18.26%,500个/μL者占14.36%。不同性别HIV/AIDS患者CD4~+T淋巴细胞绝对值的中位数差异无统计学意义(P0.05),不同年龄和样本来源HIV/AIDS患者CD4~+T淋巴细胞绝对值的中位数差异有统计学意义(P0.05)。结论赣州市多数HIV/AIDS患者CD4~+T淋巴细胞免疫水平偏低,HIV感染者已经进入发病高峰期,应加强防控措施。     

微波联合咪喹莫特治疗HIV/AIDS合并肛门尖锐湿疣110例临床分析

目的探讨微波治疗联合外涂咪喹莫特乳膏治疗HIV/AIDS合并肛门尖锐湿疣的效果。方法对110例HIV/AIDS合并肛门尖锐湿疣患者治疗前进行血清CD4+T淋巴细胞数量和HIV-RNA载量检测,采用微波治疗1周后外涂咪喹莫特乳膏联合治疗,每4周复诊一次,如有复发重复治疗,并进行末次治疗后4个月的随访。结果在CD4+T淋巴细胞数量≥350×106/L的HIV患者中,20周时的治愈率为89.55%(60/67),CD4+T淋巴细胞数量<350×106/L的患者治愈率为72.09%(31/43)。结论 HIV/AIDS合并肛门尖锐湿疣治疗后易复发,在CD4+T细胞数量≥350×106/L患者中,微波结合咪喹莫特乳膏外涂治疗时间短,复发率低。     

高效抗逆转录病毒疗法治疗HIV感染和艾滋病患者的观察

目的观察高效抗逆转录病毒疗法(HAART)治疗HIV感染和艾滋病(AIDS)患者的疗效和副作用。方法8例HIV感染和AIDS患者CD4+T细胞计数基线水平范围为1×106/L~443×106/L,均值231×106/L,HIV鄄1病毒载量为3.66log~>5.70log拷贝/mL。接受茚地那韦(indinavir)加双汰芝(combivir,含齐多夫定和拉米夫定)治疗12个月,每月用流式细胞仪MultiSET绝对计数法检测患者CD4+T细胞水平,bDNA法(检测范围1.70log~5.70logRNA拷贝/mL)检测血浆HIV鄄1病毒载量1次,并对患者进行严密的临床观察。结果治疗后12个月CD4+T细胞计数平均升高267×106/L(P<0.01)。病毒载量于治疗后1~4个月全部降至可测水平(1.70log拷贝/mL)以下,平均下降2.13log拷贝/mL。1例患者有过1次因漏服药物所致的小幅度且短暂的病毒载量反弹,其他患者的病毒载量均维持在可测水平之下或仅在可测的水平。1例晚期艾滋病患者(CD4+T细胞基线水平为1×106/L)的卡氏肺孢子虫肺炎和皮肤真菌感染消失,临床症状明显改善,恢复正常工作。其他患者也见临床好转。药物副作用有:8例患者中有早期胃肠道反应6例,一过性白细胞减少3例,轻度贫血2例,血淀粉酶升高2例,血总胆红素升高4例,血糖升高1例。无药物相关的心、肝、肾功能损害,亦无肾结石和胰腺炎的表现。结论茚地那韦加双汰芝的规     

CD8~+T淋巴细胞各亚群与HIV感染疾病进程的关系

目的探讨CD8+T淋巴细胞各亚群在HIV感染性疾病发病中的作用。方法应用流式细胞仪荧光染色技术检测HIV/AIDS患者Ⅱ期25例、Ⅲ期17例和26名健康体检人员外周血CD8+/CD28+T,CD8+/CD38+T,CD8+/CD95+T,CD8+/HLA-DR+T淋巴细胞表达,并用RT-PCR检测HIV/AIDS患者血清HIV-RNA载量。结果 CD8+/CD38+T和CD8+/HLA-DR+T细胞在健康对照组、HIV/AIDS患者Ⅱ期、Ⅲ期中差异均有统计学意义(P0.01),并都与HIV-RNA载量存在正相关(r=0.480,P0.01;r=0.455,P0.01);Ⅱ期、Ⅲ期患者中,CD8+/CD95+T细胞高于健康对照组,差异有统计学意义(P0.01);Ⅱ期患者和健康对照组中,CD8+/CD28+T细胞均高于Ⅲ期患者(P0.01)。结论 CD8+/CD38+T,CD8+/HLA-DR+T淋巴细胞亚群与HIV感染疾病进展显著相关,并参与患者免疫活化的调节。     

Patterns of skin manifestations and their relationships with CD4 counts among HIV/AIDS patients in Cameroon

BACKGROUND: Skin manifestations are common clinical features among HIV/AIDS-positive patients. Their frequencies, patterns and associated factors have been shown to vary from region to region. The present study is aimed at documenting skin manifestations and their relationships with CD4 cell counts among HIV/AIDS patients in Cameroon. METHODS: This study lasted for 16 months (from September 2001 to December 2002). After informed consent, data on skin disorders, HIV status, CD4 and viral load were obtained by physical examination and laboratory methods. RESULTS: Of the 384 subjects studied, 236 (61.5%) were females and 148 (38.5%) were males. Up to 264 (68.8%) patients presented with at least one type of skin problem. Generalized prurigo, oral candidiasis, herpes zoster, and vaginal candidiasis were the most common skin problems. Mean CD4 cell count (128 +/- 85 cells/mm(3)) and mean viral load (79,433 copies/mL) in patients with herpes zoster were higher (P < 0.001). Patients with oral candidiasis and vaginal candidiasis had significantly lower (109 +/- 127 cells/mm(3), P < 0.02) and higher (131 +/- 85 cells/mm(3), P < 0.05) mean CD4 cell counts, respectively. Prurigo was associated with higher mean viral load (31,623 +/- 20 copies/mL, P < 0.04). Viral lesions were associated with high mean CD4 cell count (123 +/- 83 cells/mm(3), P < 0.001). Kaposi's sarcoma and parasitic lesions (crusted scabies) were both, respectively, associated with lower mean CD4 cell counts [(78 +/- 66 cells/mm(3), P < 0.001) (6 +/- 0 cells/mm(3), P < 0.04)]. CONCLUSION: We conclude, first that skin problems are common in HIV-infected individuals in Cameroon and that patients with advanced stages of these problems have relatively very low mean CD4 cell counts. Second, that mucocutaneous disorders like vaginal candidiasis and herpes zoster occur early in HIV infection while Kaposi's sarcoma is common in advanced HIV infection.     

Prevalence of skin disorders in HIV patients in Senegal and relationship to degree of immunosuppression

BACKGROUND: The aim was to evaluate the association between dermatological findings in HIV-infected patients in Senegal and degree of immunosuppression and HIV stage. PATIENTS AND METHODS: All consecutive HIV infected patients followed up at three dermatology centres in Senegal from 01 January 2004 to 01 January 2006 were evaluated retrospectively regarding dermatological findings, CD4 cell count and HIV stage. PATIENTS AND METHODS: One hundred and forty-nine patients with 331 skin diseases were evaluated. The most common forms of dermatosis were oral candidiasis (53%), herpes zoster (24%), prurigo (24%) and dermatophytosis (16%). An increasing number of skin diseases was significantly associated with CD4 counts of below 200 per cubic millimeter and Aids diagnosis. A significant association (p<0.05) was found between two types of dermatosis (oral candidiasis and chromonychia) and CD4 counts of below 200 per cubic millimeter and between four types of dermatosis (straightened hair, herpes, oral candidiasis and xerosis) and Aids diagnosis. CONCLUSION: Dermatological findings are of great diagnostic and prognostic significance. We found some features specific to black skin: longitudinal melanonychia and blue ungueal pigmentation potentially related to immunosuppression and straightened hair, associated with Aids, probably resulting from denutrition.     

The prevalence of skin disease in HIV infection and its relationship to the degree of immunosuppression

A cross-sectional study of human immunodeficiency virus (HIV) positive patients who attended the HIV clinic in Brighton over a 4-month period was carried out to describe the prevalence and severity of skin manifestations in HIV-positive patients and to elucidate their association with the peripheral CD4 cell count and with the HIV disease stage. The subjects were consecutively examined by an experienced dermatologist. Skin manifestations were classified into infections, dermatoses, pruritus and neoplasm. A severity index was derived by scoring each condition as either absent, mild, moderate or severe. One hundred and fifty-one patients were enrolled with a mean age of 38·3 years. One hundred and thirty-nine were homo/bisexual men; 58 were asymptomatic and 35 had acquired immune deficiency syndrome (AIDS): 37 had CD4 counts below 200. Skin conditions were present in 138 of the 151 subjects (91·4%). The total number of events was 331. The most frequent problem was infection followed by dermatoses, pruritus and malignancy. The most frequent condition was seborrhoeic eczema followed by tinea and xerosis. We have demonstrated a statistically significant association between CD4 count, disease stage and skin manifestations in HIV-positive individuals.     

Skin disease: clinical indicator of immune status in human immunodeficiency virus (HIV) infection

BACKGROUND: Dermatological manifestations are seen at every stage of HIV/AIDS (human immunodeficiency virus), and are often the presenting features. These manifestations not only act as markers but also reflect the underlying immune status. OBJECTIVE: To establish skin diseases as clinical indicators of underlying immune status in HIV disease by estimating and correlating with the CD(4), CD(4) : CD(8) ratio. MATERIALS AND METHODS: The CD(4), CD(8), CD(4) : CD(8) ratios were estimated using the fluorescence activated cell sorter (FACS) count system in 20 asymptomatic HIV patients, 80 HIV patients with various skin manifestations and 72 healthy volunteers as the control group. RESULTS: In comparison with the CD(4) cell count of the control group (mean 885/mm(3), standard deviation 331), that of the HIV-positive individuals (mean 409.83/mm(3), standard deviation 263.07) was statistically correlated with low counts (z = 10.099 and P < 0.05). Similarly there was statistical significance with the CD(4) : CD(8) ratio among these two groups. In comparison with the CD(4) cell count of the asymptomatic HIV-positive individuals (mean 620.65/mm(3) and standard deviation 262.065), the CD(4) cell count of the HIV-positive patients with various dermatological manifestations (mean 357.15/mm(3), standard deviation 236.95) was statistically correlated with low counts (z = 4.0978 and P < 0.05). Similarly there was statistical significance with the CD(4) : CD(8) ratio among these two groups. CONCLUSIONS: There was an inverse relation between the CD(4) counts and the incidence and severity of skin diseases in the HIV/AIDS patients. Cutaneous manifestations of HIV can be considered as good clinical indicators to predict and access the underlying immune status in resource-poor countries.     

HIV/AIDS合并药疹患者实验室资料和预后的相关性研究

目的 了解HIV/AIDS患者发生药疹对内脏系统的影响及导致患者死亡的相关因素.方法 对72例HIV/AIDS合并药疹住院患者进行人口学资料、流行病学资料、实验室检查及疾病转归情况研究.结果 HIV/AIDS合并药疹患者病死率为6.9％,均死于感染,CD4＋T淋巴细胞数＜200 cells/μl者病死率为10.6％,病毒载量高于1×102 copies/ml者病死率为10.2％.55.3％患者天冬氨酸氨基转移酶升高,54.1％患者丙氨酸氨基转移酶升高,22.2％患者总胆红素升高,4.2％肾功能损伤,9.1％患者白蛋白减低,白蛋白降低患者病死率为16.1％,50.0％白细胞总数减少,45.9％中性粒细胞减少,33.3％淋巴细胞减低,低淋巴细胞病死率为12.5％,红细胞减少患者病死率10.3％,低血红蛋白病死率为16.4％.结论 感染是HIV/AIDS合并药疹患者的主要死亡原因,低CD4＋T淋巴细胞、高病毒载量、低蛋白血症、低淋巴细胞、低红细胞及低血红蛋白提示患者预后不良.     

Treatment of HIV-associated facial lipoatrophy: impact on infection progression assessed by viral load and CD4 count

BACKGROUND

HIV/AIDS-Associated Lipodystrophy Syndrome includes changes in body fat distribution, with or without metabolic changes. The loss of fat from the face, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome.

OBJECTIVES

To evaluate the effect of FL treatment using polymethylmethacrylate (PMMA) implants on disease progression, assessed by viral load and CD4 cell count.

METHODS

This was a prospective study of 44 patients treated from July 2009 to December 2010. Male and female patients, aged over 18 years, with clinically detectable FL and who had never been treated were included in the study. PMMA implantation was done to fill atrophic areas. Laboratory tests were conducted to measure viral load and CD4 count before and after treatment.

RESULTS

Of the 44 patients, 72.72% were male and 27.27% female, mean age of 44.38 years. Before treatment, 82% of patients had undetectable viral load, which increased to 88.6% after treatment, but without statistical significance (p = 0.67). CD4 count before treatment ranged from 209 to 1293, averaging 493.97. After treatment, the average increased to 548.61. The increase in CD4 count after treatment was statistically significant with p = 0.02.

CONCLUSION

The treatment of FL with PMMA implants showed a statistically significant increase in CD4 count after treatment, revealing the impact of FL treatment on disease progression. Viral load before and after treatment did not vary significantly.     

Incidence and prognostic significance of skin disease in patients with HIV/AIDS: a 5-year observational study

Mucocutaneous diseases are common in HIV-infected patients. The aim of the present study was to determine the observed frequency of skin diseases and their prognostic significance for the progression of HIV infection. In a cohort of 150 HIV-infected patients diagnosed from 1986 to 1987 the number of mucocutaneous diseases, the CD4+ cell count, time to development of AIDS and survival time were registered for a period of 5 years. Eight patients were lost for follow-up. In the remaining 142 patients the number of mucocutaneous findings increased markedly during the observation period. The most frequent registered diseases and these with the highest increase were oral candidiasis, hairy leukoplakia, seborrhoeic dermatitis and herpes simplex. On average, 5.2 different diagnoses were registered per patient at the end of the follow-up period. The study showed that the total number of mucocutaneous diseases and the CD4+ cell count were significantly correlated to survival time and time to development of AIDS. The number of mucocutaneous diseases, like the CD4+ count, is an indicator of the immune system and the prognosis of HIV infection.     

扬州市传染病院2016年至2018年HIV/AIDS患者的临床特征调查分析

目的调查和分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者的临床特征。方法选择2016~2018年扬州市第三人民医院诊治的186例HIV/AIDS患者的临床资料进行回顾性分析,统计其临床特征,包括流行病学特征、临床症状和体征、机会性感染情况和实验室指标检查结果。结果 186例患者中,男性,31岁~50岁、51岁~70岁,有同性性接触史,城镇,III期、IV期占比均较高,分别为89.2%,43.5%、39.2%,51.6%,56.5%,31.2%、26.9%,2016年、2017年和2018年占比基本持平;咳嗽、咳痰、口腔白色腐状物覆盖、淋巴结肿大、发热、呼吸困难、腹泻、皮疹、恶心、胸痛、头痛、夜间盗汗、呕吐、视力下降者的占比依次降低,分别为65.1%、62.9%、62.4%、54.8%、52.2%、52.2%、24.7%、19.9%、10.8%、10.8%、9.1%、8.6%、6.5%、4.8%;真菌感染、肺孢子菌肺炎、鹅口疮、巨细胞病毒感染、持续腹泻、皮肤损害、结核感染、机会性感染肿瘤占比依次下降,分别为61.3%、59.7%、58.1%、36.6%、19.4%、8.6%、5.4%、1.6%;不同临床分期患者体质量指数(BMI)、白细胞计数、血红蛋白、总淋巴细胞计数、CD4、CD8比较,其差异均具有统计学意义(均P<0.05),IV期者相似文献   

Dermatological findings correlated with CD4 lymphocyte counts in a prospective 3 year study of 1161 patients with human immunodeficiency virus disease predominantly acquired through intravenous drug abuse

Several prospective studies on dermatological findings in human immunodeficiency virus (HIV) type 1 infected patients have been published, mostly in populations in which the predominant risk factor for HIV infection is homosexuality. We attempted to identify cutaneous diseases associated with HIV-1 infection and to assess disease progression in a cohort of Spanish patients in whom the predominant cause of HIV infection was intravenous drug abuse. We prospectively examined 1161 HIV-1-positive patients for 38 months. Seventy-four per cent of patients were intravenous drug abusers, whereas heterosexual contact was the only risk factor in 14% and homosexuality in 9%. Centers for Disease Control stage II disease predominated (51%), whereas stage IV disease was less frequent (39%). The mean CD4 count was 353/mm³. We took patients' past and present medical history and performed a complete physical examination as well as taking photographs and carrying out the necessary diagnostic procedures. CD4 counts/mm³ were measured at each visit. A diagnosis of cutaneous disease was made in 799 patients (69%). Oral candidiasis and seborrhoeic dermatitis were the most common skin disorders, followed by xerosis, drug eruptions, dermatophytosis and the papular eruption of acquired immunodeficiency syndrome. Condyloma acuminatum, herpes zoster and herpes simplex were the most frequent viral infections. Conditions that have a statistically significant association with advanced stage and low CD4 levels include drug eruptions, xerosis, light reactions, diffuse alopecia, herpes simplex, oral candidiasis, psoriasis, oral hairy leucoplakia, molluscum contagiosum, Kaposi's sarcoma, furuncles, candidal intertrigo, folliculitis and ungual infection, as well as onychomycosis and tinea pedis or manuum. Dermatoses commonly associated with homosexuality, such as Kaposi's sarcoma and oral hairy leucoplakia, were rare in our patients.