HIV感染儿童抗病毒治疗后外周血单个核细胞的TK2表达水平及意义

目的探讨艾滋病病毒(HIV)感染儿童抗病毒治疗后外周血单个核细胞(PBMC)中潜在线粒体毒性标志物表达水平及其相关机制。方法选择60例抗病毒治疗的HIV感染儿童和20例健康儿童,检测PBMC中胸苷激酶2(TK2)基因的mRNA和蛋白质表达水平变化,与治疗方案及治疗时间的相关性分析。结果 HIV感染患儿抗病毒治疗的PBMC中TK2基因mRNA和蛋白质表达水平显著高于对照组儿童(mRNA:2.45/1,蛋白质:3.2/1)差异均有统计学意义(P<0.05)。随着治疗时程的增加,司他夫定治疗组较齐多夫定治疗组的TK2蛋白质水平增加更显著(P<0.05)。将患儿分别按基线CD4+T淋巴细胞计数、基线病毒载量、性别、年龄以及HIV传播途径进行分组比较,各组患儿间TK2水平差异无统计学意义(P>0.05)。结论外周血PBMC的TK2水平可反映儿童抗病毒治疗后的线粒体毒性,有望成为线粒体毒性检测指标。     

Prevalence of oral lesions and periodontal diseases in HIV-infected patients on antiretroviral therapy

A cross-sectional study examining oral manifestations was carried out in HIV-infected patients of a general HIV-specialized unit to provide prevalence data on oral lesions and periodontal diseases. The occurrence of oral lesions was correlated with demographic and clinical characteristics, immunologic and virologic parameters. Among 139 patients 86% presented any oral lesions with a prevalence of 76% of any periodontal diseases. Most periodontal lesions were classified as conventional gingivitis (28%) or periodontitis (30%). Dental plaque formation was associated with a higher prevalence of periodontal diseases (p = 0.01) and periodontal inflammation scores were higher in patients with more reduced CD4-counts (p = 0.03). Prevalence for HIV-specific oral lesions was 29% with a proportion of 9% of linear gingival erythema (LGE), 3.6% of necrotizing and ulcerative gingivitis (NUG) or periodontitis (NUP), 7% of oral candidiasis, 3.6% of oral hairy leucoplakia (OHL) and single other lesions. HIV-specific lesions (NUG/NUP, oral candidiasis and OHL) were found predominantly in patients with advanced immunosuppression and elevated viral load. Compared with data of oral diseases of the pre-HAART era prevalence of HIV-specific lesions was markedly reduced. Especially frequently known lesions such as oral candidiasis and OHL were less common seen. We noticed a shift of prevalence towards periodontal diseases. Lack of oral hygiene determined by plaque formation and reduced CD4-counts with pronounced periodontal inflammation can be seen as risk factors for periodontal disease. Overall high prevalence of manifestations underlines the importance of oral examination for the general practitioner and visits by oral specialists should become a routine procedure in HIV-patients care.     

Highly active antiretroviral therapy and survival in HIV-infected injection drug users

Evan Wood, MD, PhD; Robert S. Hogg, PhD; Viviane Dias Lima, PhD; Thomas Kerr, PhD; Benita Yip, BSc (Pharm); Brandon D. L. Marshall, MSc; Julio S. G. Montaner, MD, FRCPC

JAMA. 2008;300(5):550-554.

Context  Highly active antiretroviral therapy (HAART) is often withheld from injection drug users (IDUs) infected with the human immunodeficiency virus (HIV) based on the belief that their unstable lifestyles may predetermine a markedly inferior outcome with HAART. However, long-term evaluations of HIV treatment outcomes among IDUs in comparison with other risk groups are not available.

Objective  To compare survival rates among HIV-infected patients initiating HAART with and without a history of injection drug use.

Design, Setting, and Patients  Population-based, prospective cohort study (HAART Observational Medical Evaluation and Research [HOMER]) of 3116 antiretroviral-naive HIV-infected patients in a province-wide HIV/AIDS treatment program in British Columbia, Canada. Of the 3116 patients, 915 were IDUs (29.4%), 579 were female (18.6%), and the median age was 39.4 years (interquartile range, 33.3-46.4 years). Treatment with HAART was initiated between August 1, 1996, and June 30, 2006. The median duration of follow-up was 5.3 years (interquartile range, 2.8-8.3 years) for IDUs and 4.3 years (interquartile range, 2.0-7.6 years) for non-IDUs. Patients were followed up until June 30, 2007. Data were analyzed between November 1, 2007, and May 26, 2008.

Main Outcome Measure  All-cause mortality.

Results  Overall, 622 individuals died (20.0%) during the study period (232 IDUs and 390 non-IDUs), for a crude mortality rate of 20.0% (95% confidence interval [CI], 18.4%-21.5%). At 84 months after the initiation of HAART, the product limit estimate of the cumulative all-cause mortality rate was similar between the 915 IDUs (26.5%; 95% CI, 23.2%-29.8%) and 2201 non-IDUs (21.6%; 95% CI, 16.9%-26.2%) (Wilcoxon P = .47). In multivariate time-updated Cox regression, the hazard ratio of mortality was similar between IDUs and non-IDUs (1.09; 95% CI, 0.92-1.29).

Conclusion  In this study population, injection drug use was not associated with decreased survival among HIV-infected patients initiating HAART.

     

昆明市HIV感染者未接受抗病毒治疗原因及对策分析

目的 对昆明市未治疗的HIV感染者进行调查,分析未接受抗病毒治疗的原因,为制定针对性的干预措施、提高HIV感染者治疗率及治疗依从性提供参考依据.方法 采用方便抽样的方法,抽取昆明市截至2018年8月31日尚存活但未治疗的HIV感染者进行问卷调查,调查内容包括一般人口学信息和和未治疗原因(包括对ART的认知、躯体因素、社...     

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.     

乌鲁木齐市88例HIV感染者抗病毒治疗状况调查

目的：了解乌鲁木齐市HIV感染者进行抗病毒治疗状况,为制定相关政策提供依据。方法：采用自行设计的问卷对88例HIV感染者进行单独面访,同时收集相关的实验室结果和诊疗记录,所获资料采用Excel录入,用SPSS11．0进行统计分析。结果：88例HIV感染者中有21例HIV感染者接受免费的抗病毒治疗,占23．9%。应进行抗病毒治疗人数为39人,未治疗23人,占59．0％。未治疗的主要原因是经济困难（57．1％）和自认身体健康（23．8％）。能90％～100％坚持服药的占71．4％,50％～90％间断服药的占23．8％,〈50％间断服药的占4．8％,间断服药的主要原因为机会性感染和不良反应。结论：为符合接受免费治疗的HIV感染者提供医疗救助,提高依从性。     

Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children

OBJECTIVE: To investigate the effect of antiretroviral (ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children. METHODS: Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status. RESULTS: Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071). CONCLUSIONS: ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.     

Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children

OBJECTIVE: To investigate the effect of antiretroviral ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children. METHODS: Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status. RESULTS: Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071). CONCLUSIONS: ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.     

广西钦州市2008—2018年初始抗病毒治疗HIV感染者死亡和脱失分析

目的 了解初始抗病毒治疗HIV感染者死亡和脱失情况及其影响因素,为HIV感染者有效管理和治疗提供依据。方法 采用回顾性队列研究方法,从艾滋病综合防治信息系统下载广西钦州市2008—2018年初始抗病毒治疗（ART）HIV感染者数据,采用Cox比例风险回归模型分析其死亡和脱失情况。结果 共7 812例HIV感染者进入队列,总体病死率和脱失率分别为3.25/100人年和2.41/100人年。抗病毒治疗第1年内病死率和脱失率分别为5.70/100人年和 4.88/100人年。Cox回归分析显示,死亡影响因素是年龄≥50岁（HR=2.60,95%CI：2.27~2.98）、男性（HR=1.90,95%CI：1.62~2.23）、静脉吸毒（HR=1.84,95%CI：1.56~2.17）、治疗前WHO临床分期为Ⅲ/Ⅳ期（HR=1.33,95%CI：1.15~1.53）、治疗前CD4⁺T淋巴细胞计数<200 cells/μL（HR=1.58,95%CI：1.25~1.99）、治疗机构为县级（HR=2.74,95%CI：2.36~3.19）、HIV诊断到抗病毒治疗间隔天数30~< 90 d（HR=1.17,95%CI：1.01~1.36）、间隔天数90 ~<365 d（HR=1.21,95%CI：1.02~1.44）;脱失影响因素是年龄≥50岁（HR=1.60,95%CI：1.37~1.87）、男性（HR=1.56,95%CI：1.32~1.85）、静脉吸毒（HR=1.96,95%CI：1.62~2.36）、开始ART前CD4⁺T淋巴细胞计数≥ 350/μL（HR=1.43,95%CI：1.16~1.77）、抗病毒治疗初始方案含LPV/r（HR=1.80,95%CI：1.36~2.38）、抗病毒治疗开始时间在2013—2016年（HR=1.36,95%CI：1.12~1.65）、抗病毒治疗开始时间在2017—2018年（HR=1.66,95%CI：1.30~2.14）、HIV诊断到抗病毒治疗时间间隔天数>365 d（HR=1.21,95%CI：1.01~1.45）。结论 钦州市HIV感染者抗病毒治疗效果较好,但治疗第1年内病死率和脱失率较高。需针对死亡和脱失的影响因素,加强抗病毒治疗医疗卫生人员培训和治疗者宣传教育以提高抗病毒治疗效果。     

儿童青少年肥胖伴原发性高血压营养干预的研究

目的:研究肥胖儿童高血压的发病率及经合理饮食干预、运动等综合治疗后的转归,为儿童青少年高血压的防治提供营养治疗指导。方法:以72例6～18岁的肥胖伴高血压儿童青少年为研究对象。总热能根据年龄、性别、身高及肥胖程度制定,一般为4 180～7 524 kJ/d,高蛋白质、脂肪和碳水化合物三者占总热能的百分比分别为20%～25%、25%～30%和45%～50%。除营养干预外,每天运动不少于30 min并常规补充多种维生素及微量元素制剂。结果:经以合理营养干预为主的综合治疗后,体质指数(Body mass index,BMI)、收缩压、舒张压较治疗前明显下降(P<0.05),高血压的痊愈率为79.2%(57/72),好转率为16.7%(12/72),未愈率为4.1%(3/72)。结论:以合理营养干预为主的综合治疗对儿童青少年肥胖伴原发性高血压(Essential hyperten-sion,EH)的防治具有明显疗效。     

儿童青少年肥胖伴原发性高血压营养干预的研究

目的：研究肥胖儿童高血压的发病率及经合理饮食干预、运动等综合治疗后的转归,为儿童青少年高血压的防治提供营养治疗指导。方法：以72例6～18岁的肥胖伴高血压儿童青少年为研究对象。总热能根据年龄、性别、身高及肥胖程度制定,一般为4 180～7 524 kJ/d,高蛋白质、脂肪和碳水化合物三者占总热能的百分比分别为20%～25%、25%～30%和45%～50%。除营养干预外,每天运动不少于30 min并常规补充多种维生素及微量元素制剂。结果：经以合理营养干预为主的综合治疗后,体质指数（Body mass index,BMI）、收缩压、舒张压较治疗前明显下降（P<0.05）,高血压的痊愈率为79.2%（57/72）,好转率为16.7%（12/72）,未愈率为4.1%（3/72）。结论：以合理营养干预为主的综合治疗对儿童青少年肥胖伴原发性高血压（Essential hyperten－sion,EH）的防治具有明显疗效。     

Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection

Context  Use of antiretroviral drugs, including protease inhibitors, for treatment of human immunodeficiency virus (HIV) infection has been anecdotally associated with hepatotoxicity, particularly in persons coinfected with hepatitis C or B virus. Objectives  To ascertain if incidence of severe hepatotoxicity during antiretroviral therapy is similar for all antiretroviral drug combinations, and to define the role of chronic viral hepatitis in its development. Design  Prospective cohort study. Setting  University-based urban HIV clinic. Patients  A total of 298 patients who were prescribed new antiretroviral therapies between January 1996 and January 1998, 211 (71%) of whom received protease inhibitors as part of combination therapy (median follow-up, 182 days) and 87 (29%) of whom received dual nucleoside analog regimens (median follow-up, 167 days). Chronic hepatitis C and B virus infection was present in 154 (52%) and 8 (2.7%) patients, respectively. Main Outcome Measure  Severe hepatotoxicity, defined as a grade 3 or 4 change in levels of serum alanine aminotransferase and aspartate aminotransferase, evaluated before and during therapy. Results  Severe hepatotoxicity was observed in 31 (10.4%) of 298 patients (95% confidence interval [CI], 7.2%-14.4%). Ritonavir use was associated with a higher incidence of toxicity (30%; 95% CI, 17.9%-44.6%). However, no significant difference was detected in hepatotoxicity incidence in other treatment groups, ie, nucleoside analogs (5.7%; 95% CI, 1.2%-12.9%), nelfinavir (5.9%; 95% CI, 1.2%-16.2%), saquinavir (5.9%; 95% CI, 0.15%-28.7%), and indinavir (6.8%; 95% CI, 3.0%-13.1%). Although chronic viral hepatitis was associated with an increased risk of severe hepatotoxicity among patients prescribed nonritonavir regimens (relative risk, 3.7; 95% CI, 1.0-11.8), most patients with chronic hepatitis C or B virus infection (88%) did not experience significant toxic effects. Rate of severe toxicity with use of any protease inhibitor in patients with hepatitis C infection was 12.2% (13/107; 95% CI, 6.6%-19.9%). In multivariate logistic regression, only ritonavir (adjusted odds ratio [AOR], 8.6; 95% CI, 3.0-24.6) and a CD4 cell count increase of more than 0.05 x 10⁹/L (AOR, 3.6; 95% CI, 1.0-12.9) were associated with severe hepatotoxicity. No irreversible outcomes were seen in patients with severe hepatotoxicity. Conclusions  Our data indicate that use of ritonavir may increase risk of severe hepatotoxicity. Although hepatotoxicity may be more common in persons with chronic viral hepatitis, these data do not support withholding protease inhibitor therapy from persons coinfected with hepatitis B or C virus.      

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。     

合并病毒性肝炎HIV感染患儿接受高效抗逆转录酶病毒治疗后肝功能变化

目的：观察获得性免疫缺陷综合征（AIDS）患儿合并乙型肝炎病毒（HBV）/丙型肝炎病毒（HCV）感染与否在接受1年高效抗逆转录酶病毒疗法（HAART）后肝功能的变化情况。方法：收集2011年3月至2012年3月河南省141例AIDS患儿HAART治疗1年前后临床资料,分为HIV+HBV+HCV组（n=78）,HIV+HBV组（n=19）,单纯HIV组（n=44）。治疗前后分别用逆转录PCR检测血浆HIV RNA载量,流式细胞术检测CD4+T细胞数,酶联免疫吸附试验检测HCV抗体和HBV表面抗原,全自动生化分析仪检测丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和总胆红素（TB）水平。结果：HAART治疗1年后,90.34%（127/141）患儿HIV RNA载量下降到检测水平以下（t=2.61, P<0.01）,CD4+T细胞数从（170.187±132.405）个/μl上升到（796.014±158.491）个/μl（t=3.17, P<0.01）。HAART治疗后患儿的转氨酶均升高（t=2.02, 均P<0.05）,奈韦拉平治疗组的ALT和AST分别由治疗前（18.28±13.74）U/L和（24.23±8.09）U/L升高到（55.35±22.40）U/L和（69.97±26.72）U/L（t=3.80、4.11,均P<0.01）,同时奈韦拉平治疗组的ALT和AST变化量亦明显高于依非韦伦治疗组(均P<0.01);使用奈韦拉平治疗的HIV+HBV+HCV合并感染患儿ALT和AST的变化量亦显著高于使用依非韦伦治疗患儿(均P<0.01)。结论：无论是否合并HBV/HCV感染,HAART均能有效抑制病毒复制,使CD4+T细胞计数上升,但同时会一定程度损伤肝细胞,尤见于合并感染者;正确选择用药方案,能够减少药物不良反应。