口腔念珠菌病、单纯疱疹性口炎与 HIV 患者相关性的研究

目的：探讨口腔念珠菌病、单纯疱疹性口炎与 HIV 患者免疫状况的关系。方法：选取2013年1月～2015年12月血清 HIV-1感染阳性者126例,其中合并口腔念珠菌病患者67例,合并单纯疱疹性口炎患者29例,无口腔念珠菌病/单纯疱疹性口炎患者30例,检测患者外周血 CD4+T 淋巴细胞计数、IL-4、IL-17（A/F）、IFN-γ等。结果：合并口腔念珠菌病 HIV 患者 CD4+T 细胞计数和 IL-17（A/F）分别为76（199.00）mm3和19.08（14.15）pg/mL,低于其他患者,而病毒载量为160772（401525.00）VLcopies/mL,高于其他患者,差异比较有统计学意义;合并单纯疱疹性口炎 HIV 患者与无口腔念珠菌病/单纯疱疹性口炎 HIV 患者外周血相关检测因子比较差异无统计学意义;Logistic 回归模型显示 HIV 患者口腔念珠菌病发生与 IL-17（A/F）有关,IL-17（A/F）为罹患口腔念珠菌的保护因素。结论：合并口腔念珠菌病 HIV 患者 CD4+T 细胞计数和 IL-17（A/F）水平低,病毒载量高,其中 IL（A/F）发挥重要作用;合并单纯疱疹性口炎 HIV 患者暂未查见有意义指标。     

Zosteriform herpes simplex

Herpes simplex virus (HSV) infection, though most commonly seen in the oral, perioral and genital areas, can occur anywhere on the body. After primary infection, HSV then establishes latency in sensory nerve ganglia and reactivates intermittently, precipitated by various factors. These reactivations may be recurrent and appear in a dermatomal distribution, mimicking herpes zoster, often leading to misdiagnosis if no confirmatory laboratory tests are carried out. We report a 65-year-old man who presented with recurrent episodes of a "zosteriform eruption", who was initially clinically diagnosed and treated as for recurrent herpes zoster, but was subsequently found to have recurrent herpes simplex virus type 2 after laboratory investigations.     

HIV／AIDS病人的口腔病损及其临床护理

HIV感染和艾滋病病人相关的口腔病变往往是该病最早和唯一的临床体征。现将口腔病损的发生及原因、口腔病损的表现、治疗、护理进行综述。     

南京市生殖器疱疹人群乙肝、丙肝和艾滋病检测结果分析

目的：了解南京市性病门诊中生殖器疱疹人群中乙型肝炎病毒、丙型肝炎病毒和艾滋病病毒的携带情况。方法：收集南京市性病门诊HSV阳性血液样本266份,用酶联免疫吸附试验（ELISA）检测HBV表面抗原、HCV抗体和HIV抗体。结果：266份生殖器疱疹人群血液样本中HBV、HCV及HIV的感染率分别为11.65%（31/266）、2.26%（6/266）,1.13%（3/266）。结论：HSV/HBV混合感染率高于HSV/HCV混合感染率和HSV/HIV混合感染率。HSV/HBV双重感染在通过性接触途径而感染HSV者中多见,性病门诊中感染单纯疱疹病毒（HSV）人群可易感HBV、HCV、HIV,尤其易感HBV,要引起高度重视。     

43例HIV感染者皮肤损害的临床特点分析

目的 分析HIV感染者皮肤损害的临床特点.方法 选取我院于2011年2～10月收治的43例HIV感染患者的临床资料,对其皮肤损害的临床特征进行分析总结.结果 43例患者中共发现急性发疹、带状疱疹、单纯疱疹、传染性软疣、尖锐湿疣、梅毒以及马尔尼菲青霉菌病几种皮肤损伤,皮肤损害不具有特异性,损害类型多样化.结论 HIV感染者皮肤损害的种类较多,侵犯面积较大,感染患者首要症状就是皮肤损害,可以为临床HIV的诊断提供帮助,应当引起重视.     

深圳男同性恋性病和艾滋病感染状况调查

目的 了解近年深圳市男同性恋性病和艾滋病感染的发展趋势及行为特征，并对其进行分析，为实施有效的干预策略提供客观依据。方法 从2002～2005年连续4年在深圳市男同性恋活动场所对目标人群进行包括梅毒、疱疹和HIV等病原抗体血标本检测，并于2004年底通过匿名问卷进行行为监测。结果 HIV抗体、梅毒抗体捡出率分别由2002年的0．9％和9．4％上升至2005年的2．7％和15．8％；普遍存在多性伴现象，与艾滋病传播有关的，无保护肛交等危险性行为发生率高；安全套使用率低，或从未使用安全套的比例为40．7％。只有22．7％每次使用安全套；现场被检出和确认为HIV阳性的11例感染者91％合并患有梅毒和疱疹，有过半是提供性服务的年轻人。结论 深圳市同性恋HIV感染率几年来迅速上升，普遍存在多性伴、无保护的肛交等行为，目前未建立使用安全套等保护意识，提示应及尽早实施对男同性恋的有效行为干预，遏制STD／HIV在人群中的迅速传播，并有效阻断其向其他人群传播的危险。     

Correlation of CD4 counts and CD4/CD8 ratio with HIV-infection associated oral manifestations

BACKGROUND: The relationship between oral lesions arising from HIV infection and CD4/CD8 cell ratios is of relevance in clinical assessment of immune suppression. OBJECTIVE: To correlate the prevalence of oral manifestations arising from HIV infection and the levels of CD4/CD8 cell ratios. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Two hundred and seven HIV-infected patients in medical wards were recruited in the study. RESULTS: Seventy eight (37.7%) were male and 129 (62.3%) female, with an age range of 18-73 years (mean=34.81 years). Oral manifestations encountered with highest prevalence in the oral cavity included: hyperplastic candidosis (labial mucosa) 15%, erythematous candidosis (gingival) 5%, angular cheilitis 32.4%, herpes simplex (corner of the mouth) 0.5%, persistent oral ulceration (labial mucosa) 0.5%, Parotid enlargement 2% and Kaposis sarcoma (hard/soft palate) 2.9%. CONCLUSION: The prevalence of oral manifestations was higher with low CD4 count <200 cell/mm3 and mean CD4/CD8<0.39(95%CI 0.32-0.48).     

Part XIV. Antiviral agents other than antiretrovirals: therapy for herpesvirus infections, viral hepatitis, and influenza

The incidences of viral infectious diseases are increasing at an alarming rate in the US and worldwide. Antiviral therapy is challenging because viruses subsume normal host cellular mechanisms for many functions, have rapid replication rates, have poor error scanning when reading genetic code, and undergo frequent drug target mutations. This article will focus on antiviral drugs and principles of treatment for infections due to herpes simplex viruses (HSV1 and HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), hepatitis B and hepatitis C viruses, and influenza virus. Therapy for human immunodeficiency virus (HIV) infection will be discussed in the next symposium segment.     

The association between genital ulcer disease and acquisition of HIV infection in homosexual men

We analyzed the association of herpes simplex virus (HSV) infection and syphilis, the two most common causes of genital ulceration in homosexual men, with human immunodeficiency virus (HIV) infection in 200 men enrolled between 1983 and 1986 into a study evaluating the microbial causes of acute proctitis. Infection with HIV was independently associated with a history of syphilis, serologic evidence of syphilis, a history of HSV infection, and antibody to HSV-2. Antibody to HIV was not associated with a history of other genital infections or with antibody to Chlamydia trachomatis or HSV-1. Similar associations were observed in 111 asymptomatic homosexuals seen for HIV screening. Men who presented with primary HSV proctitis had a lower prevalence of HIV antibody than those with preexisting HSV-2 antibody (44% vs 68%); this suggests that HSV-2 infection antedated HIV infection. These data suggest that genital ulcerative diseases are an important risk factor for the acquisition of HIV infection in homosexual men; measures directed at control of these diseases may reduce the transmission of HIV in this population.     

Alterations in the oral microbiome in HIV infection: causes,effects and potential interventions

A massive depletion of CD4⁺ T lymphocytes has been described in early and acute human immunodeficiency virus (HIV) infection, leading to an imbalance between the human microbiome and immune responses. In recent years, a growing interest in the alterations in gut microbiota in HIV infection has led to many studies; however, only few studies have been conducted to explore the importance of oral microbiome in HIV-infected individuals. Evidence has indicated the dysbiosis of oral microbiota in people living with HIV (PLWH). Potential mechanisms might be related to the immunodeficiency in the oral cavity of HIV-infected individuals, including changes in secretory components such as reduced levels of enzymes and proteins in saliva and altered cellular components involved in the reduction and dysfunction of innate and adaptive immune cells. As a result, disrupted oral immunity in HIV-infected individuals leads to an imbalance between the oral microbiome and local immune responses, which may contribute to the development of HIV-related diseases and HIV-associated non-acquired immunodeficiency syndrome comorbidities. Although the introduction of antiretroviral therapy (ART) has led to a significant decrease in occurrence of the opportunistic oral infections in HIV-infected individuals, the dysbiosis in oral microbiome persists. Furthermore, several studies with the aim to investigate the ability of probiotics to regulate the dysbiosis of oral microbiota in HIV-infected individuals are ongoing. However, the effects of ART and probiotics on oral microbiome in HIV-infected individuals remain unclear. In this article, we review the composition of the oral microbiome in healthy and HIV-infected individuals and the possible effect of oral microbiome on HIV-associated oral diseases. We also discuss how ART and probiotics influence the oral microbiome in HIV infection. We believe that a deeper understanding of composition and function of the oral microbiome is critical for the development of effective preventive and therapeutic strategies for HIV infection.     

HIV感染伴口腔念珠菌病患者全唾液sIgA的改变

目的:从口腔局部免疫角度探讨艾滋病病毒感染者口腔念珠菌病的发生机制。方法:①放射免疫法测定HIV感染伴发口腔念珠菌病患者和非伴发口腔念珠菌病患者全唾液sIgA含量,并与正常对照组比较;②流式细胞仪检测HIV感染伴发口腔念珠菌病患者和非伴发口腔念珠菌病患者CD4+T淋巴细胞计数,并与正常对照组比较。结果:HIV感染伴发口腔念珠菌病患者和非伴发口腔念珠菌病患者全唾液sIgA含量和CD4+T淋巴细胞计数均较正常人明显下降(均为P<0.01),HIV感染伴发口腔念珠菌病患者全唾液sIgA含量和CD4+T淋巴细胞计数较HIV感染非伴发口腔念珠菌病患者下降(均为P<0.05)。结论:HIV感染患者口腔念珠菌病的发病可能与全唾液中sIgA的含量有关,全唾液sIgA在局部黏膜免疫过程中具有非常重要的作用。     

The Vancouver Lymphadenopathy-AIDS Study: 7. Clinical and laboratory features of 87 cases of primary HIV infection.

In an ongoing prospective study of homosexual men conducted in Vancouver since November 1982, 87 cases of human immunodeficiency virus (HIV) seroconversion have been documented to date. Comparison of laboratory results obtained a mean of 4.9 months before and 5.4 months after the estimated date of seroconversion revealed that a significant increase in the serum IgG level (from 1149 to 1335 mg/dl on average) and in C1q binding (from 8.8% to 14.2% on average) was associated with early HIV infection (p less than 0.001). A marginally significant decrease in the ratio of helper to suppressor (CD4 to CD8) cells (from 1.55 to 1.29 on average) was also noted (p = 0.025). A marked decrease in absolute number of CD4 cells was not seen with seroconversion, which suggests that profound loss of these cells may be a long-term effect of HIV infection. The occurrence of symptoms (including fatigue, fever, night sweats, unintentional weight loss, diarrhea, joint pains, cough unrelated to smoking, shortness of breath, oral thrush, herpes zoster and rash) did not increase with seroconversion. This finding suggests that most cases of HIV seroconversion may be asymptomatic or associated with relatively minor symptoms. On the other hand, generalized lymphadenopathy was found to develop after HIV seroconversion in about 50% of cases.     

A review of neurological complications in AIDS

Involvement of the central nervous system is now being recognized as an important aspect of HIV infection. Acting as a sanctuary site, it may pose problems to effective therapeutic strategies. HIV-induced AIDS dementia complex is the commonest mode of presentation. Other causes include opportunistic infections and, more infrequently, malignancies. The precise diagnosis is often difficult to make and requires the judicious use of the CT scan. Treatment has been disappointing and is characterized by frequent relapses.     

Herpes zoster myelitis: report of two cases

Two male patients aged 40 and 45 years with HIV infection and paraplegia are presented. The two had sub-acute onset paraplegia with a sensory level, which developed 10 days after herpes zoster dermatomal rash. They both had asymmetrically involvement of the lower limbs. Investigation including imaging of the spinal cord did not reveal any other cause of the neurological deficit. The two responded very well to treatment with acyclovir. Herpes zoster myelitis is a condition likely to rise with the upsurge of HIV infection and there is a need to identify the condition early. We also review the literature on the subject.     

Oral acyclovir for treatment of first-episode herpes simplex virus proctitis

Twenty-nine patients with first-episode rectal herpes simplex virus infection were enrolled in a double-blind trial of oral acyclovir, 400 mg five times daily, vs placebo treatment. Eighty percent of those receiving acyclovir compared with 25% of placebo recipients no longer had herpes simplex virus isolated from their rectal lesions three days after onset of therapy. The median duration of rectal lesions and viral excretion from rectal lesions (median, five and zero days, respectively) was significantly shorter in patients treated with acyclovir than in placebo-treated patients (14 and 11 days, respectively). Durations of local signs and symptoms of proctitis, such as rectal pain, discharge, and friability, were shorter in acyclovir recipients than in placebo recipients, but these differences were not statistically significant. Daily administration of 2 g of oral acyclovir for ten days alleviates some of the clinical signs of herpes simplex virus rectal infection.     

单纯疱疹病毒感染与女性生殖道黏膜及口腔黏膜疾病发病关系的试验研究

目的：探讨单纯疱疹病毒感染与女性生殖道黏膜及口腔黏膜疾病的发病关系。方法：用多聚酶链反应(PCR)对33例口腔黏膜病患者和女性生殖道黏膜病患者病变局部涂抹标本进行了单独疱疹病毒DNA(HSV DHA)的检测。结果：其阳性检出率分别为85．7％和89．5％，总阳性率为87．5％，并且HSV感染口腔黏膜和女性生殖道黏膜的阳性感染率相接近，在二者间无显著性差异。结论：表明HSV感染与口腔黏膜疾病及女性生殖道黏膜疾病的发病有密切关系，HSV感染可能是引起黏膜疾病的一个触发因素。     

福建地区HIV感染者及艾滋病患者口腔病损临床观察和HAART治疗的影响

目的：了解福建地区人免疫缺陷病毒感染及艾滋病感染(HIV/AIDS)患者口腔病损状况,为我国HIV/AIDS人群口腔疾病的防治提供依据。方法方便选取2014年1月＿2015年12月经福建省疾病控制中心确诊为HIV/AIDS患者160例为调查对象,由专业人员采集病史,进行口腔专科检查,并将详细记录的结果与世界卫生组织艾滋病感染口腔表征协作中心制定的艾滋病口腔表征分类及诊断标准相比较。同时记录CD4+T细胞计数及HAART半年后的CD4+T细胞计数。结果160例HIV/AIDS患者,年龄范围为23~68岁,其中男93例,女67例。有32例患者出现了口腔病损,其类型依照患病率的高低依次是：白色念珠菌病11例,单纯疱疹7例,口腔溃疡6例,AIDS相关性牙周病变4例,卡波济肉瘤3例和乳头状瘤2例。入组HIV/AIDS患者使用HAART法进行治疗6个月后,口腔病损明显减轻,且大多数患者CD4+T淋巴细胞计数提高。结论 HIV/AIDS患者常伴有口腔表征,并且部分口腔表征出现较早。口腔念珠菌病是HIV/AIDS患者最常见的口腔表征。 HAART治疗后这些口腔病损减轻。     

Primary infection by type 1 human immunodeficiency virus: diagnosis and prognosis.

Primary infection by type 1 human immunodeficiency virus (HIV) is symptomatic in about 70% of cases. The acute illness is a mononucleosis-like syndrome with characteristics such as mucosal ulcerations. The duration and severity of the symptoms appear to be related to the prognosis. After reviewing the most frequent signs and symptoms of primary HIV infection, we report different prognostic studies which examined the association between the acute illness and the progression of HIV disease.     

生殖器疱疹患者合并TP、HIV、HCV感染状况分析

目的:了解生殖器疱疹(genital herpes,GH)患者的梅毒螺旋体(treponema pallidum,TP)、艾滋病病毒(human immunodeficiency virus,HIV)、丙型肝炎病毒(hepatitis C virus,HCV)抗体水平,为性病门诊制订性病防控措施提供科学依据.方法:对所研究对象抽血并分离血清,用梅毒螺旋体明胶凝集试验(TPPA)检测梅毒特异性抗体,用ELISA法检测HCV抗体、HIV抗体,并用蛋白质印迹法对HIV抗体进行确认.结果:GH患者组TPPA阳性率为30.99%,HIV抗体阳性率为4.23%,HCV抗体阳性率为5.63%,均高于非GH患者组(分别为χ2=99.75,P=0.000;χ2=14.72,P=0.000;χ2=9.30,P=0.002).结论:GH患者组TPPA、HIV、HCV抗体阳性率明显高于非GH患者组,对GH患者应加强干预,以进一步控制TP、HIV、HCV的传播.     

皖北地区获得性免疫缺陷综合征2例报道及启示

目的:探讨皖北地区获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)的临床病理学特点。方法:回顾性分析皖北地区2例AIDS的临床和病理学资料,并复习有关文献。结果:2例AIDS患者的人类免疫缺陷病毒(HIV)感染均经安徽省疾病控制中心(CDC)确认,1例主要表现为持续发热、消瘦、淋巴结病及带状疱疹,另1例主要表现为呼吸道症状。结论:在AIDS高发地区,临床和病理医师要熟悉AIDS的临床和病理学表现,对于不明原因的皮肤黏膜、淋巴结和呼吸道疾病,要考虑到AIDS的可能,并做进一步检查。