利什曼原虫与艾滋病病毒的合并感染:利什曼病防治上值得重视的一个问题

由于艾滋病 (AIDS)和内脏 /皮肤利什曼病 (VL/CL)在农村和城镇地区流行的扩展 ,VL/CL和AIDS合并感染的病例日益多见。合并感染极大地增加了利什曼病的传播机会 ,使患者的症状更趋严重、治疗更加困难。介绍了多年来对合并感染的研究进展 ,供我国尚有VL/CL流行的省、自治区发现和防治合并感染作参考     

HIV和HCV合并感染研究进展

人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）感染是全球性问题,因两者具有相同的传播途径,合并感染现象相当常见。合并感染者中,HIV、HCV相互作用加速了疾病的进展,严重危害人类健康。高效抗逆转录病毒治疗（HAART）的应用显著降低了艾滋病患者的死亡率和机会性感染等合并症,延长了患者的生存期。HCV合并感染导致的慢性肝脏疾病成为HIV感染者死亡的主要原因之一。本文就近年来HIV／HCV合并感染方面的研究综述如下。     

利什曼原虫/HIV合并感染流行病学特征及发病机理研究进展

随着利什曼病正向城郊蔓延和艾滋病不断向农村传播,利什曼原虫/HIV合并感染已成为两病原体重叠分布国家的严重威胁。然而,我国当前面临的合并感染发生形势更为复杂,却几乎无人关注。鉴于此,本文综述了利什曼原虫/HIV合并感染在流行病学特征和发病机理等方面的最新进展,以期引起重视。     

rK39抗原应用于我国西北地区内脏利什曼病诊断…

评价ｒＫ３９抗原诊断内脏利什曼病的价值。     

内脏利什曼病治疗后64年复发1例

患者,74岁,日照莒县人,1957年在山东省莒县当地医院诊断为内脏利什曼病,予以五价锑治疗6 d后好转。1964年移居安徽省马鞍山市,2014年10月回日照莒县省亲半个月后返回马鞍山市,2020年7月移居安徽省亳州市,期间均否认白岭叮咬,家中无养犬,无内脏利什曼病患者及病犬接触史。2020年7月出现不明原因的消瘦、乏力,2021年4月出现头晕症状,2021年6月无明显诱因突发高热,乏力及头晕加重。患者骨髓涂片查见利什曼原虫无鞭毛体;骨髓病原微生物高通量基因检测,检出利什曼原虫属序列30 366条,其中杜氏利什曼原虫种序列128条;血清rk39免疫层析试条检测结果阳性。结合流行病学史和实验室检测结果,确诊患者为内脏利什曼病复发。予五价锑（0.6 g/d,肌内注射,总量6 g,疗程10 d）治疗后好转出院。出院后电话随访,患者无发热症状,但未遵医嘱到医院复查。     

rK39免疫层析试条诊断人体内脏利什曼病和感染犬

目的 评价rk39免疫层析试条对内脏利什曼病诊断和流行病学调查中的应用价值.方法 用rk39试条检测就诊者或临床医生考虑为黑热病的患者或进行过病原学检查的患者,并在黑热病疫区现场检测家犬.结果 用rk39试条检测具有流行病学史就诊者358人,黑热病抗体阳性244例,阳性检出率68.16％.接受rk39试条与病原学2种方法检查的207人中,均为阳性者131例,2者阳性符合率为100％;对单-显示rk39试条阳性71例,用锑剂治疗均治愈,证实均为黑热病.rk39试条检查疫区家犬443只,检出阳性犬43只,阳性率为9.71％,阳性犬以5岁以下犬龄多见.结论 与传统诊断内脏利什曼病方法相比较,rK39试条具有更快速、操作简便、敏感和特异性高以及低损伤性,可用于流行区的内脏利什曼病的诊断和筛选;rK39试条可在潜伏期中发现黑热病患者和无症状感染犬,对黑热病患者的诊断和感染犬的检出具有很高的价值.     

快速ELISA法诊断犬内脏利什曼病及应用价值的研究

本研究建立一种用PVC薄膜作载体,将前鞭毛体可溶性抗原包被在PVC凹板上采用HRP-SPA作第二抗体及无每的TMB作底物的加速ELISA方法,该法简便、经济、实用。与经典ELISA平行对照检测24份骨髓穿刺证实的内脏利什曼病犬血清,结果：快速ELISA法阳性符合率为100%（24/24）,而经典ELISA法为95.83%(23/24);对47份采自非流行区的正常犬血清,两法均仅有1例呈假阳性反应,占左.13%;用快速ELISA法检测实验感染了旋毛虫、肺吸虫、钩虫、弓形虫等犬血清共26份,均未见交叉反应,用该法又调查了四川汶川县黑热病重流行区的124份犬血清,同时进行骨髓涂片检查,结果快速ELISA查出阳性犬39只,占31.45%(39/124),骨髓涂片查见利什曼原虫者有24只,占19.35%(24/124),这24只犬血清对快速ELISA法均呈阳性反应。     

新疆维吾尔自治区喀什试点内脏利什曼病的人群感染状况调查

目的了解喀什试点内脏利什曼病的人群感染状况。方法选择喀什市内脏利什曼病发病率较高的村为试点,在入户普查的同时开展人群血清学调查和利什曼素皮内试验,运用SAS软件对调查结果进行综合分析。结果不同年龄组之间皮试阳性率差异有统计学意义(χ2=11.53,P<0.05),皮试阳性率随年龄的增加有逐渐增高的趋势。当地内脏利什曼病患者与既往隐性感染者之比为1∶9。试点地区曾感染过内脏利什曼病的免疫人群占36.15%(60/166),从未感染过内脏利什曼病的易感人群占61.45%(102/166),无临床症状的现感染人群占2.41%(4/166)。结论试点地区内脏利什曼病的流行状况仍然比较严重,无症状现感染者所占比例较高,具有潜在传染源的流行病学意义。     

Rapid clearance of circulating Leishmania kinetoplast DNA after treatment of visceral leishmaniasis

With the aim of evaluating the utility of the detection of Leishmania kDNA in peripheral blood for the cure assessment of visceral leishmaniasis (VL), a PCR based method was performed in patients with confirmed VL at three follow-up periods after specific chemotherapy with pentavalent antimonial. In 16 out of 17 (94.1%) patients with pre-treatment detectable kDNA that were clinically cured, the PCR turned negative up to 37 days after the initiation of treatment, remaining negative over 90 days after treatment. The clearance of Leishmania kDNA from peripheral blood of patients with VL hints to occur during or shortly after treatment concurring or preceding clinical recovery.     

HBV合并HCV或人类免疫缺陷病毒感染的抗病毒治疗进展

乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染是目前全球慢性肝病的主要原因,HBV合并人类免疫缺陷病毒(HIV)感染也较常见,全球4000万HIV感染者中10%并发慢性乙型肝炎(CHB).自从高效抗逆转录病毒治疗的推广,艾滋病相关原因的死亡已经减少,但由肝脏疾病造成的死亡却不断上升,逐渐成为HIV感染者发病和死亡的一个主要原因.     

内脏利什曼病诊断方法研究进展

内脏利什曼病(黑热病)是在世界范围内流行的严重危害人类健康的重要寄生虫病.发展快速而又准确的诊断技术是治疗和控制该病的关键之一.随着免疫学技术、分子生物学技术的应用,黑热病的诊断技术不断取得进展,相应地我国黑热病诊断技术的研究和应用也在不断进步.该文就黑热病诊断技术研究取得的进展作一综述.     

Management of hepatitis C virus infection in HIV/HCV co-infected patients： Clinical review

Nearly one fourth of individuals with human immunodeficiency virus （HIV） infection have hepatitis C virus （HCV） infection in the US and Western Europe. With the availability of highly active antiretroviral therapy and the consequent reduction in opportunistic infections, resulting in the prolongation of the life span of HIV-infected patients, HCV co-infection has emerged as a significant factor influencing the survival of HIV patients. Patients with HIV/HCV co-infection have a faster rate of fibrosis progression resulting in more frequent occurrences of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. However, the mechanism of interaction between the two viruses is not completely understood. The treatment for HCV in co-infected patients is similar to that of HCV monoinfection; i.e., a combination of pegylated interferon and ribavirin. The presence of any barriers to anti- HCV therapy should be identified and eliminated in order to recruit all eligible patients. The response to treatment in co-infected patients is inferior compared to the response in patients with HCV mono-infection. The sustained virologic response rate is only 38% for genotype-1 and 75% for genotype-2 and -3 infections. Liver transplantation is no longer considered a contraindication for end-stage liver disease in coinfected patients. However, the 5 year survival rate is lower in co-infected patients compared to patients with HCV mono-infection （33% vs 72%, P = 0.07）. A betterunderstanding of liver disease in co-infected patients is needed to derive new strategies for improving outcome, and survival.     

Central role of interleukin-15 in human immunodeficiency virus (HIV)-infected patients with visceral leishmaniasis

To evaluate clinical and immunological parameters, interleukin (IL)-15 production and outcome of patients with visceral leishmaniasis (VL), including HIV positive patients, we analyzed 48 cases of VL. Clinical manifestations and response to therapy were similar in VL/HIV- and VL/HIV+ patients. However, relapses were more frequent in patients with HIV infection. Low levels of IL-15 concentrations were found in HIV+ patients without VL. These levels were comparable to concentrations obtained in healthy donors. We found a relationship between response to therapy and IL-15 levels. We found increased levels of IL-15 in VL/HIV- and VL/HIV+ patients with clinical and parasitological response to therapy. Our data demonstrate that VL in HIV-infected patients occurs in subjects with severe immunodeficiency and presents high rate of relapses. Low levels of IL-15 in illness patients and restored production in cured persons suggest that this cytokine could play a central role in immune responses during Leishmania/HIV co-infection.     

Cost-effectiveness of treatment for hepatitis C in an urban cohort co-infected with HIV

Purpose

Recent clinical trials have evaluated treatment strategies for chronic infection with hepatitis C virus (HCV) in patients co-infected with human immunodeficiency virus (HIV). Our objective was to use these data to examine the cost-effectiveness of treating HCV in an urban cohort of co-infected patients.

Methods

A computer-based model, together with available published data, was used to estimate lifetime costs (2004 US dollars), life expectancy, and incremental cost per year of life saved (YLS) associated with 3 treatment strategies: (1) interferon-alfa and ribavirin; (2) pegylated interferon-alfa; and (3) pegylated interferon-alfa and ribavirin. The target population included treatment-eligible patients, based on an actual urban cohort of HIV-HCV co-infected subjects, with a mean age of 44 years, of whom 66% had genotype 1 HCV, 16% had cirrhosis, and 98% had CD4 cell counts >200 cells/mm³.

Results

Pegylated interferon-alfa and ribavirin was consistently more effective and cost-effective than other treatment strategies, particularly in patients with non-genotype 1 HCV. For patients with CD4 counts between 200 and 500 cells/mm³, survival benefits ranged from 5 to 11 months, and incremental cost-effectiveness ratios were consistently less than $75,000 per YLS for men and women of both genotypes. Due to better treatment efficacy in non-genotype 1 HCV patients, this group experienced greater life expectancy gains and lower incremental cost-effectiveness ratios.

Conclusions

Combination therapy with pegylated interferon-alfa and ribavirin for HCV in eligible co-infected patients with stable HIV disease provides substantial life-expectancy benefits and appears to be cost-effective. Overcoming barriers to HCV treatment eligibility among urban co-infected patients remains a critical priority.     

2018年全国内脏利什曼病疫情分析

目的了解2018年全国内脏利什曼病的疫情状况。方法收集2018年中国疾病预防控制中心传染病报告信息管理系统中全国内脏利什曼病病例信息,剔除疑似病例、重复病例以及皮肤利什曼病病例,建立数据库,采用Microsoft Excel 2016软件对内脏利什曼病病例的三间分布进行描述性流行病学分析。结果2018年全国11个省份的78个县共报告内脏利什曼病180例,病例主要分布于甘肃(66例)、山西(38例)和陕西(27例)等3个省。其中40个县属于流行区,共报告本地感染病例134例,其余38个县属于非流行区,共报告输入性病例46例。其中甘肃省舟曲县(22例)、宕昌县(18例)和武都区(10例)为主要流行县,报告病例占全国总报告病例数的27.8%(50/180)。陕西省渭南市化州区和临渭区再现本地感染病例,为内脏利什曼病复燃流行县。内脏利什曼病发病高峰为4-6月,男女病例比为1∶0.7。农民和儿童是我国内脏利什曼病高风险人群,分别占全部病例数的42.2%(76/180)和34.5%(55/180)。内脏利什曼病病例主要分布于≥15岁年龄组,不同流行类型病例年龄分布明显不同,野生动物源型病例主要分布于0~2岁婴幼儿,人源型与犬源型病例主要分布于≥15岁农民。结论我国内脏利什曼病呈低度流行态势,但流行区范围逐渐蔓延。