HIV感染抗病毒治疗的副作用

HIV感染通过联合应用抗逆转录药物 ,可以将病毒载量抑制至检测不到的水平并升高CD4T细胞计数。然而 ,因为药物的毒副作用 ,长期联合治疗难于坚持。所有抗逆转录药物都有短期和长期副作用。每个药物、药物种类和患者 ,其副作用小同。因此 ,了解抗逆转录药物的副作用有益于优化HIV的治疗。     

Immune mechanisms in HIV infection and their role in antiretroviral therapy

In this article mechanisms of CD4 cells depletion, apoptosis, necrosis and T-cell activation, cellular immune responses to HIV infection, with emphasis on involvement of CD4 and CD8 HIV-specific cytotoxic T lymphocytes in human immunodeficiency virus infection are being discussed. Author reviews recent reports on immune restoration resulting from antiretroviral therapy, T-cell turnover within CD4 and CD8 subsets, including rapidly (activated effector and memory) and slowly (na?ve) proliferating T-cells and the influence of IL-7 on regeneration of T lymphocytes. Finally function of dendritic cells in pathomechanisms of HIV disease is summarized.     

Adherence to antiretroviral therapy during HIV infection, a multidisciplinary approach

Since HIV infection has become a chronic disease, antiretroviral therapy is now used on a long-term basis. Response to treatment is conditioned by numerous inter-dependent factors, including non-compliance, which can result in failure of the therapeutic regimen. Although compliance is crucial for long-term efficacy of the treatment, it is a dynamic factor, and therefore difficult to evaluate. This literature review proposes a multidisciplinary approach to treatment adherence during HIV infection, and deals with the following questions: how should adherence and non-adherence be defined? How are they correlated to the treatment response? How is adherence measured in trials and cohorts, as well as in clinical practice? By what factors is it influenced? What tools can be implemented to improve adherence? The interaction between adherence and response to antiretroviral therapy requires communication between clinicians, healthcare providers, patients, virologists, pharmacologists, and the companies responsible for developing drugs. The pharmaceutical industry must sustain its efforts to ensure a balance between demands for efficacy and adherence when developing new drugs. And the methods implemented by numerous healthcare teams plead in favour of a dynamic approach to adherence, with the active participation of all.     

Surveillance of AIDS and HIV infection: opportunities and challenges

From 1980 to 1984 Americans with no health insurance increased from 13.9% to 17.1% of the non-elderly population. Non-elderly persons covered by Medicaid declined from 6.2% to 5.6%. Previous studies of the share of the burden of uncompensated care borne by various provider groups present opposing findings. The National Hospital Discharge survey data presented here demonstrate that for-profit hospitals serve significantly lower percentages of uninsured discharges than secular or church-affiliated non-profit hospitals and public hospitals. The same pattern of differentials is observed with respect to Medicaid. On the whole the results of the survey tend to support the argument that private non-profit hospitals do indeed render greater public services in treating indigent patients than do for-profit hospitals. It must also be emphasized, however, that the results show all private hospitals falling somewhat short of the standard set by public hospitals in treating indigents. Thus, the continued shrinkage of the public hospital sector has serious policy implications.     

Commentary: Early antiretroviral therapy for HIV infection in sub-Saharan Africa, a challenging new step

Recent changes in guidelines (World Health Organization (WHO), USA, and likely Europe soon) all move towards earlier initiation of antiretroviral therapy in asymptomatic patients infected with human immunodeficiency virus (HIV). Sonia Menon appropriately questions the feasibility and consequences at both individual and community levels of the early initiation of antiretroviral therapy in sub-Saharan Africa as likely effects will be both positive and negative. Local context should drive the uptake process in every country. Money, national and international, will be essential for the successful implementation of the new WHO recommendation. Leaders at both levels must take their responsibilities and mobilize the necessary resources, for example, doubling those for the Global Fund to Fight AIDS, Tuberculosis and Malaria from $10 billion to $20 billion USD for 2011-2013.     

河南省艾滋病抗病毒治疗成就与挑战

为了纪念全球发现艾滋病40周年,本文从历史发展、现状分析、困难与挑战和未来展望四个方面总结了河南省艾滋病抗病毒治疗的历程,并对各个方面取得的进展进行了综述.河南省开展艾滋病抗病毒治疗30多年来,挽救了大批艾滋病患者的生命,遏制了 HIV经血液途径传播,阻断了 HIV母婴传播,控制了 HIV单阳家庭内性传播,减少了HIV...     

HIV感染及抗病毒治疗与糖尿病关系研究进展

随着抗病毒治疗的广泛使用,HIV感染者的预期寿命、生活质量得到较大改善。与此同时,HIV相关的代谢性疾病,尤其是糖尿病的患病风险也有所增加。HIV感染者中糖尿病的风险增加与很多因素共同作用有关。近年来研究表明HIV感染及抗病毒治疗与糖尿病密切相关。本文综述了近年来HIV感染及抗病毒治疗在糖尿病发生发展中的作用机制。     

Anthropometric and immunological success of antiretroviral therapy and prediction of virological success in west African adults

Objective

The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step. In sub-Saharan Africa, few people have access to plasma viral-load measurement. We assessed the gain or loss in body mass index (BMI), alone or in combination with the gain or loss in CD4+ T-cell count (CD4), as a tool for predicting the response to ART.

Methods

In a cohort of 622 adults in Abidjan, Côte d’Ivoire, we calculated the sensitivity, specificity and predictive values of BMI and CD4 for treatment success defined as viral-load undetectability (< 300 copies/ml) as gold standard.

Findings

After 6 months of ART, the median change in BMI was an increase of 1.0 kg/m² (interquartile range, IQR: 0.0–2.1), the median change in CD4 an increase of 148/μl (IQR: 54–230) and 84% of patients reached viral-load undetectability. The distribution of change in BMI was similar among patients who reached undetectability and those who did not (increases of 1.06 kg/m² versus 0.99 kg/m², P = 0.51). With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%. All results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4.

Conclusion

In settings where viral-load measurement is not available, a high BMI gain does not reflect virological success, even when combined with a high CD4 gain. In our population, most patients with detectable viral-load had probably adhered to the drug regimen sufficiently to reach significant gains in body mass and CD4 count but had adhered insufficiently to reach viral suppression.     

A brief history of the global effort to develop a preventive HIV vaccine

Soon after HIV was discovered as the cause of AIDS in 1983–1984, there was an expectation that a preventive vaccine would be rapidly developed. In trying to achieve that goal, three successive scientific paradigms have been explored: induction of neutralizing antibodies, induction of cell mediated immunity, and exploration of combination approaches and novel concepts. Although major progress has been made in understanding the scientific basis for HIV vaccine development, efficacy trials have been critical in moving the field forward. In 2009, the field was reinvigorated with the modest results obtained from the RV144 trial conducted in Thailand. Here, we review those vaccine development efforts, with an emphasis on events that occurred during the earlier years. The goal is to provide younger generations of scientists with information and inspiration to continue the search for an HIV vaccine.     

The discovery and development of HIV therapy: the new challenges

The therapy of HIV infection has been dramatically improved over the years, and allowed the achievement of unexpected results. The availability of many drugs, and the knowledge of HIV related pathogenesis, helped in selecting highly effective antiviral therapies, yet today a major challenge stands, that is the selection of the best regimen(s) in clinical practice. In this frame, evidence-based medicine remains a cornerstone of modern medicine, but its structure needs to be adapted to the new challenges, made by an excess of information (not always fully reliable), by highly sophisticated statistical systems that may overlook the clinical practice despite their ability to define the statistical significance, and the limited number of independent controlled studies. The revision of the criteria of evidence-based medicine, and their adaptation to the new tools available, may allow a better contribution to the definition of the best therapy for each single patient.     

探讨艾滋病抗病毒治疗的管理及对策

[目的]探讨在艾滋病抗病毒治疗工作中存在的问题。[方法]收集了2005年9月～2007年6月底治疗的47例AIDS流行病学资料进行分析。[结果]抗病毒治疗初期面临许多问题，近年艾滋病病人逐年增加，急需加强艾滋病抗病毒治疗管理。[结论]建议为抗病毒治疗的开展提供政策和经费保障。     

流行病学发展的回顾与展望

流行病学是在人类与疾病作斗争的过程形成和发展起来的一门应用学科,在探索疾病病因、预防控制疾病、制定和评价公共卫生策略措施,以及改善人群健康等诸多方面扮演着重要的角色.随着人类疾病谱的变化和医学模式的转变,流行病学的应用范围已经由传染性疾病扩展到慢性非传染性疾病、伤害和健康相关领域等,流行病学理论和方法也日趋完善成熟,它已经成为预防医学的基础学科和现代医学的骨干学科,被誉为"公共卫生之母".本文扼要地回顾了流行病学的发展历程,归纳总结了近些年流行病发展趋势,探讨了今后流行病学发展可能面临的挑战与困惑.     

A brief history of vaccines and vaccination

Human vaccinology, with its primary focus on the individual, seems far removed from veterinary medicine, with its concern for the health of the herd. Yet several episodes in the past (smallpox, fowl cholera, anthrax, swine erysipelas, rabies, tuberculosis, etc.) serve to illustrate the proximity between research on veterinary and human vaccines. In some cases the human vaccine was developed first, while in other cases it was the animal vaccine. The history of vaccinology clearly demonstrates the importance of these 'two medicines' working together. Foot and mouth disease (FMD) vaccines were among the first vaccines to be developed, beginning at the end of the 19th Century. Thanks to the discoveries of several researchers, including European researchers such as Vallée (French), Waldmann (German), Frenkel (Dutch) and Capstick (British), FMD vaccines began to be produced on an industrial scale from 1950 onwards, making possible vaccination of millions of animals in Europe and beyond. Vaccination strategies against FMD have always been dependent on the properties of the vaccines being used. At the beginning of the 21st Century FMD vaccines are designed in such a way that serological tests can differentiate infected from vaccinated animals, which has affected OIE regulations on international trade in animals and animal products. The history of vaccination against rinderpest, bovine contagious pleuropneumonia, and Marek's disease will also be dealt with.