初治人类免疫缺陷病毒感染者合并代谢综合征及心血管病风险状况及其临床特点分析

目的 探讨尚未进行高效抗反转录病毒治疗（highly active antiretroviral therapy,HAART）的人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者代谢综合征（metabolic syndrome,MS）及心血管病风险状况及其临床特点。方法 以HIV感染者193人为研究对象,按照MS的诊断标准选择诊断为MS的患者为MS组,选对应的非MS患者为非MS组;按照Framingham风险评分筛选心血管病中高危患者为中高危组,低危者为低危组。分别比较2组的临床特征。结果 本研究中代谢综合征的患病率为9.33%,MS各组分中比例最大的为体质量指数（body mass index,BMI）≥25 kg/m²,其次为高密度脂蛋白胆固醇降低。与对照组相比,代谢综合征患者年龄更高,BMI较大,差异有统计学意义（P < 0.05）;MS患者的心血管病风险明显高于非MS患者,年龄、BMI和吸烟史与初治HIV感染者心血管病风险有关,冠状动脉粥样硬化性心脏病风险评估为中高危组患者HIV RNA载量更高,但差异无统计学意义。结论 年龄与BMI与初治HIV感染者代谢综合征风险有关,MS患者心血管病风险明显高于非MS者。HAART治疗前需评估相关危险因素,密切监测并控制患者代谢紊乱及心血管疾病。     

江苏省HIV感染者和艾滋病患者抗病毒治疗1年后CD4+T淋巴细胞检测结果分析

目的 :了解江苏省首次接受艾滋病免费抗病毒治疗的HIV/AIDS患者治疗1年后CD4+T变化及影响因素。方法 :收集江苏省首次接受抗病毒治疗的基线和治疗随访1年时均有CD4+T细胞检测结果记录的HIV/AIDS患者资料,随访截止时间为2014年5月31日。建立Excel数据库并用SPSS16.0软件进行分析。结果:首次接受抗病毒治疗的基线和随访1年时均有CD4+T检测结果记录的HIV/AIDS共3 290例。81.4%为江苏省籍,男女比例为4.36∶1,平均年龄(39.7±12.1)岁。感染途径主要为性传播。入组时基线CD4+T细胞计数均数为185.81个/μl。治疗1年后的CD4+T细胞均数为312.20个/μl。Logistic回归分析显示,年龄大、基线CD4+T高、在疾控中心治疗和临床Ⅰ期的HIV/AIDS患者,其CD4+T较基线增长值≥100个/μl的比例低。结论:江苏省HIV/AIDS抗病毒治疗对免疫功能恢复效果显著,应继续规范、早期开展抗病毒治疗工作。     

脂肪因子与高效抗逆转录病毒治疗相关脂肪营养不良的临床研究

目的 调查接受高效抗逆转录病毒治疗(HAART)的AIDS患者糖脂代谢异常的发生率及其在HIV相关脂肪营养不良综合征(HIV related lipodystrophy,HIV-LD)组和非HIV-LD)组中的差异;比较两组的脂联素(adiponectin,APN)、瘦素(leptin,LEP)水平及其与糖脂代谢、脂肪异常分布的关系.方法 募集2007年3至5月期间在北京协和医院门诊随诊的成年HIV/AIDS患者52例,根据患者报告和医师评估结果,将上述患者分成HIV-LD组与非HIV-LD组,并对其进行全身双能X射线扫描(DEXA)检查和血浆胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和胰岛索测定,应用ELISA法测定血浆APN和LEP水平,调查血脂异常和高胰岛素血症的发生情况及两组之间差异,并分析APN和LEP水平及其与血脂、胰岛素水平和各部位体脂含量的相关性.结果 ①52例HIV/AIDS患者中,至少一项血脂指标异常者59.6%,合并CHO、TG及HDL-C异常血症者分别为17.3%、50.0%和17.3%,空腹高胰岛素血症发生率25.0%.②LD组的TG水平显著高于非HIV-LD组,LD组的HDL-C水平和APN水平显著低于非HIV-LD组.HIV-LD患者的APN水平降低是HDL-C和胰岛素水平异常的独立预测指标,与四肢/全身脂肪总含量正相关,与躯干/全身脂肪总含量负相关.两组的血浆LEP水平均与全身脂肪总含量、四肢和躯干脂肪含量正相关.结论 血脂异常和胰岛素抵抗在接受HAART的AIDS患者中有较高发生率,HIV-LD组比非HIV-LD组更为明显.血浆APN水平下降在HIV-LD组中是HDL-C和胰岛素水平异常的独立预测指标,与脂肪异常分布密切相关;血浆LEP水平则是反映人体内脂肪总最的生物学标志之一.     

Activation and coreceptor expression of T lymphocytes induced by highly active antiretroviral therapy in Chinese HIV/AIDS patients

Background At the end of 2005, 650 000 people lived with human immunodeficiency virus type-1 (HIV-1) in China, of whom 75 000 were AIDS patients. Many AIDS patients received highly active antiretroviral therapy (HAART) supported by the “China CARES” program but the immune responses of HAART were seldom reported. This study investigated the effect of HAART on the activation and coreceptor expression of T lymphocytes in Chinese HIV/AIDS patients and evaluated its effect on immune reconstitution. Methods Seventeen HIV/AIDS patients were enrolled and three-color-flow cytometry was used to detect the activation of HLA-DR CD38 and the coreceptor CCR5, CXCR4 expression on T lymphocytes in whole blood samples taken from the patients before and after 3- or 6-month HAART.Results The activation percents of CD4(+), CD8(+) T lymphocytes were significantly higher before therapy than the normal controls (HLA-DR/CD4: 40.47±18.85 vs 11.54±4.10; CD38/CD4: 81.34±10.86 vs 53.34±11.44; HLA-DR/CD8: 63.94±12.71 vs 25.67±9.18; CD38/CD8: 86.56±11.41 vs 58.84±6.16, all P&lt;0.01). After 6-month combined antiretroviral treatment, the activation of T lymphocytes in HIV/AIDS patients was significantly decreased (HLA-DR/CD4: 28.31±13.48; CD38/CD4: 69.88±12.64; HLA-DR/CD8: 46.56±18.64; CD38/CD8: 70.17±14.54, all P&lt;0.01 compared with the pre-treatment values). Before the treatment, CCR5 expression on CD8(+) T lymphocytes was up-regulated while CXCR4 expression on CD8(+) T lymphocytes downregulated in HIV/AIDS patients compared with the normal controls (CD8/CCR5: 70.91±10.03 vs 52.70±7.68; CD8/CXCR4: 24.14±11.08 vs 50.05±11.68, all P&lt;0.01). After 6-month HAART, CCR5 expression on CD8(+) T lymphocytes significantly decreased (56.35±12.96, P&lt;0.01), while CXCR4 expression on CD8(+) T lymphocytes increased (36.95±9.96, P&lt;0.05) compared with the pre-treatment and the normal controls. A significant statistical relationship was observed between the expression of activation markers, CCR5 and the CD4(+) T lymphocyte counts after HAART (P&lt;0.05).Conclusions Reduced activation of T lymphocytes and a normalization of coreceptor expression were observed in Chinese HIV/AIDS patients after HAART. Immunity can be restored in HIV/AIDS patients receiving HAART.     

艾滋病HAART治疗免疫重建炎性综合征的好发因素和临床特征

目的 观察我国艾滋病患者(AIDS)启动高效抗反转录病毒治疗(HAART)后,发生免疫重建炎性综合征(IRIS)的发病率、病死率、临床特征及其好发易感影响因素.方法 以2007年10月到2009年9月来自湖南省和江四省的接受HAART治疗的238例AIDS患者建立前瞻性研究队列,在24周内进行定期随访.将此期间发生IRIS的47例患者纳入IRIS组,24周时仍未发生IRIS的191例患者纳入非IRIS组.收集两组患者的一般资料、临床发病表现和诊断治疗的相关资料,在HAART的0、12和24周采集患者的血标本检测HIV病毒载量和CD4+细胞计数,对所有资料进行统计学处理和对比分析.结果 IRIS发生率为19.7%(47/238),病死率6.2%(2/47);HAART起动后发生IRIS的平均天数为28(9～36)d.IRIS中以结核感染占多数(61.7%,29/47),IRIS组与非IRIS组在年龄、性别、传播途径以及抗病毒治疗的方案上差异均无统计学意义.在0、12和24周时两组的病毒载量均逐步明显下降,CD4+细胞数均逐步明显上升.但是启动HAART时IRIS组的CD4+细胞数明显低于非IRIS组(48×106个/L比146×106个/L,P＜0.01),IRIS组的CD4+细胞数在100×106个/L以内者占85.1%(40/47).结论 IRIS多发生在HAART治疗启动后的1～3个月内,接受HAART治疗者的年龄、性别、传播途径以及抗病毒治疗的方案均与IRIS的发生无明显相关.在治疗24周内IRIS组与非IRIS组的HIV RNA病毒载量下降幅度和CD4细胞上升数量均无明显差别,但起动HAART前CD4+细胞计数＜100 × 106个/L的感染者更容易出现IRIS.我国HAART发生IRIS多为结核感染,一般无须停用抗病毒药物,对症处理即可,但对结核病或其他严重的感染仍须抗感染治疗.

Abstract：

Objective To summarize the morbidity, mortality, clinical manifestations and risk factors for IRIS (immune reconstruction inflammatory syndrome) during HAART (highly active antiretroviral therapy) in China. Methods From October 2007 to September 2009, a prospective cohort of 238 AIDS (acquired immunodeficiency syndrome) patients on HAART from Hunan and Jianxi provinces was recruited for a follow-up of 24 weeks. And 47 and 191 patients were assigned into the IRIS and non-IRIS groups respectively. The data of general information, clinical manifestations and treatment of two groups were collected and compared. Blood samples were collected in both groups at pre-and post-HAART 12 weeks, 24weeks for HIV viral load and CD4 + cell count examinations. A statistical analysis was performed. Results A total of 47 ( 19. 7% ) IRIS cases was analyzed. The median onset of IRIS was 28 (9 -36) days. And 29(61.7%) cases of tuberculosis IRIS were found. There was no significant difference in age, gender, route of transmission and antiretroviral regimens between the IRIS and non-IRIS groups. At baseline, Weeks 12 and 24, both groups showed a significant decline of viral load. And there was no significant difference between them. Both groups showed a significant increase of CD4 + cell count. But there was no significant difference between two groups. However, the baseline CD4+ cell count was markedly lower in the IRIS group than that in the non-IRIS group. In 85. 1% (40/47)of cases, the CD4+ cell count was ＜ 100 × 106/L in the IRIS group at the baseline of HAART. Conclusion IRIS mostly occurs during 3 months of HAART initiation.The age, gender, route of transmission and antiretroviral treatment regimens of patients on HAART are not risk factors for the development of IRIS. The HIV RNA viral load decreases in both IRIS and non-IRIS groups without any significant difference. The patients with a CD4 + cell count ＜ 100/μl are more vulnerable to develop IRIS.     

Highly active antiretroviral therapy per se decreased mortality and morbidity of advanced human immunodeficiency virus disease in Hong Kong

Background Morbidity and mortality of advanced human immunodeficiency virus infection (HIV) have declined in Western industrialized countries since the availability of highly active antiretroviral therapy (HAART). It is unclear if this has also happened in Hong Kong.Methods We studied a retrospective cohort of patients with advanced HIV disease in Hong Kong, China. First, the mortality of advanced HIV disease per year was calculated for the decade 1993 to 2002, both annually and according to patient observation before and after 1997. Second, the event rates were estimated for the clinical end points of acquired immune deficiency syndrome (AIDS) and death. Univariate and multivariate analyses were then performed to identify associated factors. Results The crude mortality of advanced HIV disease declined from 10.8-30.4 per 100 patients during 1993-1996, to 0.8-6.9 per 100 patients during 1997-2002. A rate ratio of 4.04 (95% CI, 2.52-6.47) was evident for those observed in 1993-1996, compared to those in 1997-2002. In a multivariate analysis where calendar period was adjusted, use of highly active antiretroviral therapy was associated with rate ratios of 0.13 (95% CI, 0.05-0.33) for death after AIDS, 0.08 (95% CI, 0.04-0.19) for AIDS after a CD4 cell count &lt;200/μl, and 0.21 (95% CI, 0.07-0.67) for death after CD4 cell count &lt;200/μl. In the same analysis, calendar period ceased to be a significant factor after adjustment for use of HAART.Conclusions The mortality and morbidity of advanced human immunodeficiency virus disease have declined in Hong Kong. This improved prognosis was attributable to the use of highly active antiretroviral therapy.     

Predictors of impaired renal function among HIV infected patients commencing highly active antiretroviral therapy in Jos, Nigeria

Background:

Kidney disease is a common complication of human immunodeficiency virus (HIV) infection even in the era of antiretroviral therapy, with kidney function being abnormal in up to 30% of HIV-infected patients. We determined the predictors of impaired renal function in HIV-infected adults initiating highly active antiretroviral therapy (HAART) in Nigeria.

Materials and Methods:

This was a retrospective study among HIV-1 infected patients attending the antiretroviral clinic at the Jos University Teaching Hospital (JUTH), between November 2005 and November 2007. Data were analysed for age, gender, weight, WHO clinical stage, CD4 count, HIV-1 RNA viral load, HBsAg and anti-HCV antibody status. Estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault equation. Statistical analysis was done using Epi Info 3.5.1.

Results:

Data for 491 (294 females and 197 males) eligible patients were abstracted. The mean age of this population was 38.8±8.87 years. One hundred and seventeen patients (23.8%; 95% CI, 20.2-27.9%) had a reduced eGFR (defined as <60 mL/min), with more females than males (28.6% vs. 16.8%; P=0.02) having reduced eGFR. Age and female sex were found to have significant associations with reduced eGFR. Adjusted odds ratios were 1.07 (95% CI, 1.04, 1.10) and 1.96 (95% CI, 1.23, 3.12) for age and female sex, respectively.

Conclusions:

Older age and female sex are independently associated with a higher likelihood of having lower eGFRs at initiation of HAART among our study population. We recommend assessment of renal function of HIV-infected patients prior to initiation of HAART to guide the choice and dosing of antiretroviral drugs.     

重庆市1978例初始接受抗逆转录病毒治疗HIV感染者的回顾性分析

目的 了解重庆市人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者临床特征及影响疾病进展的危险因素.方法 收集2013-2015年在重庆市公共卫生医疗救治中心接受初始抗逆转录病毒治疗(antiretroviral therapy,ART)治疗的HIV感染者临床资料,根据病情对基本资料、临床检测指标、合并疾病进行回顾性分析.结果 1 978例初始接受ART治疗的HIV感染者中,54.9％的患者在ART治疗前病情进入艾滋病期,90％以上HIV感染者CD4+淋巴细胞水平低于350个/μL;病情进入艾滋病期的HIV感染者1个月内开始ART治疗的患者比例明显高于无症状期感染者(X2=69.14,P＜0.05),而HIV感染确证4个月后才开始ART治疗的无症状期感染者比例明显高于病情进入艾滋病期的感染者(X2 =75.56,P＜0.05);来自区县的患者中艾滋病期患者比例明显高于主城地区(X2 =28.50,P＜0.05),前者出现艾滋病的发病风险为后者的1.69倍(95％CI:1.47～1.95);接受ART治疗者以20 ～ 40岁的HIV感染者为主(58.6％),男男同性性行者在总病例中占有较高比例(47.6％),且病情进入艾滋病期者比例最低(39.6％),有男男同性性行为的HIV感染者进入艾滋病期的比例低于经其他途径获得感染者.结论 重庆市HIV感染者在诊断为HIV感染时,大部分已进入艾滋病期;无症状期HIV感染者存在拖延ART治疗开始时间的倾向;来自区县的HIV感染者艾滋病发病风险高于主城区感染者;年龄偏大和非经男男性行为途径而获得HIV感染的患者病情进展到艾滋病期的风险高于年轻和男男同性恋者.     

HIV感染者/AIDS患者高效抗逆转录病毒治疗感知效果影响因素分析

目的:研究影响HIV感染者/AIDS患者(people living with HIV or AIDS,PLWH)感知高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)效果的影响因素,为促进抗病毒治疗提供科学依据。方法:采用回顾性调查研究方法和面对面问卷调查收集一般人口学信息、艾滋病基本知识、服药情况、服药依从性、HAART疗效自我感知等信息。采用卡方检验、秩和检验、有序分类变量logistic回归进行统计学分析。结果:共收集到321名调查对象的有效信息,艾滋病基本知识知晓率为88.16%,最近1年有259例患者开展了HIV病毒载量检测,258例病毒载量<50拷贝/mL,最近1次CD4+T细胞平均为(444.23±178.29)个/μL。70.09%的PLWH感知到治疗效果为"有效",6.23%的PLWH感知到治疗效果"非常有效"。出现不良反应后可否自行停药或者减药(OR=0.337,95%CI=0.178～0.638)、治疗前CD4+T细胞数量(OR=2.931,95%CI=1.479～5.807)和治疗持续时间(OR=...     

人类免疫缺陷病毒合并乙型肝炎病毒感染患者高效抗反转录病毒治疗效果和肝脏损伤研究

目的 对人类免疫缺陷病毒(HIV)合并乙型肝炎病毒(HBV)感染患者高效抗反转录病毒治疗(HAART)的临床效果和伴随的肝脏损伤情况作出评价.方法 将患者按有无HBV合并感染分为HIV单纯感染组75例和HIV/HBV合并感染组69例,应用HAART方案治疗1年,对比观察患者血浆HIV载量,外周血CD4+T淋巴细胞计数、丙氨酸氨基转移酶等指标变化.结果 治疗前,HIV单纯感染组和HIV/HBV合并感染组的HIV载量均值分别为6.31和5.85 log10copies/mL,治疗12个月后,分别降低至2.90 log10 copies/mL(P＜0.05)和2.93log10 copies/mL(P＜0.05),两组HIV RNA抑制率分别为82.67％和92.75％.HIV单纯感染组和HIV/HBV合并感染组CD4+T细胞均值由治疗前的77.8个/μL和75.4个/μL,分别上升到221.4个/μL和214.3个/μL(P＜0.05).1年内HIV单纯感染组和HIV/HBV合并感染组的肝功能异常率分别为6.4％和19.7％ (P ＜0.05),但HAART期间无因发生严重肝脏损伤而停止治疗的患者.结论 应用HAART的HIV/HBV合并感染患者,短期内可以有效抑制HIV病毒复制,重建患者的免疫功能;HBV可能因促进HIV复制而加重肝损伤与免疫损伤,但并不影响HAART的效果.     

高效抗逆转录病毒治疗对AIDS患者MCP-1和MSP水平的影响

目的:研究高效抗逆转录病毒治疗(HAART)对AIDS患者血清中MCP-1、MSP水平的影响。方法:采用ELISA法检测40例经HAART3个月的国内AIDS患者及84例经HAART3至6年的德国患者血清MCP-1、MSP的水平,荧光定量PCR测定HIV-RNA滴度,流式细胞术检测CD4 T细胞计数。结果:HIV-1感染者血清MCP-1的水平显著高于正常人群(P<0.01),MSP则显著低于正常人群(P<0.01);经短期HAART(3月)后,MCP-1水平下降(P<0.01),MSP无明显改变;长期HAART(3至6年)后MCP-1水平显著升高(P<0.01),而MSP显著下降(P<0.01),MCP-1和MSP水平的变化呈负相关(r=-0.99,P=0.029)。结论:MCP-1、MSP与AIDS病程进展有密切关系,HAART对AIDS患者MCP-1、MSP水平有显著的改变,进而改善患者病程进展。     

Impact of baseline CD4^＋ T cell counts on the efficacy of nevirapinebased highly active antiretroviral therapy in Chinese HIV/AIDS patients： a prospective,multicentric study

Background CD4^＋T cell counts have been used as the indicator of human immunodeficiency virus type 1 （HIV-1） disease progression and thereby to determine when to start highly active antiretroviral therapy （HAART）. Whether and how the baseline CD4^＋T cell count affects the immunological and viral responses or adverse reactions to nevirapine （NVP）-containing HAART in Chinese HIV-1 infected adults remain to be characterized. Methods One hundred and ninety-eight HIV-seropositive antiretroviral therapy （ART）-naive subjects were enrolled into a prospective study from 2005 to 2007. Data were analyzed by groups based on baseline CD4^＋T cell counts either between 100-200 cells/μl or 201-350 cells/μl. Viral responses, immunologic responses and adverse events were monitored at baseline and at weeks 4, 12, 24, 36, 52, 68, 84, 100. Results Eighty-six and 112 subjects ranged their CD4^＋T cell counts 100-200 cells/μl and 201-350 cells/μl, respectively. The pre-HAART viral load in CD4 201-350 cells/μl group was significantly lower than that in CD4 100-200 cells/μl group （P=0.000）. After treatment, no significant differences were observed between these two groups either in the plasma viral load （pVL） or in the viral response rate calculated as the percentage of pVL less than 50 copies/ml or less than 400 copies/ml. The CD4^＋T cell counts were statistically higher in the 201-350 group during the entire follow-ups （P 〈0.01） though CD4^＋ T cell count increases were similar in these two groups. After 100-week treatment, the median of CD4^＋ T cell counts were increased to 331 cells/μl for CD4 100-200 cells/μl group and to 462 cells/μl for CD4 201-350 cells/μl group. Only a slightly higher incidence of nausea was observed in CD4 201-350 cells/μl group （P=0.05） among all adverse reactions, including rash and liver function abnormality. Conclusions The pVLs and viral response rates are unlikely to be associated with the baseline CD4^＋T cell counts. Initiating HAART in Chinese HIV-1 infected patients with higher baseline CD4^＋T cell counts could result in higher total CD4^＋T cell counts thereby achieve a better immune recovery. These results support current guidelines to start HAART at a threshold of 350 cells/μl.     

Crystalluria in HIV/AIDS patients on highly active anti-retroviral therapy in the Kumasi metropolis; a cross sectional study

Background:

Crystalluria is associated with some highly active anti-retroviral therapies (HAART''s) used in the management of HIV/AIDS. Aims: This study used light microscopy to establish the prevalence of crystalluria among HIV/AIDS patients on HAART and identified the routine crystals present in their urine.

Materials and Methods:

In this simple randomised cross-sectional study, 200 HIV/AIDS participants, comprising 150 on HAART and 50 HAART-naïve were recruited from the HIV clinic at the Komfo Anokye Teaching Hospital (KATH). Urine and blood samples were collected, for urinalysis and the determination of the CD4 count, respectively. A well-structured pre-tested questionnaire was used to obtain socio-demographic data and clinical history of the participants.

Results:

The prevalence of crystalluria was higher among HIV-infected persons on HAART than those not on HAART (6.7% vs 4%; P = 0.733). Calcium oxalate and triple phosphate crystals were the crystal types present in their urine (3.5% and 2.5%, respectively) and was present only in HIV subjects on first line of treatment (without protease inhibitors). Participants aged between 40-50 years and those with hypersthenuria and acidic urine had the highest amount of crystalluria (41.6%, 83.3%, and 58.3%, respectively).

Conclusion:

HAART is associated with crystalluria in HIV patients. Light microscopy will be of disgnostic value in resource limited settings.     

辽宁省阜新市抗病毒治疗患者HIV-1 DNA耐药情况及亚型分析

目的 了解阜新市已接受HAART患者HIV耐药株的发生及基因亚型分布情况。方法 采集全血标本进行白细胞富集和前病毒DNA提取,巢式PCR扩增HIV-1 pol区基因并测序,使用MEGA以及斯坦福大学HIV耐药数据库等工具对序列信息进行分析。结果 在112份全血标本中获得101例有效基因序列,CRF01_AE亚型占84.16%(85/101),CRF07_BC 亚型占8.91%(9/101),B亚型占3.96%(4/101),CRF65_cpx亚型占1.98%(2/101),G亚型0.99%(1/101);耐药分析显示27例患者发生耐药位点突变,其中,19例对核苷类逆转录酶抑制剂耐药,主要耐药突变位点为M184I/V,14例对非核苷类逆转录酶抑制剂耐药,主要耐药突变位点为G190S,对两类逆转录酶抑制剂同时耐药的样本有6例,尚未出现蛋白酶抑制剂耐药突变患者;治疗时间以及基线CD4水平的差异对耐药突变具有统计学意义。结论 阜新市HIV-1存在5种亚型,CRF01_AE为主要流行亚型;耐药情况的研究为更科学有效地指导艾滋病防治工作提供参考依据,应继续加强耐药监测,掌握基线数据,严防耐药株的流行。     

Clinical outcomes and immune reconstitution in 103 advanced AIDS patients undergoing 12-month highly active antiretroviral therapy

Background Highly active antiretroviral therapy (HAART) produces profound suppression of HIV replication, substantial increase in CD4(+) T cells, and partial reconstitution of the immune system. However, the numbers of subjects were small in previous Chinese studies. This study evaluated the efficacy and side effects of HAART in Chinese advanced AIDS patients.Methods One hundred and three antiretroviral drug naive AIDS patients were enrolled in this study and were divided into two groups by their baseline CD4(+) count: &lt;100 cells/&micro;l or ≥100 cells/&micro;l. Clinical, virological and immunological outcomes were monitored at baseline and at 1, 3, 6, 9 and 12 months during the course of treatment with HAART.Results One patient died and another was lost from the follow-up. For the remaining 101 HIV/AIDS patients at the 12th month during the HAART, the plasma viral load (VL) was reduced to (3.2±0.7) lg copies/ml, the CD4(+) count increased to (168±51) cells/&micro;l [among which the naive phenotype (CD45RA(+)CD62L(+)) increased to (49±27) cells/&micro;l and the memory phenotype (CD45RA(－)) increased to (119±55) cells/&micro;l], and the percentage of CD4(+)CD28(+) cells increased. At the same time, there was a significant reduction of CD8(+) T cell activation. In the 69 patients with the baseline CD4(+) count &lt;100 cells/&micro;l, 37 had a VL &lt;50 copies/ml; while in the 34 patients with the baseline CD4(+) count ≥100 cells/&micro;l, 25 had a VL &lt;50 copies/ml, the difference between the two groups was statistically significant. The CD4(+) T cell count showed a two-phase increase during HAART and a significant positive correlation was shown between the change of CD4(+) count and plasma VL. Over 12 months of HAART, 10 patients had gastrointestinal side effects, 13 peripheral neuritis, 7 hepatic lesions, 8 hematological side effects, 8 skin rashes, 10 lipodystrophy and 1 renal calculus.Conclusions Immune reconstitution as well as the significantly improved clinical outcomes is observed in Chinese advanced AIDS patients after HAART. Side effects are common during HAART and require clinical attention.     

127例HIV/AIDS患者抗病毒治疗1年CD4~+T淋巴细胞结果

目的分析HIV/AIDS患者抗病毒治疗前后CD4~+T淋巴细胞数的变化情况,为全省的抗病毒治疗提供科学依据。方法对青海省2013—2015年间接受抗病毒治疗的127名HIV/AIDS患者治疗前、治疗后3个月、6个月、9个月及12个月CD4~+T淋巴细胞数进行检测和统计学分析。结果 127例HIV/AIDS患者的平均开始治疗年龄为(37.6±10.8)岁,治疗前CD4~+T淋巴细胞数平均水平为(321.2±108.4)个/μL;患者治疗3个月、6个月、9个月和12个月时与进入治疗时点相比,其CD4~+T淋巴细胞数平均增加了52.2个/μL、75.8个/μL、75.3个/μL和76.5个/μL,差异均有统计学意义(P0.01);经抗病毒治疗1年后,CD4~+T淋巴细胞数500个/μL的患者从0例增至37例,占患者总数的29.1%;CD4~+T淋巴细胞数分为≤200个/μL、201~350个/μL和350个/μL三组患者,经抗病毒治疗1年后,CD4~+T淋巴细胞数平均分别增加了80.7个/μL、84.7个/μL和65.8个/μL,不同组患者HAART治疗1年后CD4~+T淋巴细胞数均值变化差异有统计学意义(P均0.05)。结论青海省目前的HAART治疗效果明显,同时提高HIV/AIDS患者的依从性,并尽早开展抗病毒治疗,有利于提高患者的生命质量,延缓疾病进程,降低病死率。     

AIDS合并结核感染患者抗逆转录病毒治疗后发生免疫重建炎性综合征高危因素分析

目的 探讨艾滋病合并结核感染患者(acquired immune deficiency syndrome patients with tuberculosis infection,AIDS/TB)在高效抗逆转录病毒治疗(highly active anti-retroviral therapy,HAART)中出现免疫...     

江苏省2005~2010年抗病毒治疗艾滋病患者流行病学特征比较分析

目的:了解2005~2010年江苏省艾滋病免费抗病毒治疗患者入组时的流行病学特征,比较分析其变化情况,为江苏省进一步实施艾滋病免费抗病毒治疗工作提供依据?方法:收集江苏省2005~2010年内所有接受抗病毒治疗艾滋患者入组治疗时的基本情况,建立Excel数据库并用SPSS17.0软件分析并比较其流行病学特征变化趋势?结果:江苏省2005~2010累计治疗1 276例艾滋病患者,新增治疗人数逐年上升,增幅逐年扩大?江苏籍占93.7%,男女性别比2.7∶1?平均年龄(39.2 ± 11.0)岁,变化不大,但低年龄组有上升趋势?已婚或同居占65.1%?来源主要为医院被动发现,占40.9%,但有下降趋势?感染途径主要为异性性传播和同性性传播,两者合计占76.1%,同性性传播比例逐年上升,2010年达到32.8%?患者治疗时CD4+ T 细胞平均为134.9个/μl,开始治疗时间与确证时间的间隔天数中位数为147 d(P25 = 55,P75 = 489),有上升趋势?结论:江苏省艾滋病患者开始抗病毒治疗时机较晚,但逐渐有所改善?患者发现晚仍是主要原因,感染者早发现能力仍需加强?