天津市高危人群艾滋病早期感染检测策略研究

目的 本研究利用天津市现有的高危人群HIV-1抗体筛查检测体系, 比较核酸检测、P31条带分析法与捕获酶联免疫(BED)检测组合方法, 探讨天津市适合的艾滋病急性期感染检测策略。方法 2013年天津市市区自愿咨询检测门诊的男男性行为人群三代HIV筛查试剂筛查阴性的样本, 采用四代HIV抗体筛查试剂进一步筛查, 发现阳性后做确证实验, 确证阴性及不确定者进行核酸检测;以及经第四代试剂筛查阴性的样本, 采用集合核酸方法进一步检测。天津市2012-2013年部分经免疫印迹实验(WB)检测新确认的HIV抗体阳性并且CD4计数200的感染者, BED检测判为新近和既往感染者, 并进行P31条带分析。结果 2320例MSM样本三代试剂筛查并确证阳性样本140例; 2180例筛查阴性的样本, 应用四代试剂检测, 进一步筛出19例阳性样本, 进行WB检测确认6例阳性, 11例阴性, 2例不确定;对13例阴性及不确定样本进行核酸验证, 发现4例阳性; 2161例四代试剂筛查阴性样本, 经集合核酸进一步检测、拆分发现阳性样本1 例, 总计检核酸测出5例阳性。294份WB阳性样本进行BED检测, 117份判定为新近感染, 177份为既往感染, 从WB结果中p31条带情况分析, 新近感染者中p31阴性者占23.9%(28/117), 长期感染者0例(0/177), AIDS患者1例, 占1.1%(1/95), 结果差异有统计学意义。结论 针对高危人群应分人群进行不同检测策略的组合, 并应重点针对天津市MSM HIV阳性群体进行更加精确的新发感染时间段构成情况连续监测。     

Autoimmune manifestations of human immunodeficiency virus (HIV) infection

The human immune deficiency virus (HIV) is not only capable of inducing a state of immunodeficiency, but it is also associated with a state of profound immune dysregulation. This immune dysregulation may manifest itself as autoimmune reactivity that may participate in the overall pathogenic process of HIV infection as well as in the development of a variety of autoimmune laboratory phenomena and clinical syndromes. If autoimmune mechanisms are operative in the immunopathogenesis of the virus itself in the form of autocytotoxicity, the knowledge of this is critically important for the development of effective forms of antiviral therapy. The recognition that individuals infected with HIV can develop a wide variety of autoimmune laboratory phenomena including hypergammaglobulinemia circulating immune complexes and autoantibodies is important to assist in the proper interpretation of tests. The development of clinical autoimmune syndromes in HIV-infected individuals, such as connective tissue disorders, immune cytopenias, and other conditions, is important to the clinician, who must recognize these alternative forms of disease presentation for accurate diagnosis and treatment.     

Myocardial disease in human immunodeficiency virus (HIV) infection: a review

Heart muscle disease is the most important cardiovascular manifestation of HIV infection and is likely to become even more prevalent as HIV infected patients live longer. This may present as myocarditis, dilated cardiomyopathy or isolated left or right ventricular dysfunction. Myocardial involvement in HIV infection is multifactorial and may arise as a result of myocardial invasion with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiac toxicity, nutritional deficiencies, and prolonged immunosuppression. Both adults and children are affected with severity ranging from incidental microscopic inflammatory findings at autopsy to clinically significant cardiac disease with chronic cardiac dysfunction. It is associated with a poor prognosis, and results in symptomatic heart failure in up to 5% of HIV patients. Clinical pathological studies from the pre-HAART era show a 30% prevalence of cardiomyopathy in patients with AIDS. The introduction of highly active antiretroviral therapy (HAART) regimens has substantially modified the course of HIV disease by lengthening survival and improving quality of life of HIV-infected patients. There is also good evidence that HAART significantly reduces the incidence of cardiovascular manifestations of HIV infection. By preventing opportunistic infections and reducing the incidence of myocarditis, HAART regimens have reduced the prevalence of HIV-associated cardiomyopathy by almost 7-fold from the pre-HAART era. HAART is however only available to a minority of HIV infected individuals in most areas of the world and studies from the pre-HAART period still apply. In this review, the aetiopathogenesis and presentation of HIV related myocardial disease were reviewed and measures taken to improve survival discussed.     

Screening potential blood donors at risk for human immunodeficiency virus

Even though all blood donated for transfusion is tested for the presence of human immunodeficiency virus (HIV) antibodies, there exists a period of time after infection by the virus before these antibodies can be detected. Blood donated during this window period is capable of transmitting the virus. Therefore, the blood of persons who are at risk for acquired immune deficiency syndrome (AIDS) should not enter the blood supply. Over a period of 4 months, 6573 potential blood donors who entered fixed and mobile blood collection sites in two cities were exposed to alternative interventions the aim of which was to exclude persons at risk for AIDS. We compared the interventions to one another and to existing materials in terms of the numbers of at-risk persons who did or did not donate for transfusion, the amount of attention paid to the materials, the scores on a comprehension test, and the self-reports by the subjects of attitudes towards the various interventions. At-risk donors who were asked direct AIDS risk behavior questions in addition to the current health history questions were more likely to be screened out than those who underwent alternative health history interviews (p less than 0.01). Potential donors paid more attention to the experimental brochures than to the experimental video or current materials (p less than 0.05). Comprehension scores were better for the new brochure and the video than for the current brochure (p less than 0.05). Donors were not offended by the experimental interventions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Absence of human immunodeficiency virus type 2 infection among patients in a hospital serving a New York community at high risk for infection. Centers for Disease Control and Prevention/Bronx-Lebanon Hospital Center HIV Serosurvey Team

BACKGROUND: Although human immunodeficiency virus type 2 (HIV-2) infection among United States residents is considered rare, there are US populations at high risk. Few studies have surveyed these populations with a high likelihood of infection, that is, those with high percentages of persons from HIV-2-endemic areas and high prevalences of behaviors that would allow for transmission. STUDY DESIGN AND METHODS: Patients (n = 832) enrolled in a confidential HIV serosurvey at a hospital that serves a community with a relatively high percentage of West African immigrants, drug injectors, and persons who practice high-risk sexual activity were evaluated. Sera were tested for HIV type 1 (HIV-1) and HIV-2 by rapid enzyme immunoassays, standard enzyme immunoassays and Western blots. RESULTS: Eight of 832 patients were weakly reactive to HIV-2 on rapid assay, but none was confirmed to be infected when tested by standard immunoassay and Western blot. Five of these eight were reactive to HIV-1. CONCLUSION: Weak reactivity to HIV-2 antibody on the rapid assay is best explained by cross-reactivity with HIV-1 antibody; thus, even in this population at high risk for infection, false-positive reactions are more likely than true infections. The finding that HIV-2 is absent in this population at potentially high risk for infection corroborates the findings of other studies that HIV-2 infection is rare among US residents. These results support previous recommendations that, in settings other than blood collection facilities, HIV-2 testing should be selectively offered to persons with epidemiologic risk factors.     

Validation of a new immunoblot assay (LiaTek HIV III) for confirmation of human immunodeficiency virus infection

BACKGROUND: Used as a supplemental assay, new anti-human immunodeficiency virus (HIV) immunoblots, employing recombinant and synthetic antigens, appeared to resolve the majority of samples with false-reactive Western blot results. Would it be possible to completely replace the Western blot by an immunoblot for confirmation and exclusion of HIV infection? STUDY DESIGN AND METHODS: The sensitivity of the new LiaTek HIV III immunoblot assay (Organon Teknika, Turnhout, Belgium) was tested on 416 Western-blot positive samples (386 HIV-1, 22 HIV-2, 1 HIV-1/2, and 7 HIV-O) and on 45 HIV-1 seroconversion samples. The specificity was tested on 146 samples from noninfected donors with false-positive results on a HIV screening test. RESULTS: All Western- blot-positive samples tested positive in the immunoblot (sensitivity: 100%). The immunoblot could not discriminate between HIV-1 and HIV-2 infection in 22 of 416 (5%) samples. The LiaTek assay showed reactivity in 28 of 45 seroconversion samples, whereas the Western blot reacted in 30 of 45 seroconversion samples. With false-positive donor samples, the immunoblot was indeterminate in 10 of 146 samples (specificity: 93%), and the Western blot was indeterminate in 44 of 146 samples (specificity: 70%). CONCLUSION: Like the Western blot, the immunoblot runs the risk of missing samples that are reactive by enzyme immunoassay during the early stage of HIV infection. Nevertheless, considering its superior specificity on false-positive donor samples, it appears that the immunoblot offers a cost-effective alternative to the Western blot assay for confirmation and exclusion of HIV infection.     

Adolescents at risk for HIV infection.

Although adolescents currently compose fewer than 1% of AIDS cases nationally, they represent an expanding and pivotal population. This article is written for those who currently provide health care for adolescents and for those who will do so in the future. Much of what is known about AIDS in adolescents will be reviewed. Epidemiology, specific risk groups and behavior as well as legal, ethical, educational, and preventive issues unique to adolescents are discussed. In addition, some recommendations and techniques for interviewing teenagers are suggested.     

Neurologic abnormalities in human immunodeficiency virus infection

Neurologic abnormalities involving the central and peripheral nervous system are common in patients infected with the human immunodeficiency virus (HIV). Evidence of central nervous system infection (cerebrospinal fluid abnormalities) occurs early; however, evidence of central and peripheral nervous system dysfunction usually occurs at later stages. Neurologic manifestations may be due to chronic immunosuppression, direct neurotropic effect of HIV, or medication effects. It is important to recognize that brain and spine imaging studies are highly sensitive in detecting abnormal pathologic processes, but these studies have low specificity for establishing a specific pathologic diagnosis.     

Serum prolactin in human immunodeficiency virus infection

Patients infected with human immunodeficiency virus (HIV) have higher serum prolactin compared to healthy controls but this is controversial. As part of a laboratory audit investigating the interference of macroprolactin in our prolactin assay, we investigated whether low biological activity macroprolactin could account for the increased serum prolactin concentrations observed in HIV infection. We, therefore, compared serum total prolactin and free prolactin in 32 subjects infected with HIV (HIV+ve) with 52 subjects not infected with HIV (HIV-ve). Serum total prolactin concentrations were similar in HIV+ve and HIV-ve patients [median (95% confidence limits); 167.0 (122.4 - 313.8) vs 206.5 (187.8 - 248.4) mU/L respectively]. Serum free prolactin concentrations were lower (p <0.005) in HIV+ve subjects than in HIV-ve subjects [112.0 (91.1-141.8) vs 171.0 (154.5 - 200.9) mU/L respectively; p<0.0005]. These results are consistent with the notion that low biological activity macroprolactin contributes to circulating prolactin concentrations in HIV+ve subjects.     

Pyomyositis and human immunodeficiency virus infection

Pyomyositis is a bacterial infection of skeletal muscle usually caused by Staphylococcus aureus and characterized by localized muscle pain, swelling, and tenderness. The disease is endemic in the tropics. Though only approximately 50 cases have been reported from the continental United States, pyomyositis has been increasingly recognized here in the last decade. We report two patients with human immunodeficiency virus (HIV) infection and pyomyositis, and review five previously reported cases. Given the predisposition of patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) for infections caused by S aureus, pyomyositis may become increasingly more common in temperate areas.     

Gene-based immunotherapy for human immunodeficiency virus infection and acquired immunodeficiency syndrome

More than 40 million people are infected with human immunodeficiency virus (HIV), and a successful vaccine is at least a decade away. Although highly active antiretroviral therapy prolongs life, the maintenance of viral latency requires life-long treatment and results in cumulative toxicities and viral escape mutants. Gene therapy offers the promise to cure or prevent progressive HIV infection by interfering with HIV replication and CD4+ cell decline long term in the absence of chronic chemotherapy, and approximately 2 million HIV-infected individuals live in settings where there is sufficient infrastructure to support its application with current technology. Although the development of HIV/AIDS gene therapy has been slow, progress in a number of areas is evident, so that studies to date have significantly advanced the field of gene-based immunotherapy. Advances have helped to define a series of ongoing and planned trials that may shed light on potential mechanisms for the successful clinical gene therapy of HIV.     

Factors influencing reduction of sexual risk behaviors for human immunodeficiency virus infection: A review

The past decade witnessed an alarming increase in prevalence of human immunodeficiency virus (HIV) infection. In this paper, we review the literature on factors which influence the reduction of risk behaviors for human immunodeficiency virus among gay and bisexual men, intravenous drug users, and non-intravenous drug using heterosexual adolescents and adults. In this review, specific attention is paid to the reduction of sexual modes of viral transmission. Several risk reduction factors are identified. Methodological limitations are discussed and suggestions for further research are offered.