13例HIV/HBV重叠感染患者的实验指标分析

目的了解艾滋病病毒与乙型肝炎病毒（HIV/HBV）重叠感染患者的临床特征,分析HIV与HBV在疾病进展中的相互作用。方法回顾性分析、比较13例HIV/HBV重叠感染组、28例单纯HIV感染组、28例单纯HBV感染组患者,在免疫功能、肝脏功能及血常规方面的差异。结果免疫功能检测：CD4^＋T细胞计数和CD4^＋/CD8^＋T细胞比值表现为HIV/HBV重叠感染组〈单纯HIV组〈单纯HBV组（P〈0.01）;肝脏功能检测：HIV/HBV重叠感染组与单纯HIV感染组各项指标无显著性差异,而单纯HBV组的丙氨酸氨基转移酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素显著高于（P〈0.01）或高于（P〈0.05）另外两组;血常规检测：HIV/HBV重叠感染组和单纯HIV组各指标无显著性差异,但与单纯HBV组比较,则红细胞和血红蛋白显著降低（P〈0.01）,血小板明显升高（P〈0.01）。结论研究结果初步提示,HIV与HBV重叠感染后,可能减轻患者的肝细胞损伤,进一步降低患者的免疫功能。     

T淋巴细胞对HBV反应能力的比较研究HIV感染急性期及慢性期

目的 探索HIV感染急性期及慢性期T淋巴细胞对HBV反应能力的差异.方法 入组合并HBV感染的HIV感染急性期患者10例,合并HBV感染的HIV感染慢性期患者15例,分析HBV DNA与HIV RNA及CD4+T细胞之间的相关性;收集患者的外周血单个核细胞,用HBsAg重叠肽刺激培养后检测CD4+T细胞及CD8+T细胞分泌IFN-γ的能力.结果 HBV DNA水平与HIV RNA水平呈正相关(r=0.502,P=0.011),HBV DNA水平与CD4+T细胞计数呈负相关(r=-0.409,P=0.042).HIV感染急性期患者经HBsAg重叠肽刺激后CD4+T细胞及CD8+T细胞分泌IFN-γ的能力(分别为9.1％±3.9％及4.4％±1.8％)明显高于HIV感染慢性期患者(分别为5.7％±2.5％及2.7％±1.4％).结论 HIV合并HBV感染的患者在HIV感染急性期对HBV的清除能力明显高于HIV感染慢性期,本研究为探究HIV感染不同时期对HBV清除能力差异提供了证据.     

HIV合并HBV感染者T淋巴细胞亚群血浆病毒载量与肝脏功能的关系

目的 探讨HIV合并HBV感染者T淋巴细胞亚群、血浆病毒载量与肝脏功能的关系.方法 选取宁德师范学院附属宁德市医院2018年9月至2020年11月收治的103例HIV合并HBV感染者(研究组)及98例单纯HIV感染者(对照组)为研究对象,测定CD3+、CD4+、CD8+T淋巴细胞(简称CD3细胞、CD4细胞、CD8细胞...     

4例HBV重叠感染HIV的临床分析

至今，对艾滋病病毒（HIV）／乙型肝炎病毒（HBV）重叠感染对机体的作用尚无一致的结果，两种病毒之间的相互影响和作用尚在研究中。我国为乙型肝炎（乙肝）高发区，HBV重叠感染HIV后其肝病的发展及两种病毒间的自然病程值得探讨。     

早期HAART治疗可以延迟无症状HIV感染者的疾病进展

瑞士苏黎世大学医院的Opravil博士等人指出 ,在CD4 细胞计数 >350人个细胞 /ml的无症状HIV感染者中 ,早期推迟 1年开展HAART治疗 ,可以明显延缓疾病的进程。他们比较了 1 996～ 1 999年间开始HAART治疗的 2 83名患者 ,和同时期内至少推迟 1 2个月开展治疗的 2 83名患者的病情进展情况。入选研究时 ,所有患者均为CD4 细胞计数 >350个细胞 /ml的无症状患者。早期治疗组和延迟治疗组患者的随访期分别平均为 3 1 9年和 2 66年。结果发现 ,在研究期间 ,延迟治疗组患者的疾病进展率明显高于早期治疗组。延迟治疗组患者发展为艾滋病的比率…     

HBV/HIV重叠感染的抗病毒治疗

随着人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染率快速增长,乙型肝炎病毒(hepatitis B virus,HBV)/HIV重叠感染成为一种临床易见疾病.HBV/HIV重叠感染使HBV和HIV的生物学行为发生改变,进而相互影响病情进展,使得HBV/HIV重叠感染患者的抗病毒...     

急性期/早期HIV-1感染的临床研究进展

原发Ⅰ型艾滋病病毒(HIV-1)感染(PHI)包括急性期感染(AHI)和早期感染(EHI)。AHI通常与急性的"反转录病毒综合征"有关,包括一系列非特异的症状和实验室检测异常。AHI和EHI的分界点在于HIV抗体的阳转,而PHI和其后的慢性感染阶段的临界点在于体内何时达到HIV-1的调定点。早期诊断有赖于检测HIV-1RNA和P24抗原。大约50%经性传染HIV发生在急性期阶段,对急性期/早期感染者尽早诊断并给予抗病毒治疗,能明显减少HIV的传播。一些研究显示,早期抗病毒治疗能够使病毒得以长期抑制,并能保持甚至增加HIV-1特异性T细胞免疫应答,但早期治疗和治疗中断的临床益处还没有足够数据支持。     

141例HIV感染者合并梅毒HBV及HCV感染状况分析

艾滋病(AIDS)已成为危害全球民众健康的公共卫生问题[1-2].国内最新数据显示,截至2017年底我国的现存活艾滋病病毒(HIV)感染者/AIDS患者75万余例,当年新发患者13余万例,其中95％以上为性传播途径感染[3-41.HIV感染者因传播方式或自身免疫力下降易感染其他病原体,如乙型肝炎(简称乙肝)病毒(HBV...     

HIV感染者中HCV及HBV感染状况的研究

目的 了解HIV感染者中HCV、HBV的感染状况。方法 对197例HIV感染者中的HCV、HBV感染情况进行了血清流行病学调查研究。结果 HIV感染者中HCV的感染率为90.35％,HBV的总感染率为51.94％,HIV、HCV、HBV三重感染率为49.35％。结论 HIV感染者中有极高的HCV感染率,有较高的HBV感染率。     

HBV/HIV coinfection is associated with poorer outcomes in hospitalized patients with HBV or HIV

We examined the impact of HBV/HIV coinfection on outcomes in hospitalized patients compared to those with HBV or HIV monoinfection. Using the 2011 US Nationwide Inpatient Sample, we identified patients who had been hospitalized with HBV or HIV monoinfection or HBV/HIV coinfection using ICD‐9‐CM codes. We compared liver‐related admissions between the three groups. Multivariable logistic regression was performed to identify independent predictors of in‐hospital mortality, length of stay and total charges. A total of 72 584 discharges with HBV monoinfection, 133 880 discharges with HIV monoinfection and 8156 discharges with HBV/HIV coinfection were included. HBV/HIV coinfection was associated with higher mortality compared to HBV monoinfection (OR 1.67, 95% CI 1.30–2.15) but not when compared to HIV monoinfection (OR 1.22, 95% CI 0.96–1.54). However, the presence of HBV along with cirrhosis or complications of portal hypertension was associated with three times greater in‐hospital mortality in patients with HIV compared to those without these complications (OR 3.00, 95% CI 1.80–5.02). Length of stay and total hospitalization charges were greater in the HBV‐/HIV‐coinfected group compared to the HBV monoinfection group (+1.53 days, P < 0.001; $17595, P < 0.001) and the HIV monoinfection group (+0.62 days, P = 0.034; $8840, P = 0.005). In conclusion, HBV/HIV coinfection is a risk factor for in‐hospital mortality, particularly in liver‐related admissions, compared to HBV monoinfection. Overall healthcare utilization from HBV/HIV coinfection is also higher than for either infection alone and higher than the national average for all hospitalizations, thus emphasizing the healthcare burden from these illnesses.     

安岳县42例HIV/AIDS病人免费抗病毒治疗情况分析

目的探讨四川省安岳县艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(HIV/AIDS病人)抗病毒治疗的效果及相关状况,为艾滋病的综合防治提供基础资料和科学依据。方法采用前瞻性随访研究方法,对HIV/AIDS病人的实验室检查相关结果、治疗方案及随访情况做描述性分析、重复测量方差分析、Logistic回归分析。结果 42例病人治疗前、治疗半年后及治疗1年后,CD+4T淋巴细胞(简称CD4细胞)计数的变化差异有统计学意义(F=307.93,P0.001);当基线CD4细胞计数200个/μL时,其出现治疗效果较差的危险性是基线CD4细胞计数≥200个/μL的5.675倍;基线CD4细胞计数200个/μL,发生艾滋病相关死亡的风险较大。按医嘱定期检查肝功、血常规等的次数,随着治疗时间的延长而逐渐减少。结论抗病毒治疗后,病人身体素质有所提高;基线CD4细胞计数越低,治疗效果就越差;抗病毒治疗病人随着治疗时间的增加,依从性逐渐降低。     

乙型肝炎肝硬化患者外周血T淋巴细胞亚群和NK细胞的变化及临床意义

目的：探讨乙肝肝硬化患者外周血中T淋巴细胞亚群及NK细胞含量的变化,了解乙肝肝硬化患者的免疫功能状况。方法乙肝肝硬化患者81例,并按Child-Pugh分为A、B、C三级,26例健康者作为健康对照,采用流式细胞仪检测血清中CD3＋ T淋巴细胞、CD4^＋ T淋巴细胞、CD8^＋ T淋巴细胞和NK细胞的含量。结果 Child-Pugh B级和C级的乙肝肝硬化患者外周血中CD3^＋ T淋巴细胞、CD4^＋ T淋巴细胞和NK 细胞的含量明显降低,而CD8^＋ T淋巴细胞含量升高,与健康对照组比较,差异有统计学意义（P＜0．05）,而Child-Pugh A级的乙肝肝硬化患者T淋巴细胞亚群变化不明显（P＞0．05）。结论乙肝肝硬化患者的机体免疫功能低下,并且随着其肝功能下降及Child-Pugh 分级的增加而显著,对判断乙肝肝硬化患者的病情及预后具有重要的临床价值。     

300例艾滋病患者高效抗逆转录病毒治疗后免疫重建规律探讨

目的探讨高效抗逆转录病毒治疗（HAART）对中国南部地区艾滋病患者的免疫重建规律。方法收集近3年来300例患者的完整资料,按基线CD4^＋T细胞数分为A、B、C三组,观察基线及治疗1、3、6、12月末CD4^＋T淋巴细胞数、12月末血浆病毒载量（VL）、临床症状和毒副作用。结果抗病毒治疗12月末300例患者CD4^＋T淋巴细胞计数平均上升127个／1,以治疗3月后增长明显,3、12月末与基线CD4^＋T淋巴细胞计数比较差异有显著性（P〈0．05）;12月末273例（91％）患者血浆病毒载量（VL）〈5copies/ml,27例（9％）患者病毒载量（VL）〉50copies/ml,高病毒载量A组16例,C组4例;A组与C组比较差异有显著性（P〈0．05）;药物不良反应主要是外周神经炎（35．4％）、骨髓抑制（18．2％）、皮疹（15．2％）、肝功能损害（12．1％）、乳酸酸中毒（12．1％）和肾结石（6．1％）。结论HAART治疗对中国南部地区的艾滋病患者有效,能够实现免疫重建,但存在较多毒副作用。     

Correlation between CD4/CD8 ratio and neurocognitive performance during early HIV infection

Introduction

CD4/CD8 ratio is a marker of immune activation in HIV infection and has been associated with neurocognitive performance during chronic infection, but little is known about the early phases. The aim of this study was to examine the relationship between blood CD4/CD8 ratio and central nervous system endpoints in primary HIV infection (PHI) before and after antiretroviral treatment (ART).

Methods

This was a retrospective analysis of the Primary Infection Stage CNS Events Study (PISCES) cohort. We longitudinally assessed blood and cerebrospinal fluid (CSF) markers of inflammation, immune activation and neuronal injury, and neuropsychological testing performance (NPZ4, an average of three motor and one processing speed tests, and a summarized total score, NPZ11, including also executive function, learning and memory) in ART-naïve participants enrolled during PHI. Spearman correlation and linear mixed models assessed the relationships between the trajectory of CD4/CD8 ratio over time and neurocognitive performance, blood and CSF markers of immune activation and neuronal injury.

Results

In all, 109 PHI participants were enrolled. The mean CD4/CD8 ratio decreased with longer time from infection to starting treatment (p < 0.001). Every unit increase in NPZ4 score was independently associated with a 0.15 increase in CD4/CD8 ratio (95% CI: 0.002–0.29; p = 0.047), whereas no correlation was found between CD4/CD8 ratio and NPZ11. Among the cognitive domains, only a change in processing speed was correlated with CD4/CD8 ratio over time (p = 0.03). The trajectory of the CD4/CD8 ratio was negatively correlated with change in CSF neurofilament light chain (p = 0.04).

Conclusions

The trajectory of CD4/CD8 ratio was independently associated with motor/psychomotor speed performance, suggesting that immune activation is involved in brain injury during the early stages of the infection.     

扶正逐毒丸治疗25例HIV/AIDS病人效果分析

目的观察扶正逐毒丸治疗艾滋病(AIDS)病人的临床疗效。方法对25例艾滋病病人口服扶正逐毒丸后,观察临床症状和CD+4T淋巴细胞(简称CD4细胞)计数的变化。结果治疗3-6个月后,病人出现的症状基本消失,治疗3个月时和治疗前相比,CD4细胞平均升高75.29/μL,差异有统计学意义(P0.05);在治疗6个月和12个月时,CD4细胞的平均升幅均超过了50/μL。结论扶正逐毒丸在改善病人临床症状、升高CD4细胞方面具有一定作用。     

Prolonged use of tenofovir in HIV/hepatitis B virus (HBV)-coinfected individuals does not lead to HBV polymerase mutations and is associated with persistence of lamivudine HBV polymerase mutations

Objectives

The aim of the study was to identify and characterize hepatitis B virus (HBV) polymerase gene mutations associated with ongoing HBV replication in HIV/HBV‐coinfected individuals receiving tenofovir (TDF).

Methods

This retrospective cross‐sectional study identified 28 HIV/HBV‐coinfected individuals who had received TDF for at least 3 months. All patients had samples available while receiving TDF (on‐TDF), and 24 also had samples available prior to treatment (pre‐TDF). Case records were reviewed to obtain clinical and virological data at the times of sampling (±3 months). The HBV DNA of all samples was amplified using polymerase chain reaction (PCR), and the polymerase region of PCR‐positive samples was sequenced and compared with reference HBV data.

Results

Of the pre‐TDF samples, 15 of 24 (63%) were HBV PCR positive. Of the on‐TDF samples, four of 28 (14%) were HBV PCR positive (mean time on TDF 13.5 months; range 3–23 months). Lamivudine (3TC)‐resistance mutations were detected in three of four (75%) of these viraemic samples. The previously identified putative TDF‐resistance mutations, rtA194T+rtL180M+rtM204V, were not detected in any individual.

Conclusions

Unique mutations in the HBV polymerase gene associated with TDF resistance are rare in HIV/HBV coinfection. 3TC‐resistance mutations persist and a significant proportion of patients are HBV PCR positive despite the addition of TDF.     

成人HIV／AIDS CD^4＋细胞数与病毒载量之间关系分析

目的分析成人HIV/AIDS患者CD4~+细胞数与病毒载量(VL)之间的关系。方法对1990年—2001年在本院就诊的200例HIV/AIDS患者进行跟踪分析。结果 CD4~+≥200/μl时,血浆VL(log10)为4.17±0.79;CD4~+<200/μl时,血浆VL(log10)为5.01±0.72,VL水平明显高于CD~+≥200/μl组(P<0.01)。其中CD4~+>350/μl时,血浆VL(log10)为3.95±0.82;CD4~+200～350/μl时.血浆VL(log10)为4.43±0.63;CD4~+100～200/μl时,血浆VL(log10)为4.85±0.68;CD4~+<100/μl时,血浆VL(log10)为5.16±0.68。结论 HIV/AIDS患者CD4~+细胞数与病毒复制有非常密切的关系,外周血CD4~+细胞数与血浆VL的变化呈负相关关系。当血浆VL(log10)>5.01±0.72时,应考虑患者已进入艾滋病期。