中国南方四省区流行的HIV-1 CRF01_AE病毒株基因特征研究

Objective To analyze the genetic characteristics of HIV-1 CRF01_AE strains prevailing in. the four provinces of southern China. Methods Plasma samples were collected from the newly diagnosed HIV-1 individuals reported in 2006 in Guangdong, Guangxi, Jiangxi and Hunan province. The gag and env gene fragments were amplified from RNA template extracted from plasma using RT and nested PCR methods. CRF01_AE sequences were analyzed by phylogcnetie methods and characterized by calculating the genetic distance and Entropy analysis. Results Two main epidemic clusters were found to exist in the CRF01 AE strains from 210 HIV-1 CRF01 AE infected individuals collected in the 4 provinces, southern China. It was found that no international reference strain was closely correlated with cluster Ⅰ , which including 123 samples. The strains in cluster Ⅱ, consisting 57 cases of samples, were closely related with the strains identified in Vietnam. Genetic distance analysis of gag and env genes showed that the diversity of cluster Ⅰ was obviously less than that of cluster Ⅱ. Data on nucleotide polymorphism showed that nucleotides compositions of 42 sites in gag and 40 sites in env wer esignificantly different between the two clusters. When compared with cluster Ⅱ , the polymorphism decreased at 61 nucleotide sites but increased at 21 sites in cluster Ⅰ. Conclusion This was the first report describing that two main epidemic clusters were existed in CRF01_AE strains prevailing in the 4 provinces, Southern China. The vires in cluster Ⅰ was the dominant strain in this region, with shorter period of circulation and higher proportion seen in the HIV-infected population, which might belong to CRF01_AE strain with certain features facilitating the spread of the virus. The virus in cluster Ⅱ was highly homology with the CRF01_AE strains from Vietnam, and seemed to have had several events of epidemics in populations in border regions of China and Vietnam.     

湖南省HIV-1低病毒血症患者的生存质量及影响因素调查

目的 了解湖南省艾滋病低病毒血症(low-level viremia,LLV)患者生存质量的影响因素,为艾滋病防治策略的制定提供依据。 方法 应用方便抽样的方式,采用自编的一般情况调查表和世界卫生组织生存质量测量简表(WHOQOL-HIV BREF)对44例LLV患者进行横断面调查,采用t检验、F检验、多元线性回归分析生存质量的影响因素。 结果 44例LLV人群中,男性29例(65.91%),45~59岁年龄组16例(36.36%),37例(84.09%)服药依从性较好,7例(15.91%)服药依从性差,存在漏服药物的情况。LLV患者生存质量总均分为(68.58±6.04)分,生理领域均分为(10.77±1.49)分。单因素分析显示,不同生活居住地、职业、月收入水平、是否出现药物不良反应患者的生理领域得分比较,差异均有统计学意义(均P < 0.05);多元线性回归分析显示不同文化程度(B_心理=0.449,P_心理=0.048;B_环境=0.851,P_环境=0.028)、月收入水平(B_独立性=1.072,P_独立性=0.006;B_环境=0.989,P_环境=0.026)、是否出现药物不良反应(B_生理=-1.665,P_生理=0.002)等是影响患者生存质量各领域的重要因素。 结论 LLV患者的生存质量得分较低,应更加重视文化程度低、收入水平低、出现药物不良反应的患者,改善其生活质量。     

2011—2019年湖南省男男性行为人群哨点HIV、梅毒感染状况及性行为特征趋势分析

目的 分析2011—2019年湖南省男男性行为哨点数据,了解男男性行为者(men who have sex with men, MSM)HIV、梅毒感染状况及性行为特征,为下一步制定MSM防控策略提供依据。方法 2011—2019年在湖南省选择男男性行为人群较多的城市设立MSM哨点,采用滚雪球抽样、MSM人群活动场所招募和网络招募方法,对MSM进行匿名问卷调查和采集血样,收集被调查者的人口学信息、性行为和血清学信息,分析其变化趋势和感染HIV、梅毒的影响因素。结果 2019年HIV抗体阳性率和梅毒抗体阳性率分别为6.00%和2.38%,历年有线性趋势变化(均P<0.05)。艾滋病知识知晓率为94.00%。最近六个月性伴类型：仅有同性性伴、有同性且有异性性伴、有同性且有商业性伴、有多种性伴、仅有异性性伴、无性伴的比例分别为83.63%,6.38%、0.75%,0.25%、8.00%和1.00%。logistic回归多因素分析,离异或丧偶(OR=1.85,95%CI:1.08～3.16)、样本来源于网络招募(OR=1.94,95%CI:1.32～2.85)、最近六个月仅有同性性伴(O...     

湖南省2014—2018年HIV/AIDS患者免费抗病毒治疗情况及影响因素分析

目的 分析2014—2018年湖南省艾滋病抗病毒治疗开展情况及影响因素,为实现“治疗90%、有效90%”的目标提供参考和依据。 方法 利用湖南省2014—2018年随访管理数据库和抗病毒治疗管理数据库,采用Excel 10.0及SPSS 20.0软件,计算抗病毒治疗比例和治疗成功率,计算不同年度新报告HIV/AIDS患者纳入抗病毒治疗的时间分布,分析2018年湖南省存活HIV/AIDS接受抗病毒治疗的影响因素及不同特征对抗病毒治疗比例的影响。 结果 2014—2018年间,湖南省抗病毒治疗比例从67.2%上升到86.7%,治疗成功率从90.8%上升到94.4%,确证后30 d内纳入抗病毒治疗的比例从38.1%上升到55.9%,女性(OR:1.17,95%CI:1.08~1.27)、25~50岁人群(OR:1.32,95%CI:1.18~1.48)和＞50岁人群(OR:1.47,95%CI:1.28~1.68)、已婚或有配偶(OR:2.03,95%CI:1.86~2.22)、离异或丧偶(OR:1.45,95%CI:1.32~1.60)、最近一次CD4⁺ T淋巴细胞＜200个/μl(OR:1.50,95%CI:1.35~1.67)等因素人群抗病毒治疗比例较高。结论 抗病毒治疗及时性和治疗比例仍需要进一步提高,性别为男性、年龄≤24岁、异性传播及注射毒品、未婚、高CD4⁺ T淋巴细胞水平(＞500个/μl)及未及时进行CD4⁺T细胞检测等因素是患者接受抗病毒治疗的不利因素,需针对不同特征人群采取有效措施,加大治疗宣教力度及规范管理,进一步提高治疗比例。     

中国南方四省区流行的HIV-1 CRF01_AE病毒株基因特征研究

Objective To analyze the genetic characteristics of HIV-1 CRF01_AE strains prevailing in. the four provinces of southern China. Methods Plasma samples were collected from the newly diagnosed HIV-1 individuals reported in 2006 in Guangdong, Guangxi, Jiangxi and Hunan province. The gag and env gene fragments were amplified from RNA template extracted from plasma using RT and nested PCR methods. CRF01_AE sequences were analyzed by phylogcnetie methods and characterized by calculating the genetic distance and Entropy analysis. Results Two main epidemic clusters were found to exist in the CRF01 AE strains from 210 HIV-1 CRF01 AE infected individuals collected in the 4 provinces, southern China. It was found that no international reference strain was closely correlated with cluster Ⅰ , which including 123 samples. The strains in cluster Ⅱ, consisting 57 cases of samples, were closely related with the strains identified in Vietnam. Genetic distance analysis of gag and env genes showed that the diversity of cluster Ⅰ was obviously less than that of cluster Ⅱ. Data on nucleotide polymorphism showed that nucleotides compositions of 42 sites in gag and 40 sites in env wer esignificantly different between the two clusters. When compared with cluster Ⅱ , the polymorphism decreased at 61 nucleotide sites but increased at 21 sites in cluster Ⅰ. Conclusion This was the first report describing that two main epidemic clusters were existed in CRF01_AE strains prevailing in the 4 provinces, Southern China. The vires in cluster Ⅰ was the dominant strain in this region, with shorter period of circulation and higher proportion seen in the HIV-infected population, which might belong to CRF01_AE strain with certain features facilitating the spread of the virus. The virus in cluster Ⅱ was highly homology with the CRF01_AE strains from Vietnam, and seemed to have had several events of epidemics in populations in border regions of China and Vietnam.     

湖南省2006年艾滋病自愿咨询检测工作情况分析

目的分析湖南省艾滋病自愿咨询检测工作的开展情况。方法利用卫生部统一下发的《艾滋病自愿咨询检测统计报表》进行数据收集,对全省艾滋病自愿咨询检测工作开展的相关情况进行分析。结果2006年全省137个自愿咨询检测点共接受咨询67942人,其中59593人接受了HIV初筛检测,检测率为87.71%,初筛阳性681例,确认阳性人数540人。HIV阳性人群中占比例最高的是吸毒人群,占49.8%,最低的是职业暴露人群,为0%。从求询者类型来看,前来接受咨询的人群以男性异性性接触者为主,占43.4%,其次是女性异性性接触和吸毒人群,分别占15.15%和14.4%。结论艾滋病自愿咨询检测工作起到了宣传HIV知识,发现感染者的作用,今后应对HIV感染高危人群进一步加大工作力度,吸引更多的人来接受咨询和检测服务。     

左冠状动脉异常起源于肺动脉伴主动脉瓣狭窄1例

1 临床资料 患者,女,65岁,因"活动后胸闷气短20余天"于2015年7月8日入大连医科大学第一附属医院.查体:BP 140/80 mmHg,HR 62次/min,神清语明,颈静脉无怒张,双肺呼吸音清.心界左侧扩大,心前区未触及震颤,心律齐,胸骨左缘第2肋间可闻及收缩期III/6级喷射样杂音,向胸骨右缘传导.腹软,肝脾肋下未及,双下肢无浮肿.X线片示:心影增大,心胸比0.66,双肺纹理增强.ECG示心率120次/min,窦性心律.UCG示,左房44 mm×67 mm,右房37 mm×48 mm,右室20 mm,左室50 mm;LVEF 56%,主动脉瓣增厚,回声增强,开放受限,跨瓣血流峰值压差80 mmHg,平均压差45 mmHg,主动脉瓣钙化并重度狭窄,中等量心包积液.     

HIV-1母婴传播早期诊断检测方法应用

目的应用核酸扩增技术对母婴传播婴幼儿人类免疫缺陷病毒(HIV)感染进行早期诊断,为临床应用提供依据。方法对2009-2010年HIV阳性孕产妇活产的34例3~14个月龄婴幼儿收集足底干血斑样本进行HIV-1 DNA检测。随访18个月后进行血清HIV抗体检测比较。结果 34例婴幼儿中,检出HIV-1 DNA 9例,检出率26.5%。9例HIV-1 DNA阳性患儿均未使用过抗病毒治疗。18个月后随访,34例婴幼儿除1例失访,2例检出HIV-1 DNA婴儿已死亡(根据临床有机会性感染体征诊断为AIDS),7例检出HIV-1 DNA婴儿血清抗体阳性外,其他24例未检出HIV-1 DNA的婴儿其血清抗体为阴性。两种方法检测结果比较符合率为100.0%。结论核酸检测是有效的早期诊断方法,早期诊断有利于后续开展母婴阻断工作。     

国产HIV抗体双抗原夹心EIA法试剂与进口同类试剂的比较

目的 评价国产和进口HIV抗体检测试剂盒的质量。方法 采用对比方法，比较5种国产和1种进口试剂盒的敏感性、特异性和功效值。结果 6种试剂的敏感性除华美为100％(100／100)，余均为97．9％(44／45)；5种国产试剂的特异性和功效值分别为97．4％、98．0％、99．4％、98．7％、98．1％和97．5％、98，0％、99．0％、98．5％、98．5％，进口试剂特异性和功效值分别为96．8％和97．0％。结论 国产试剂盒的三项指标与进口试剂盒间比较无明显差别。     

长沙市男男性接触人群HIV-1、梅毒及HSV-2感染状况调查

目的 了解长沙市男男性接触人群(MSM)HIV、梅毒、生殖器疱疹(HSV-2)感染状况。 方法 在长沙市MSM人群经常活动的浴池、KTV娱乐场所、酒吧、会所等场所中,依据知情同意原则,收集目标人群EDTA-K₂抗凝全血10 ml,分别进行HIV、梅毒和HSV-2抗体检测,同时填写完成有关人口信息简单的问卷。 结果 826名调查对象,以学生、青壮年、高学历人群、未婚为主。实验室检出HIV-1抗体阳性86人(10.41%),梅毒抗体阳性61人(7.38%),HSV-2抗体阳性113人(13.68%)。同时感染两种以上病原体的比例达到9.08%。 结论 长沙市MSM人群HIV、梅毒、HSV-2均有较高感染率,HIV-1、梅毒和生殖器疱疹相互促进感染的风险应该引起重视,性病与艾滋病防治必须紧密结合。