The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

OBJECTIVE: To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART). DESIGN: Cohort of 143 pregnant HIV-1-infected women including a matched case-control study in a 2:1 ratio of controls to cases (n=98). SETTING: Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands. POPULATION: Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women. MAIN OUTCOME MEASURES: MTCT, preterm delivery, low birthweight, pre-eclampsia. RESULTS: MTCT was 0% (95% CI 0-2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11-27) in women infected with HIV-1 and 9% (95% CI 5-13) in controls (P=0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls. CONCLUSIONS: We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAART-associated increase in preterm delivery rate is mainly seen after first trimester HAART use.     

蛋白质组学在HIV中的研究进展

阐明AIDS的分子病理学机制,提出新的疾病预防措施是当前的研究热点.本文综述了当前普遍使用的蛋白质组学技术在HIV研究领域的应用,为人们对HIV进行更深入的研究提供了理论依据.     

中国HIV感染长期不进展者相关免疫指标的研究

目的:研究中国HIV感染长期不进展者(Long-term nonprogressors,LTNP)相关免疫指标的变化。方法:采集284例未经抗HIV治疗的LTNP、典型进展的HIV感染者和AIDS病人及130例HIV抗体阴性健康人的抗凝全血,应用流式细胞仪分析技术对CD8+T淋巴细胞、NK细胞及DC细胞进行测定。结果:LTNPCD8+T淋巴细胞绝对值[(1104.51±511.81)个/μl]高于AIDS病人[(678.40±295.39)个/μl,P<0.05]。LTNPNK细胞的绝对值[(377.59±289.23)个/μl]显著高于HIV感染者[(292.49±445.87)个/μl]和AIDS病人[(153.62±110.36)个/μl,P<0.05]。LTNPCD123+DCs细胞绝对值[(6.76±3.74)个/μl]高于HIV感染者[(5.30±3.16)个/μl]和AIDS病人[(3.32±2.09)个/μl,P<0.05]。LTNPCD11c+DCs细胞绝对值[(21.73±11.92)个/μl]高于HIV感染者[(14.51±9.53)个/μl]和AIDS病人[(7.27±3.74)个/μl,P<0.05]。结论:LTNPCD8+T淋巴细胞、NK细胞和DC细胞高于典型进展的HIV感染者和AIDS病人,是延缓疾病进程的重要因素。     

婚前保健在VCT服务中的作用探讨

目的:探讨婚前保健在VCT服务中的作用。方法:在开展婚前保健的同一群体中同时进行VCT服务,检测HIV抗体。结果:从2008年3月31日～11月30日参加婚前保健自愿咨询检测HIV抗体共5300例,检出HIV抗体阳性16例,阳性率0.30%,男女双方均为阳性者4对8例,占阳性例数的50%。有5例阳性者为外地户籍。对检测阳性者均进行婚育指导,让当事人知情选择,同时建立档案进行追踪。结论:将VCT服务与婚前保健服务结合进行是可行的,并且取得事半功倍的效果,值得推广,特别是艾滋病流行区并已经免费进行婚前保健的地方,更值得推广。     

Defensins: Natural component of human innate immunity

The widespread use of antibiotics has contributed to a huge increase in the number of resistant bacteria. New classes of drugs are therefore being developed of which defensins are a potential source. Defensins are a group of antimicrobial peptides found in different living organisms, involved in the first line of defense in their innate immune response against pathogens. This review summarizes the results of studies of this family of human antimicrobial peptides (AMPs). There is a special emphasis on describing the entire group and individual peptides, history of their discovery, their functions and expression sites. The results of the recent studies on the use of the biologically active peptides in human medicine are also presented. The pharmaceutical potential of human defensins cannot be ignored, especially considering their strong antimicrobial activity and properties such as low molecular weight, reduced immunogenicity, broad activity spectrum and resistance to proteolysis, but there are still many challenges and questions regarding the possibilities of their practical application.     

齐多呋啶阻断艾滋病病毒母婴垂直传播

目的观察应用齐多呋啶(ZDV)单剂短程疗法对人类免疫缺陷病毒(HIV)母婴传播的阻断作用。方法博茨瓦纳玛琳娜公主医院所有HIV阳性孕妇,自妊娠34周开始口服ZDV,300mg,2次/d,直到分娩开始。分娩开始时口服ZDV300mg,接着每隔3h口服300mg直到婴儿娩出,最大剂量1500mg。不能口服者ZDV静脉给药,第1小时负荷量2mg/kg,接着按1mg/(kg.h)直到婴儿娩出。婴儿治疗,出生后8～10h开始口服ZDV混悬糖浆,按8mg/(kg.d),分2次每12h口服,服药到4周。婴儿出生后避免母乳喂养。结果至出生后第6周共检测335例婴儿PCR-HIVRNA,其中阳性22例,母-婴垂直传播率降至6.6%。结论ZDV可显著降低HIV母婴传播。     

Children with human immunodeficiency virus infection admitted to a paediatric intensive care unit in South Africa

BACKGROUND: Early data regarding the outcome of human immunodeficiency virus (HIV)-infected children in paediatric intensive care units (PICU) suggested mortality as high as 100%. Recent studies report mortality of 38%. Survival depends on the indication for admission. OBJECTIVES: To describe the prevalence, duration of stay, and outcome of HIV-infected patients in a single PICU over a 1-year period. Additional objectives included describing the indications for admission as well as the clinical and laboratory characteristics of HIV-infected infants and children requiring PICU admission. METHOD: Retrospective chart review of all children with serological proof of HIV admitted to PICU at Tygerberg Children's Hospital from 1 January to 31 December 2003. RESULTS: Of the 465 patients admitted, 47 (10%) were HIV-infected. For HIV-infected children the median age on admission was 4 months. The median duration of stay was 6 days, significantly longer than for the non-HIV group (p = 0.0001). Fifty-seven percent had advanced clinical and immunological disease. Seventeen died in PICU and four shortly afterwards, poor PICU outcome was significantly associated with HIV status (p = 0.001). Lower total lymphocyte count (p = 0.004) and higher gamma globulin level (p = 0.04) were paradoxically the only findings significantly associated with survival. Acute respiratory failure (ARF) accounted for 76% of admissions, including Pneumocystis jiroveci in 38%. Fifty-one percent had evidence of cytomegalovirus infection. CONCLUSIONS: HIV-infected children requiring PICU can survive despite the lack of availability of antiretroviral therapy.