河南省HIV感染长期不进展者及病毒控制者病例特征分析

目的 调查河南省HIV感染者中长期不进展者(LTNP)和病毒控制者(HC)存在情况及其病例特征。方法 利用我国艾滋病综合防治数据信息管理系统和河南省艾滋病检测实验室数据应用平台中的病例信息,及实验室检测结果判定HC和LTNP,并进行调查核实、样本采集和相关检测。结果 148例LTNP和HC中共随访到71例,其中LTNP有58例,HC有22例,同时是LTNP和HC有12例,仅是LTNP有46例,仅是HC有10例;男性50例(70.4%);≥40岁有55例(77.5%);均为汉族;职业为农民61例(85.9%);感染途径为既往有偿供血52例(73.2%);抗-HCV阳性56例(78.9%);CD₄⁺T淋巴细胞计数均值(四分位数)538(445~654) cell/μl,病毒载量的对数均值(四分位数)为3.14(2.03~3.82) log10 copies/ml。HC的病毒载量对数均值低于LTNP(P=0.001)。结论 河南省HIV感染者中LTNP和HC的病例特征显著,更精确的分类有助于下一步研究。     

A follow-up study of neuropsychological function in asymptomatic HIV-infected patients

A group of asymptomatic HIV-infected patients (CDC II and III) was followed-up over a two year period with semi-annual neuropsychological testing. Of the total sample of 36 subjects, all were retested at test two (T2), 19 at test three (T3) and 13 at test four (T4). A subgroup of subjects was further tested on a simple and a complex task of reaction time. The CD4 + and CD8 + lymphocyte counts were measured in peripheral blood. According to our criteria, no patient could be defined as neuropsychologically impaired. A significant improvement in performance was found from T1 to T2 and from T2 to T3, with a leveling off between T3 and T4. No associations were observed between reaction time and changes in neuropsychological test results and immunological parameters. Our results indicate that neuropsychological impairment does not develope gradually in the asymptomatic stages of HIV-infection. Furthermore, measurements of reaction time do not seem to have any prognostic significance neither for neurocognitive function nor for immunological status as measured by us.     

Guidelines for the diagnosis and management of neurological complications of HIV infection

The spectrum of neurological complications of HIV-infection has remained unchanged through the years, but its epidemiology changed remarkably as a result of the introduction of highly active antiretroviral therapy (HAART). Guidelines for the diagnosis and treatment of cerebral toxoplasmosis, cryptococcal meningitis, progressive multifocal leukoencephalopathy, CMV encephalitis, CMV polyradiculomyelitis, tuberculous meningitis, primary CNS lymphoma, HIV dementia, HIV myelopathy and HIV polyneuropathy are given with a grading of evidence and recommendations.     

Detection of anti-HIV antibodies in saliva

It is sometimes difficult in clinical practice to identify carriers of the AIDS virus. Such identification is of unquestionable value in oral pathology, both for determining the pathogenests of certain lesions and for assessing their significance to the patient. We evaluated several commercially available diagnostic techniques for the detection of anti-HIV antibodies in serum, and examined the feasibility of adapting such techniques to tests on saliva. The technique chosen for experimental adaptation required only slight modifications for use with this medium. We compared the results obtained in serum from intravenous drug users with a western blot assay designed to detect p24 viral protein, against the findings with a test designed to detect salivary antibodies. The likelihood of cross-reactions in saliva containing high concentrations of other antiviral antibodies was also studied. The specificity and sensitivity of the modified saliva test were 100% and 96% respectively, and no cross-reactions were observed.     

Diminished Sexual Activity, Interest, and Feelings of Attractiveness Among HIV-Infected Women in Two Eras of the AIDS Epidemic

Despite the high prevalence of sexual inactivity, decreased sexual desire, and poor sexual satisfaction documented among HIV-infected individuals, women's experiences of sexuality following HIV-infection and their reasons for these sexual changes remain little examined. Further, the potential effects of the availability of highly active antiretroviral therapy (HAART) medications on their sexuality have not been explored among women living with HIV/AIDS. To examine these issues, focused interviews were conducted with two samples of women living with HIV/AIDS: one before the advent of HAART and a second matched sample interviewed after HAART became widely available. Women in both the pre-HAART and HAART eras frequently discussed decreased sexual activity, a loss of sexual interest, and a diminished sense of sexual attractiveness following their HIV infection. In addition, they reported a number of reasons for why they had discontinued sexual activity or were no longer interested in sex, including anxiety about HIV transmission, a loss of freedom and spontaneity during sex, fears of emotional hurt, not wanting the hassle of sexual relationships, a loss of sexual interest, and a diminished sense of sexual attractiveness. However, the types of changes in their sexuality women described, nor the reasons offered for these changes, did not differ between women in the pre-HAART and HAART eras. The findings suggest that therapeutic intervention may be needed by some HIV-infected women to overcome difficulties in resuming healthy sexual relationships following their HIV diagnosis and offer insights into the potential content of such intervention efforts.     

Low thigh muscle mass is associated with coronary artery stenosis among HIV-infected and HIV-uninfected men: The Multicenter AIDS Cohort Study (MACS)

BackgroundHIV-infected individuals are at increased risk for both sarcopenia and cardiovascular disease. Whether an association between low muscle mass and subclinical coronary artery disease (CAD) exists, and if it is modified by HIV serostatus, are unknown.MethodsWe performed cross-sectional analysis of 513 male MACS participants (72% HIV-infected) who underwent mid-thigh computed tomography (CT) and non-contrast cardiac CT for coronary artery calcium (CAC) during 2010–2013. Of these, 379 also underwent coronary CT angiography for non-calcified coronary plaque (NCP) and obstructive coronary stenosis ≥50%. Multivariable-adjusted Poisson regression was used to estimate prevalence risk ratios of associations between low muscle mass (<20th percentile of the HIV-uninfected individuals in the sample) and CAC, NCP and obstructive stenosis.ResultsThe prevalence of low thigh muscle mass was similar by HIV serostatus (20%). There was no association of low muscle mass with CAC or NCP. However, low thigh muscle mass was significantly associated with a 2.5-fold higher prevalence of obstructive coronary stenosis, after adjustment for demographics and traditional CAD risk factors [PR 2.46 (95% CI 1.51, 4.01)]. This association remained significant after adjustment for adiposity, inflammation, and physical activity. There was no significant interaction by HIV serostatus (p-interaction = 0.90).ConclusionsIn this exploratory analysis, low thigh muscle mass was significantly associated with subclinical obstructive coronary stenosis. Additional studies involving larger sample sizes and prospective analyses are needed to confirm the potential utility of measuring mid-thigh muscle mass for identifying individuals at increased risk for obstructive CAD who might benefit from more aggressive risk factor management.     

The role of T cells in the development of cardiovascular disease in HIV-infected patients

Cardiovascular disease (CVD) is highly prevalent in HIV-infected patients. Besides the classical cardiovascular risk factors, HIV related factors play a role, such as immune activation and treatment with highly active antiretroviral therapy (HAART). The resulting T cell activation is regarded as one of the driving forces behind this accelerated atherogenesis. Interventions, such as early treatment and anti-inflammatory therapy, decreasing T cell activation might lead to a lower incidence of CVD in future HIV infected patients. This review specifically explores the role of T cells in the development of atherosclerosis in HIV-infected patients.     

Cognitive deficits and emotional disorders in HIV-1 infected individuals

The associations between cognitive functioning, depression questionnaire results, and diagnosed psychiatric disorders were examined among 85 HIV-1 infected patients at different stages of systemic infection and 39 seronegative controls. An affective scale and a somatic scale of the Beck Depression Inventory (BDI) were used to measure depression. Psychiatric disorders before or after the diagnosis of seropositivity were evaluated. The patients with symptomatic HIV-1 infection (AIDS related complex, AIDS) reported more somatic symptoms of depression than the subjects with asymptomatic infection or the controls, whereas psychological depression and psychiatric disorders were unrelated to the severity of HIV-1 disease. Psychiatric disorders diagnosed during HIV-1 disease were slightly associated with poor verbal memory only among symptomatic patients. Impaired visual memory showed an association with depressive mood and with psychiatric disorders preceding the diagnosis of seropositivity which suggests that factors other than HIV-1 may explain these subjects' poor visual memory.     

The Effect of Probenecid on the Pharmacokinetics of Zalcitabine in HIV-Positive Patients

Purpose. The purpose of this study was to determine the potential effect of probenecid on the pharmacokinetics of zalcitabine in HIV-positive patients. Methods. Twelve patients received single oral 1.5 mg doses of zalcitabine alone and during probenecid treatment (500 mg at 8 and 2 hours before and 4 hours after zalcitabine dosing) in an open-label, randomized two-way crossover study with a one-week washout period between treatments. Serial blood and urine samples were collected over a 24 hour period and assayed for zalcitabine by a modified GC/MS method. Results. Coadministration of probenecid with zalcitabine resulted in a decrease in mean (%CV) renal clearance of zalcitabine from 310 (28%) ml/min when zalcitabine was given alone to 180 (22%) ml/min with probenecid and a prolonged half-life from 1.7 hours to 2.5 hours. Mean AUCs increased from 59 ng·h/ml when zalcitabine was given alone to 91 ng·h/ml when given with probenecid. Considering the short half-life of zalcitabine (1–3 hours) relative to its dosing schedule, the pharmacokinetic changes observed in this study are not expected to result in significant accumulation during chronic dosing. Conclusions. The results of this study show that co-administration of probenecid with zalcitabine results in a moderate decrease in renal clearance of zalcitabine due to inhibition of renal tubular secretion and a 50% increase in drug exposure. Although well tolerated in this single-dose study, patients taking this combination should be monitored closely for signs of toxicity and dosage reduction should be considered if warranted.     

Antiretroviral therapy and preterm birth in HIV-infected women

The use of combination antiretroviral therapy for the prevention of mother to child transmission of HIV infection has achieved vertical HIV transmission rates of <1%. The use of these drugs is not without risk to the mother and infant. Pregnant women with HIV-infection are at high risk of preterm birth (PTB <37 weeks), with 2–4-fold the risk of uninfected women. There is accumulating evidence that certain combinations are associated with higher rates of PTB that others or no antiretroviral treatment. Understanding the pathogenesis of PTB in this group of women will be essential to target preventative strategies in the face of increasing HIV prevalence and rapidly expanding mother-to-child-transmission prevention programmes.