潜伏性结核感染的诊治进展

近年来,由于耐药结核病、人类免疫缺陷病毒(human immunodeficiency virus,HIV)合并结核分枝杆菌(简称结核杆菌)感染和大规模人口流动等问题的出现,结核病疫情出现加重趋势.目前,全球每年约有900万人发展成活动性结核患者,200～300万人死于结核病[1].     

输血相关HIV感染实验室检测技术进展

开展有效的HIV检测能够控制输血传播HIV,阻断其传播途径,同时有助于确保临床输血安全.输血相关人类免疫缺陷病毒检测技术包括抗原、抗体检测和核酸检测等,抗体检测以酶联免疫吸附试验和免疫印迹试验为主要方法,辅以P24抗原和核酸检测技术检测以降低人类免疫缺陷病毒窗口期传播的残余危险度.而输血相关艾滋病的实际发生的程度取决于人群中感染人数的比例和献血者筛检工作的有效性.     

上海地区人类免疫缺陷病毒1型感染/艾滋病患者病毒耐药基因突变及亚型分布

目的 研究上海地区人类免疫缺陷病毒1型(HIV-1)感染／艾滋病(AIDS)患者中HIV-1耐药株出现的情况及亚型分布。方法 对33例HIV-1感染／AIDS患者的血浆HIV-1分离株,进行抗HIV-1药物(核苷类反转录酶抑制剂、非核苷类反转录酶抑制剂和蛋白酶抑制剂)的基因型耐药检测和亚型分析。结果 33例的HIV-1均未检出对PI的耐药突变;10例高效抗反转录病毒疗法(HAART)治疗失败或抑制病毒复制不完全者中,检出的耐药突变为70％,过渡型耐药突变为20％;23例未经抗HIV-1治疗者中,耐药突变为4．3％,过渡型耐药突变为13％。所有过渡型耐药突变均为T215S。15例经血制品传播的HIV- 1均为B亚型;18例经吸毒和性传播的HIV-1中,B和CRF01-AE亚型分别为39％,和33％,此外,还有C、D、G、K和CRF02-AG亚型。结论 上海地区HIV-1感染／AIDS患者中,HAART治疗失败或复制抑制不完全者HIV-1的NRTI和NNRTI耐药突变率高;吸毒和性传播者的HIV-1中,除主要为B和CRF01-AE亚型外,尚有其他少见的亚型。     

1例耐多药复杂重组人类免疫缺陷病毒1型亚型感染病例的抗病毒治疗

随着抗病毒治疗时间的延长,如何处理人类免疫缺陷病毒（HIV）耐药患者是临床医师面对的一个挑战。本文报道对1例耐多药复杂重组HIV-1亚型感染病例成功进行抗病毒治疗的过程,总结了抗病毒依从性的重要性,即只有规律服药才能达到好的治疗效果。临床上可应用病毒基因耐药检测来指导抗病毒药物的选择,但应注意体外实验与体内实际情况可能存在的差异。此外,需进一步研究一些少见亚型毒株对药物的反应及对药物压力的逃避机制。     

结核疫苗研究的新动向

近年来,由于人类免疫缺陷病毒的广泛传播和结核分枝杆菌耐药菌株的出现,使结核病在全球范围内的发病率大幅度上升,而其唯一的疫苗——卡介苗所具有的保护效果又颇有争议。因此,开发新型结核疫苗迫在眉睫。本文就近年来抗结核免疫机制以及3种结核疫苗研究的进展作一介绍。     

浆母细胞淋巴瘤的诊治进展

浆母细胞淋巴瘤是一种临床罕见、侵袭性极强的B细胞淋巴瘤,多发生在HIV感染的患者,也可见于HIV阴性的免疫功能正常或受抑的人群,常与EB病毒感染相关。由于其特殊的形态学及免疫表型特征、化疗耐药及复发率高的临床特点,诊断及治疗仍极具挑战性,总体预后极差。本文简要总结了PBL在流行病学、病理学特征、临床表现、诊断、治疗及预后因素等方面的进展,期望为PBL的临床诊治提供帮助。     

2014—2018年平顶山市湛河区艾滋病自愿咨询检测者HIV抗体调查分析

目的了解平顶山市湛河区艾滋病自愿咨询检测(voluntary counseling and testing, VCT)的人类免疫缺陷病毒(human immunodeficiency virus, HIV)抗体情况,为全区科学防治艾滋病工作提供理论依据。方法通过湛河区疾病预防控制中心2014—2018年3 205例VCT HIV抗体分析,研究同期报告的艾滋病病例的感染状况和人群分布特征。结果 2014—2018年湛河区疾病预防控制中心对3 205人次VCT并进行HIV抗体筛查,阳性21例,阳性率0.66%。VCT HIV抗体阳性和阳性率最高的年份是2016和2017年,各年份间无明显趋势变化,各年份差异无统计学意义;男女性别比为1.60∶1,男性VCT HIV抗体阳性和阳性率高于女性,性别差异无统计学意义;年龄分布以青壮年为主,年龄集中在>20～40岁组,占64.93%;文化程度分布,以初中及以下人群的构成比最高;婚姻状况分布发现,已婚VCT HIV抗体阳性和阳性率最多;不同高危人群HIV抗体检测,男男性行为抗体阳性率是异性性行为的23.24倍。结论疾病预防控制中心VCT是HIV阳性发现的主要部门,需进一步重视和扩大VCT门诊;加强人们艾滋病预防知识的普及工作,特别针对外来务工人员、高危行为者中男男性行为者的健康教育和行为干预;同时对婚检人群抗体阳性的出现引起足够的重视。     

CRISPR/Cas9基因组编辑技术在HIV-1感染治疗中的应用进展

基因治疗是将外源正常基因通过一定方式导入人体靶细胞以纠正或补偿因基因缺陷和异常引起的疾病,从而达到治疗目的。因此,基因治疗的技术方法在研究持续感染HIV-1或潜伏感染HIV-1原病毒患者的治疗中具有重大的现实意义。目前,现有的基因治疗方法存在识别靶向位点有限及脱靶几率大等主要问题。最新研究表明来源于细菌和古菌的规律间隔成簇短回文重复序列及其相关核酸酶9系统[Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated nuclease 9 (Cas9), CRISPR/Cas9]已被成功改造成基因组定点编辑工具。因此,如何利用CRISPR/Cas9系统实现对HIV-1病毒基因组进行高效靶向修饰,从而达到治疗HIV-1感染病患的目的已经成为当前研究的热点。本文参考最新国内外研究成果,重点介绍了 CRISPR/Cas9基因组编辑技术在HIV-1感染疾病治疗中的应用,主要包括CCR5基因编辑、清除HIV-1原病毒以及活化HIV-1原病毒,以期为HIV-1感染疾病的预防与治疗提供重要研究参考。     

衣壳蛋白:抗HIV感染的新靶点

HIV是由病毒衣壳蛋白（capsid protein,CA）形成的一个蛋白质外壳包绕着内部的核蛋白复合体所构成。HIV-1的CA在病毒的组装和成熟中起着至关重要的作用。同时,病毒传染性很大程度上取决于衣壳的结构和稳定性,因此,衣壳蛋白成为潜在的抗HIV药物研究的重要靶点之一。     

补体C3促进HIV-1感染的作用

补体是天然免疫的重要组成部分。C3是补体经典途径、旁路途径及甘露糖结合凝集素(MBL)途径的共同通路,在补体清除1型人免疫缺陷病毒(HIV-1)的过程中发挥重要作用。同时,C3在促进病毒黏膜进入、传播与储存、感染免疫细胞等方面也起重要作用。     

不同人类免疫缺陷病毒感染途径群体中戊型肝炎病毒的流行情况

本研究旨在了解不同人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染途径群体中戊型肝炎病毒(hepatitis E virus,HEV)抗体情况,探讨HEV疫苗接种的必要性。采集HIV感染者的血清或血浆,利用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测HEV IgG抗体、IgM抗体及抗原,荧光定量聚合酶链反应(polymerase chain reaction,PCR)检测HEV核酸,Roche高纯化HIV-1核酸定量检测试剂盒(PCR荧光法)检测HIV感染者的HIV载量。比较分析不同HIV感染途径群体中HEV流行率的差别。结果显示,HIV感染者中HEV IgG抗体的阳性率为37.4%,静脉吸毒、成分献血和传播途径不明HIV感染群体的HEV IgG抗体阳性率分别为49.3%、39.5%和30.4%。HEV核酸荧光PCR检测结果均为阴性。3种HIV感染群体之间HEV IgG抗体阳性率差异无统计学意义(χ~2=2.978,P0.05)。HEV IgG阳性与阴性感染者之间HIV载量差异无统计学意义(P0.05)。结果提示,为保护HIV感染者免受HEV感染,应考虑接种HEV疫苗。     

Immunogenicity of a novel, bivalent, plant-based oral vaccine against hepatitis B and human immunodeficiency viruses

A synthetic chimeric gene, TBI-HBS, encoding the immunogenic ENV and GAG epitopes of human immunodeficiency virus (HIV-1) and the surface protein antigen (HBsAg) of hepatitis B virus (HBV), was expressed in tomato plants. Tomato fruits containing the TBI-HBS antigen were fed to experimental mice and, on days 14 and 28 post-feeding, high levels of HIV- and HBV-specific antibodies were present in the serum and feces of the test animals. Intraperitoneal injection of a DNA vaccine directing synthesis of the same TBI-HBsAg antigen boosted the antibody response to HIV in the blood serum; however, it had no effect on the high level of antibodies produced to HBV.Mention of trade names or commercial products in this article is solely for the purpose of providing specific information and does not imply recommendation or endorsement by the U.S. Department of Agriculture.     

Ribosome Inactivating Proteins from Plants Inhibiting Viruses

Many plants contain ribosome inactivating proteins (RIPs) with N-glycosidase activity, which depurinate large ribosomal RNA and arrest protein synthesis. RIPs so far tested inhibit replication of mRNA as well as DNA viruses and these proteins, isolated from plants, are found to be effective against a broad range of viruses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and herpes simplex virus (HSV). Most of the research work related to RIPs has been focused on antiviral activity agains...     

Combined NMR and EPR spectroscopy to determine structures of viral fusion domains in membranes

Methods are described to determine the structures of viral membrane fusion domains in detergent micelles by NMR and in lipid bilayers by site-directed spin labeling and EPR spectroscopy. Since in favorable cases, the lower-resolution spin label data obtained in lipid bilayers fully support the higher-resolution structures obtained by solution NMR, it is possible to graft the NMR structural coordinates into membranes using the EPR-derived distance restraints to the lipid bilayer. Electron paramagnetic dynamics and distance measurements in bilayers support conclusions drawn from NMR in detergent micelles. When these methods are applied to a structure determination of the influenza virus fusion domain and four point mutations with different functional phenotypes, it is evident that a fixed-angle boomerang structure with a glycine edge on the outside of the N-terminal arm is both necessary and sufficient to support membrane fusion. The human immunodeficiency virus fusion domain forms a straight helix with a flexible C-terminus. While EPR data for this fusion domain are not yet available, it is tentatively speculated that, because of its higher hydrophobicity, a critically tilted insertion may occur even in the absence of a kinked boomerang structure in this case.     

A multiplexed protein microarray for the simultaneous serodiagnosis of human immunodeficiency virus/hepatitis C virus infection and typing of whole blood

All donor blood samples must be tested pretransfusion to determine the donor blood type. Standard testing protocols require that assays be performed for important bloodborne pathogens such as hepatitis C, syphilis, hepatitis B, and human immunodeficiency virus. We have demonstrated proof of the concept that a protein microarray can type whole blood and detect antibody to significant pathogens simultaneously from the same donor blood sample. The data collected demonstrate the ability of the array to accurately type blood samples while also detecting the presence of antibodies against both human immunodeficiency virus and hepatitis C virus. In conclusion, we have successfully developed a platform capable of typing human whole blood samples, while at the same time testing for the presence of antibodies specific for human immunodeficiency virus/hepatitis C virus. The major benefits of this system are its amenability to expansion with additional assays, for example, rhesus typing and syphilis and/or hepatitis B virus detection, and also the adaptability of the assay to higher-throughput analysis, currently 16 individual samples per slide, but readily expandable to a 96-well format.     

全球抗病毒药物研发进展与展望

病毒是危害人体健康的主要病原体之一,病毒感染和传播造成的传染性疾病严重威胁人类健康。目前,艾滋病、病毒性肝炎等发病率高、治愈率低的病毒性疾病仍在全球蔓延,流感病毒、冠状病毒等呼吸道病毒不断发生变异,2019年以来,新冠病毒引起的全球疫情对世界各国产生巨大影响,疫情走向还存在很大不确定性,开发安全有效的抗病毒药物成为应对病毒性疾病的重要手段。拟在总结全球抗病毒药物研发整体现状的基础上,分析抗艾滋病病毒、肝炎病毒、新冠病毒等重点领域的新药研发进展,提出抗病毒药物的发展建议,为未来研发更加高效的抗病毒药物提供指引和参考。     

人类免疫缺陷病毒/丙型肝炎病毒混合感染者免疫细胞和肝生化指标的分析

目的 探讨人类免疫缺陷病毒/丙型肝炎病毒(HIV/HCV)混合感染者的免疫淋巴细胞亚群和肝脏生化指标的特征。方法 检测并分析研究组(40例混合感染HIV/HCV的血友病患者)和对照组(12例单独感染HIV的血友病患者)若干相关实验室指标。结果两组(研究与对照)结果 差异显著的指标分别为:自然杀伤(NK)细胞9.26%±5.98%对12.19%±5.80%,P<0.05;CD4/CD8细胞比值0.39±0.21对0.53±0.24,P<0.05;CD3细胞74.99%±10.33%对68.42%±8.82%,P<0.05;CD8细胞52.28%±12.59%对43.58%±10.99%,P<0.05;丙氨酸氨酶(ALT)(48.59±40.21)U/L对(26.87±27.23)U/L,P<0.01;天冬氨酸转氨酶(AST)(61.66±51.02)U/L对(34.17±30.24)U/L,P<0.001;谷氨酰转肽酶(GGT)(136.50±111.50)U/L对(43.88±36.17)U/L,P<0.001;甘胆酸(CG)(683.41±962.22)μg/L对(250.96±290.81)μg/L,P<0.001;透明质酸(HA)(180.94±196.69)ng/ml对(64.68±32.74)ng/ml,P<0.001;白/球蛋白(A/G)比值1.35±0.24对1.50±0.34,P<0.05。与单独HIV感染者比较,HIV/HCV混合感染者的NK细胞、CD4/CD8细胞比值和A/G比值显著降低,而ALT、AST、GGT、CG和HA的水平显著增加。结论 HIV/HCV混合感染可能加剧患者淋巴细胞亚群的不平衡,加重肝脏损伤和出现肝硬化趋势。     

HIV and HCV: from Co-infection to epidemiology, transmission, pathogenesis, and treatment

Human immunodeficiency virus (HIV) is the infectious agent causing acquired immunodeficiency syndrome (AIDS), a deadliest scourge of human society. Hepatitis C virus (HCV) is a major causative agent of chronic liver disease and infects an estimated 170 million people worldwide, resulting in a serious public health burden. Due to shared routes of transmission, co-infection with HIV and HCV has become common among individuals who had high risks of blood exposures. Among hemophiliacs the co-infection rate accounts for 85%; while among injection drug users (IDU) the rate can be as high as 90%. HIV can accelerate the progression of HCV-related liver disease, particularly when immunodeficiency has developed. Although the effect of HCV on HIV infection is controversial, most studies showed an increase in mortality due to liver disease. HCV may act as a direct cofactor to fasten the progression of AIDS and decrease the tolerance of highly active antiretroviral therapy (HARRT). Conversely, HAART-related hepatotoxicity may enhance the progression of liver fibrosis. Due to above complications, co-infection with HCV and HIV-1 has imposed a critical challenge in the management of these patients. In this review, we focus on the epidemiology and transmission of HIV and HCV, the impact of the two viruses on each other, and their treatment.