获得性免疫缺陷综合征抗病毒治疗药物研究进展

获得性免疫缺陷综合征,即艾滋病,是由人类免疫缺陷病毒(HIV)感染造成的一种严重免疫缺陷,并发一系列机会性感染及肿瘤,严重者可导致死亡的综合征。目前,艾滋病已成为严重威胁世界人民健康的公共卫生问题。30年来,全球科学家和医学家对其病毒学、免疫学等方面进行了大量研究,希望能够寻找出预防、治疗该疾病的方法,但并未取得突破性进展。根据抗HIV药物作用靶点的不同,可将抗HIV药物分为六大类,即核苷类反转录酶抑制剂、非核苷类反转录酶抑制剂、蛋白酶抑制剂、融合抑制剂、入胞抑制剂或辅受体拮抗剂、整合酶抑制剂。治疗药物虽然不能完全治愈艾滋病,但可以抑制HIV的复制,降低病毒载量,延缓病情发展,改善症状,延长患者的生存时间。     

上海地区HIV毒株基因亚型分布及原发基因耐药的分子流行病学研究

本文通过对未经抗病毒治疗患者的人类免疫缺陷病毒1型（HIV-1）毒株进行检测,了解上海地区HIV-1的亚型分布及原发耐药基因变异现状。对118例未经治疗的HIV感染者其标本中HIV蛋白酶全长和部分反转录酶基因进行反转录-聚合酶链反应（RT-PCR）扩增,经DNA测序后进行系统进化树分析和重组分析,以确定HIV-1基因亚型和重组体,并与斯坦福耐药数据库比对,了解耐药性突变位点。使用斯坦福REGA HIV亚型分型工具和美国国立生物技术信息中心（NCBI）HIV亚型分析工具分析亚型,获得118例患者的HIV基因序列,基因分型分别为CRF01_AE重组体57例(48.3%)、B亚型36例(30.5%)、CRF07_BC 15例 (12.7%)、CRF08_BC 7例(5.9%)、C亚型2例(1.7%),亚型间或重组体间二重重组体(B/CRF01_A E)1例(0.8%)。蛋白酶抑制剂(PI)和反转录酶抑制剂相关的耐药基因突变率达54.2%（64/118）,其中2例（1.7%）发生PI耐药,基因突变位点：M46L、Q58E。5例(4.1%)对反转录酶抑制剂产生耐药,其中对核苷类反转录酶抑制剂（NRTI）和非核苷类反转录酶抑制剂（NNRTI）的耐药率分别为3例(2.4%)和5例(4.1%)。基因突变位点：NRTI为M41L、D67N、T69I/N/S、K70L、L74V、V75L、V118I、M184V、L210W/F/M/S和T215F;NNRTI为V90I、L100V、K103R/N、V106M/P/I/G、E138G/A、V179E/D/T、Y181C、G190A、H221Y、F227L、K238S和Y318F。结果提示,上海地区HIV毒株以CRF01_AE重组亚型为主,且发现新的重组体,可能出现新重组体流行的趋势。PI和反转录酶抑制剂相关的耐药基因突变率较高,且存在高度原发耐药毒株,应加强HIV-1耐药基因变异监测,科学、合理地给予抗病毒治疗。     

白藜芦醇在联合治疗鼠艾滋病中可能的增效作用研究

白藜芦醇(resveratrol,Res.)是一种潜在的抗HIV药物,在体外与AZT、3Tc、ddI等核苷类抗病毒药物联用时表现出很强的协同增强作用。在本篇论文中我们在Friend-MuLV病毒感染的BALB/c鼠艾滋病模型(MAIDS)上研究了用白藜芦醇、AZT、3Tc不同组方及白藜芦醇单独使用治疗后的抗逆转录病毒作用,分析白藜芦醇在联合治疗中可能的潜在协同增强作用。72只BALB/c小鼠随机分成9组(每组8只):正常对照组(未感染和未治疗),病毒对照组(感染但未治疗)和7个其他药物治疗组(感染病毒后并用白藜芦醇、AZT、3Tc不同组方治疗)。药物通过口服给药方式在病毒感染4 h后给药,每天一次,每周7 d,持续3周。感染后3周,所有实验组处死,对表现疾病病理特征的一些指标进行检测评价。结果表明:在体内鼠艾滋病模型上,单独运用白藜芦醇仅仅只有部分能够减少疾病的进展,未表现出所预期的显著的抗逆转录病毒作用(只有20.78%的脾肿抑制率)。白藜芦醇和AZT3、Tc的联合用药有较好的抗病毒效果(减少白细胞数83.34%,脾肿抑制率91.79%,升高CD4 /CD8 比值等)。然而,这些结果与AZT和3Tc联合给药的结果是重叠的,AZT和3Tc联合给药有类似的结果(脾肿抑制率87.65%和白细胞数减少82.25%),排除了AZT3、Tc和白藜芦醇可能的协同增效作用。因此在MAIDS模型中白藜芦醇和AZT3、Tc之间没有协同作用,AZT、3Tc并不会因为和白藜芦醇的联用而提高抗病毒效果。     

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。     

南宁市HIV-1/AIDS人群治疗前pol区遗传特性及蛋白结构分析

为探讨南宁市某县艾滋病病毒1型(HIV-1)感染人群中治疗前pol区遗传特性及蛋白结构变化情况,本研究通过RT-PCR扩增pol区部分序列并进行测序,将序列同源比对构建系统进化树;分型确定毒株亚型和斯坦福大学HIV耐药性数据库比对,分析耐药相关位点;SWISS-MODEL蛋白质同源数据库进行建模分析氨基酸的突变对蛋白质结构和功能的影响。本研究在90份HIV-1标本中获得46个pol区有效序列,共发现4种亚型,其中CRF01_AE占76.08%(35/46)、CRF08_BC占15.22%(7/46)、CRF07_BC占(3/46)6.52%、CRF59_01B1占2.17%(1/46);46个序列中有4例(8.69%)出现耐药突变位点,没有针对核苷酸反转录酶抑制剂(NRTI)的耐药突变;针对蛋白酶类抑制剂(PIs)1例,PR蛋白酶的柔性部位I47V位点发生突变,β折叠结构的I84V位点发生突变,都是异亮氨酸突变为缬氨酸;针对非核苷酸反转录酶抑制剂(NNRTI)有3例,2例位于活性中心的Y181C位点由酪氨酸突变为半胱氨酸,1例位于转角处的E138G位点由谷氨酸突变为甘氨酸。研究表明,南宁市某县HIV-1病毒CRF01_AE重组亚型比例最大,未经抗病毒治疗HIV1感染者中已经出现pol区耐药突变株,突变位点主要位于活性中心及柔性部位,传播水平已经处于中等流行状态。深入分析蛋白质与抑制剂相互作用机制,有助于为艾滋病抗病毒及耐药性监测方案提供科学依据。     

HBV定量检测对拉米夫定停药的指导意义

目的:探讨核苷类似物(NAs)拉米夫定(LAM)用药时间与乙型肝炎(CHB)患者体内HBV病毒血清HBV-DNA载量的关系。方法:选取214例HBeAg阳性患者,在LAM(100 mg/d)的36个月用药治疗前使用实时荧光定量PCR进行血清HBV-DNA载量进行测定,并使用特异性引物鉴定HBV病毒DNA保守位点YMDD的抗药性突变以及病毒株的变化情况。结果:(1)214例患者均对LAM产生应答,在治疗12-18个月后血清HBV-DNA载量稳定在较低水平。(2)病毒株在NAs治疗前已经出现耐药性突变(18%),用药加速了HBV病毒的耐药进化,18个月后耐药病毒数在214例样本中均超过10%的检测标准。结论:LAM治疗在9-18个月获得良好的治疗效果,建议24个月后停药更换临床处方防止耐药病毒株的进化。     

检测HIV—1载量的荧光实时定量PCR技术的建立其应用

准确测定HIV－1的前病毒载量和病毒载量的技术,在感染者预后和艾滋病患者药物治疗效果的评价以及艾滋病的其它研究方面,都具有十分重要的应用价值。以定量的HIV－1 DNA和RNA为标准外参照,利用SYBR Green荧光染料和GeneAmp5700Sequence Detection System（5700系统）,建立了测定HIV－1的前病毒载量和病毒载量的荧光实时定量PCR技术,以病毒感染细胞和培养上清上材料,测定了三种化合物（AZT,GL和WT）对细胞内的前病毒载量和培养上清中的病毒载量的抑制活性,并与合胞体形成抑制方法测定化合物抗病毒活性的结果进行了比较,根据病毒载量、前病毒载量和合胞体形成计算出的三种化合物的治疗指数均依次变小,提出以荧光实时定量PCR技术测定前病毒载量,会在评价药物在体内外根除或减少存在于CD4休止或记忆T淋巴细胞中的HIV－1前病毒方面有特别的价值。     

检测HIV-1载量的荧光实时定量PCR技术的建立及其应用

准确测定HIV-1的前病毒载量和病毒载量的技术,在感染者预后和艾滋病患者药物治疗效果的评价以及艾滋病的其它研究方面,都具有十分重要的应用价值。以定量的HIV-1DNA和RNA为标准外参照,利用SYBRGreen荧光染料和GeneAmp5700 Sequence Detection System(5700系统),建立了测定HIV-1的前病毒载量和病毒载量的荧光实时定量PCR技术。以病毒感染细胞和培养上清为材料,测定了三种化合物(AZT,GL和WT)对细胞内的前病毒载量和培养上清中的病毒载量的抑制活性,并与合胞体形成抑制方法测定化合物抗病毒活性的结果进行了比较。根据病毒载量、前病毒载量和合胞体形成计算出的三种化合物的治疗指数均依次变小,提出以荧光实时定量PCR技术测定前病毒载量,会在评价药物在体内外根除或减少存在于CD4休止或记忆T淋巴细胞中的HIV-1前病毒方面有特别的价值。     

产气肠杆菌菌体内核苷磷酸化酶的诱导表达

目的:阿糖腺苷(Ara-A)是一种广谱抗病毒药物,临床上用于治疗多种病毒性疾病.同时也是合成阿糖腺苷单磷酸(Ara-AMP)的重要原料.本课题旨在寻找一种高效酶法生产嘌呤类阿糖核苷的方法.方法:以产气肠杆菌完整细胞为酶源,研究产气肠杆菌菌体培养条件对核苷磷酸化酶的影响及其诱导性.结果:胸苷磷酸化酶、尿苷磷酸化酶和嘌呤核苷磷酸化酶均可被多种核苷、核苷酸甚至碱基诱导.胞苷或胞苷酸的添加量为15-20mmol/L,诱导时间在0-8小时均可.经胞苷和胞苷酸诱导的菌体可使酶反应时间缩短6倍,大大提高了反应效率.经诱导的菌体,在反应后仍保持较高的核苷磷酸化酶活力;而未经诱导的菌体,一次反应后即丧失大量的酶活力.结论:核苷磷酸化酶的活性可以通过诱导而提高,以此优化阿糖腺苷的生产.     

Prevalence and evolution of drug resistance HIV-1 variants in Henan, China

To understand the prevalence and evolution of drug resistant HIV strains in Henan China after the implementation of free antiretroviral therapy for AIDS patients. 45 drug na?ve AIDS patients, 118 AIDS patients who received three months antiretroviral therapy and 124 AIDS patients who received six months antiretroviral treatment were recruited in the southern part of Henan province. Information on general condition, antiretroviral medicines, adherence and clinical syndromes were collected by face to face interview. Meanwhile, 14 ml EDTA anticoagulant blood was drawn. CD4/CD8 T cell count, viral load and genotypic drug resistance were tested. The rates of clinical improvement were 55.1% and 50.8% respectively three months and six months after antiretroviral therapy. The mean CD4 cell count after antiretroviral therapy was significantly higher than in drug na?ve patients. The prevalence rate of drug resistant HIV strains were 13.9%, 45.4% and 62.7% in drug na?ve patients, three month treatment patients and six month treatment patients, respectively. The number of resistance mutation codons and the frequency of mutations increased significantly with continued antiretroviral therapy. The mutation sites were primarily at the 103, 106 and 215 codons in the three-month treatment group and they increased to 15 codon mutations in the six-month treatment group. From this result, the evolution of drug resistant strains was inferred to begin with the high level NNRTI resistant strain, and then develop low level resistant strains to NRTIs. The HIV strains with high level resistance to NVP and low level resistance to AZT and DDI were highly prevalent because of the AZT+DDI+NVP combination therapy. These HIV strains were also cross resistant to DLV, EFV, DDC and D4T. Poor adherence to therapy was believed to be the main reason for the emergence and prevalence of drug resistant HIV strains. The prevalence of drug resistant HIV strains was increased with the continuation of antiretroviral therapy in the southern part of Henan province. Measures, that could promote high level adherence, provide new drugs and change ART regimens in failing patients, should be implemented as soon as possible.     

Prevalence and evolution of drug resistance HIV-1 variants in Henan, China

To understand the prevalence and evolution of drug resistant HIV strains in Henan China after the implementation of free antiretroviral therapy for AIDS patients. 45 drug naive AIDS patients, 118 AIDS patients who received three months antiretroviral therapy and 124 AIDS patients who received six months antiretroviral treatment were recruited in the southern part of Henan province. Information on general condition, antiretroviral medicines, adherence and clinical syndromes were collected by face to face interview. Meanwhile, 14ml EDTA anticoagulant blood was drawn. CD4/CD8 T cell count, viral load and genotypic drug resistance were tested. The rates of clinical improvement were 55.1% and 50.8% respectively three months and six months after antiretroviral therapy. The mean CD4 cell count after antiretroviral therapy was significantly higher than in drug naive patients. The prevalence rate of drug resistant HIV strains were 13.9%, 45.4% and 62.7% in drug naive patients, three month treatment patients and six month treatment patients, respectively.The number of resistance mutation codons and the frequency of mutations increased significantly with continued antiretroviral therapy. The mutation sites were primarily at the 103, 106 and 215 codons in the three-month treatment group and they increased to 15 codon mutations in the six-month treatment group. From this result, the evolution of drug resistant strains was inferred to begin with the high level NNRTI resistant strain, and then develop low level resistant strains to NRTIs. The HIV strains with high level resistance to NVP and low level resistance to AZT and DDI were highly prevalent because of the AZT DDI NVP combination therapy. These HIV strains were also cross resistant to DLV, EFV, DDC and D4T. Poor adherence to therapy was believed to be the main reason for the emergence and prevalence of drug resistant HIV strains. The prevalence of drug resistant HIV strains was increased with the continuation of antiretroviral therapy in the southern part of Henan province. Measures, that could promote high level adherence,provide new drugs and change ART regimens in failing patients, should be implemented as soon as possible.     

Emergence of minor drug-resistant HIV-1 variants after triple antiretroviral prophylaxis for prevention of vertical HIV-1 transmission

Background

WHO-guidelines for prevention of mother-to-child transmission of HIV-1 in resource-limited settings recommend complex maternal antiretroviral prophylaxis comprising antenatal zidovudine (AZT), nevirapine single-dose (NVP-SD) at labor onset and AZT/lamivudine (3TC) during labor and one week postpartum. Data on resistance development selected by this regimen is not available. We therefore analyzed the emergence of minor drug-resistant HIV-1 variants in Tanzanian women following complex prophylaxis.

Method

1395 pregnant women were tested for HIV-1 at Kyela District Hospital, Tanzania. 87/202 HIV-positive women started complex prophylaxis. Blood samples were collected before start of prophylaxis, at birth and 1–2, 4–6 and 12–16 weeks postpartum. Allele-specific real-time PCR assays specific for HIV-1 subtypes A, C and D were developed and applied on samples of mothers and their vertically infected infants to quantify key resistance mutations of AZT (K70R/T215Y/T215F), NVP (K103N/Y181C) and 3TC (M184V) at detection limits of <1%.

Results

50/87 HIV-infected women having started complex prophylaxis were eligible for the study. All women took AZT with a median duration of 53 days (IQR 39–64); all women ingested NVP-SD, 86% took 3TC. HIV-1 resistance mutations were detected in 20/50 (40%) women, of which 70% displayed minority species. Variants with AZT-resistance mutations were found in 11/50 (22%), NVP-resistant variants in 9/50 (18%) and 3TC-resistant variants in 4/50 women (8%). Three women harbored resistant HIV-1 against more than one drug. 49/50 infants, including the seven vertically HIV-infected were breastfed, 3/7 infants exhibited drug-resistant virus.

Conclusion

Complex prophylaxis resulted in lower levels of NVP-selected resistance as compared to NVP-SD, but AZT-resistant HIV-1 emerged in a substantial proportion of women. Starting AZT in pregnancy week 14 instead of 28 as recommended by the current WHO-guidelines may further increase the frequency of AZT-resistance mutations. Given its impact on HIV-transmission rate and drug-resistance development, HAART for all HIV-positive pregnant women should be considered.