降低我国艾滋病患者病死率的几个关键措施

随着人类免疫缺陷病毒(HIV)感染者逐渐进入获得性免疫缺陷综合征(AIDS)期,我国HIV感染者病死人数逐渐增加,已超过结核病与狂犬病的病死人数,位居第1.如何降低HIV/AIDS患者的病死率是我国目前亟待解决的重要课题.针对我国HIV/AIDS患者的特点,应采用多种措施.其中关键为:落实患者对药物的依从性,优化抗病毒治疗方案;扩大抗病毒治疗覆盖面,以增加接受抗病毒治疗的患者;加大检测力度,早诊断和早治疗以延长患者寿命,改善预后;注意对患者并发症的治疗,并科学分析病死原因.这些措施的实施需要社会各界共同参与和努力.     

人类免疫缺陷病毒解剖学病毒储存库与检测方法的研究进展

由于人类免疫缺陷病毒(human immunodeficiency virus,HIV)储存库的存在,获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者即便接受高效抗反转录病毒治疗也无法完全清除体内的潜伏病毒.本文就HIV在人体内可能存在的解剖学储存库、病毒储存库...     

广西地区艾滋病患者临床标本分枝杆菌培养及耐药性分析

为探讨艾滋病患者临床标本分枝杆菌培养阳性率、菌种类型及耐药状况,本研究对2010年1月—2019年12月在广西某医院就诊的艾滋病患者的临床标本进行分枝杆菌培养,分离鉴定后用8种以上抗结核药物进行药敏试验.结果显示,艾滋病患者临床标本分枝杆菌培养总阳性率为15.68％(2163/13795),脓液、分泌物、组织标本、胸腹...     

艾滋病合并肺孢子菌肺炎1例

本文报道1例通过肺组织活检明确诊断的艾滋病合并肺孢子菌肺炎(Pneumocystis carinii pneumonia,PCP)病例,结合文献复习,分析艾滋病合并PCP的病理学特点及临床诊治措施。本例患者经实验室检查确诊为艾滋病,通过气管镜肺活检取得肺组织标本,组织病理学诊断为PCP,给予复方磺胺甲唑治疗后病情好转。PCP多见于艾滋病等免疫缺陷患者,临床上表现为间质性肺炎,提高对该病的认识并尽早进行病原学检测是确诊的关键。尽早使用复方磺胺甲唑等有效药物是改善预后的主要措施。     

On transient effects in the HIV/AIDS epidemic

During the initially exponential spread of the human immunodeficiency virus (HIV—the causative agent of AIDS) the growth rate of the number of AIDS cases decreases from plus infinity to the growth rate of HIV infections. A sensitivity analysis shows that for all reasonable values of the parameters of the HIV epidemic (incubation period, initial doubling time, etc.) the effect of this positive transient becomes negligible when the annual number of AIDS cases reaches a few dozen. Necessary and sufficient conditions are given for the growth rate of the number of AIDS cases to be monotonically decreasing during the positive transient. A mildly pathological density function for the incubation period of AIDS provides an example of a growth rate of AIDS that does not decrease monotonically, even though HIV is spreading exponentially. A negative transient occurs when the growth rate of HIV begins to decrease. In this context a somewhat surprising result emerges under the assumption that the growth rate of HIV is non-increasing: the growth rate of AIDS is at all times larger than the growth rate of HIV. A logistic HIV epidemic illustrates this result, and implications for the growth of the HIV epidemic in the United States and Europe are discussed. In particular, it is shown that the positive transient must have passed by 1982 in the United States and by 1986 or 1987 for the five European countries with the largest caseloads.     

女性艾滋病患者的抗反转录病毒治疗与人类免疫缺陷病毒母婴阻断

自从对感染人类免疫缺陷病毒(HIV)的妊娠妇女实施抗反转录病毒治疗(ART)以预防母婴垂直传播以来,HIV母婴阻断成功率明显上升。而部分抗病毒药物,如依非韦伦和替诺福韦,也逐渐被证实用于妊娠期妇女对胎儿是安全的,这增加了HIV母婴阻断药物的选择范围。     

抗人类免疫缺陷病毒1型感染的双特异性抗体的构建及其功能研究

人类免疫缺陷病毒(human immunodeficiency virus,HIV)流行毒株的靶向广谱中和抗体(broadly neutralizing antibody,bNAb)的单一疗法最终会导致机体出现病毒逃逸突变,而基于bNAb开发的双特异性或多特异性抗体则表现出较好的中和效力和广谱性。根据已公布的单链可变区基因抗体序列,通过密码子优化后合成一种由单基因编码的双特异性抗体iMab-PGT151,经双酶切和测序对重组质粒进行了验证。酶联免疫吸附试验检测双特异性抗体的结合特异性,检测U87细胞裂解液中的荧光素酶活性以定量分析双特异性抗体对HIV-1假病毒的中和作用;间接免疫荧光染色法检测双特异性抗体iMab-PGT151对人喉癌上皮细胞的反应性;酶联免疫吸附试验检测该抗体对心磷脂的结合能力,验证其自体反应性。结果显示,构建的双特异抗体iMab-PGT151能够成功表达,可分别结合亲本抗体的各个配体,具有双特异性,能100%中和20株假病毒,IC 50值为0.084μg/mL。与亲本抗体相比,该抗体具有更强的中和效力和广谱度,无自体反应性,具有临床适用性。所构建的双特异性抗体iMab-PGT151将可能成为预防和治疗HIV-1感染的有效候选药物之一。     

Neurotoxicity caused by didanosine on cultured dorsal root ganglion neurons

The purpose of the present study was to investigate whether didanosine (ddI) directly causes morphological and ultrastructural abnormalities of dorsal root ganglion (DRG) neurons in vitro. Dissociated DRG cells and organotypic DRG explants from embryonic 15-day-old Wistar rats were cultured for 3 days and then exposed to ddI (1 μg/ml, 5 μg/ml, 10 μg/ml, and 20 μg/ml) for another 3 days and 6 days, respectively. Neurons cultured continuously in medium served as normal controls. The diameter of the neuronal cell body and neurite length were measured in dissociated DRG cell cultures. Neuronal ultrastructural changes were observed in both culture models. ddI induced dose-dependent decreases in neurite number, length of the longest neurite in each neuron, and total neurite length per neuron in dissociated DRG cell cultures with 3 days treatment. There were no morphological changes seen in organotypic DRG cultures even with longer exposure time (6 days). But ddI induced ultrastructural changes in both culture models. Ultrastructural abnormalities included loss of cristae in mitochondria, clustering of microtubules and neurofilaments, accumulation of glycogen-like granules, and emergence of large dense particles between neurites or microtubules. Lysosome-like large particles emerged inconstantly in neurites. ddI induced a neurite retraction or neurite loss in a dose-dependent manner in dissociated DRG neurons, suggesting that ddI may partially contribute to developing peripheral neuropathy. Cytoskeletal rearrangement and ultrastructural abnormalities caused by ddI in both culture models may have a key role in neurite degeneration.     

HIV/AIDS患者机会性感染与CD4+ T淋巴细胞间的关联性

目的 研究人免疫缺陷病毒（HIV）感染者及艾滋病（AIDS）患者发生机会性感染的概率与自身CD4+ T淋巴细胞之间的关系,为HIV患者机会性感染的防治提供参考。方法 以2016年6月至2017年6月我院400例HIV患者为研究对象,回顾性分析不同CD4+T淋巴细胞计数HIV患者发生机会性感染的情况。结果 400例HIV患者发生机会性感染178例,总感染率为44.5%。CD4+T淋巴细胞计数≤50个/μL的患者机会性感染发生率（86.67%）最高,与其他各组比较差异有统计学意义（P<0.05）。随着CD4+ T淋巴细胞计数的减少,HIV患者机会性感染率升高。178例机会性感染者中,单一感染82例,2部位感染52例,3部位感染28例,4部位以上感染16例。感染病原体检测显示,细菌感染84例（47.19%）,结核杆菌感染36例（20.22%）,病毒感染30例（16.85%,包括巨细胞病毒感染18例、单纯疱疹病毒感染12例）,真菌感染77例（43.25%,包括假丝酵母感染35例,肺孢子菌感染20例,马尔尼菲青霉菌感染12例,新型隐球菌感染10例）,未明确病原体性质34例（19.10%）,复合感染多见。结论 CD4+ T淋巴细胞水平与HIV患者继发机会性感染的概率关系密切。HIV患者CD4+ T淋巴细胞水平的监测对其继发机会性感染的防控具有重要临床意义。     

艾滋病痴呆综合征蛋白质组学的研究进展

艾滋病痴呆综合征(acquired immunodeficiency syndrome dementia complex, ADC)是由人类免疫缺陷病毒(human immunodeficiency virus,HIV)侵犯中枢神经系统,造成患者意识、行为和运动能力改变为主要临床表现的综合征。约50%的HIV感染者表现出不同形式的认知功能损伤。ADC的发病机制尚未完全阐明,诊断也无明确的病理和生化指标。目前,蛋白质组学技术以其高灵敏度和高通量的特点广泛应用于传染病研究。本文综述了近年来ADC蛋白质组学研究领域的进展,包括ADC蛋白质组学研究所用样品、蛋白质组学技术及其在ADC研究中的应用,为ADC的诊断和发病机制研究提供新思路。     

艾滋病合并隐球菌感染17例尸检材料的临床病理学研究

在１５１例艾滋病尸检材料中发现１７例合并隐球菌感染,均经病理学确诊,患者男１５名,女２名,平均４３．６岁。１２例发生脑膜炎、肺炎和淋巴结炎各７例,尚见脾（６例）、肾（５例）等器官受累。９例为播散性感染。病变为慢性肉牙肿性,其中见有隐球菌。本文描述隐球菌性脑膜炎、肺炎等临床病理学表现,并讨论其病变特征与病理诊断问题。     

Increased Neopterin Levels in Brains of Patients with Human Immunodeficiency Virus Type 1 Infection

Postmortem levels of native neopterin (D-erythro-neopterin) were measured in cerebral cortical samples from 44 human immunodeficiency virus type 1-infected and eight uninfected, nonneurological control patients. Cerebral cortical gray and white matter neopterin levels for the controls ranged from 0.5 to 7.2 pmol/mg of protein in contrast to neopterin levels in brains of the virus-infected patients, which frequently were more than threefold and occasionally more than 30-fold higher than mean control levels. Cortical neopterin levels did not correlate with severity of the acquired immunodeficiency syndrome dementia complex, but subcortical levels correlated with the presence of active human immunodeficiency virus type 1 infection, as reflected by pathological evidence of multinucleated giant cell encephalitis. Evidence of opportunistic cytomegalovirus infections in approximately 25% of the human immunodeficiency virus type 1-infected patients was associated with enhanced levels of neopterin in frontal cortex.     

A modeled time-varying density function for the incubation period of AIDS

Building on the Weibull distribution, we develop a modeled time-varying density function of the incubation time between exposure to HIV infection and full-blown AIDS. This approach leads to a series of cohort-specific density functions that take into account the increasing impact of new therapies such as zidovudine (AZT). The resulting modeled density functions are studied in detail, particularly with regard to their modes and medians. The mode is sensitive to changes in the period incubation time distribution, with even a possibility of a bimodal distribution for certain combinations of the parameters that determine the rate at which the period median incubation time changes. An important substantive result is that when a period median incubation period slowly increases to some leveling off value, say m(x _c ), then it is surprisingly early on that cohorts of infected individuals have a median incubation period very close to that ultimate value m(x _c ).