The Progress on the Studies of HIV/AIDS Vaccine

人类控制HIV感染长远的目标是发展安全、有效、廉价的HIV AIDS疫苗。但经 2 0多年的努力 ,人类探索HIV AIDS疫苗之路仍在继续。分析了疫苗研究的复杂性和发展HIV AIDS疫苗过程中所面临的挑战 ,并对发展HIV AIDS疫苗的可能性从实验和临床方面进行了阐述。同时结合HIV感染的免疫应答原理对现有的各种HIV AIDS疫苗研究策略作一综述 ,并根据以往HIV AIDS疫苗研究的经验和教训提出未来疫苗的发展思路及展望。     

Mathematical Study of a Staged-Progression HIV Model with Imperfect Vaccine

A staged-progression HIV model is formulated and used to investigate the potential impact of an imperfect vaccine. The vaccine is assumed to have several desirable characteristics such as protecting against infection, causing bypass of the primary infection stage, and offering a disease-altering therapeutic effect (so that the vaccine induces reversal from the full blown AIDS stage to the asymptomatic stage). The model, which incorporates HIV transmission by individuals in the AIDS stage, is rigorously analyzed to gain insight into its qualitative features. Using a comparison theorem, the model with mass action incidence is shown to have a globally-asymptotically stable disease-free equilibrium whenever a certain threshold, known as the vaccination reproduction number, is less than unity. Furthermore, the model with mass action incidence has a unique endemic equilibrium whenever this threshold exceeds unity. Using the Li-Muldowney techniques for a reduced version of the mass action model, this endemic equilibrium is shown to be globally-asymptotically stable, under certain parameter restrictions. The epidemiological implications of these results are that an imperfect vaccine can eliminate HIV in a given community if it can reduce the reproduction number to a value less than unity, but the disease will persist otherwise. Furthermore, a future HIV vaccine that induces the bypass of primary infection amongst vaccinated individuals (who become infected) would decrease HIV prevalence, whereas a vaccine with therapeutic effect could have a positive or negative effect at the community level.     

ACCESS TO TREATMENT IN HIV PREVENTION TRIALS: PERSPECTIVES FROM A SOUTH AFRICAN COMMUNITY

Access to treatment, in HIV vaccine trials (HVTs), remains ethically controversial. In most prevention trials, including in South Africa, participants who seroconvert are referred to publicly funded programmes for treatment. This strategy is problematic when there is inadequate and uneven access to public sector antiretroviral therapy (ART) and support resources. The responsibilities, if any, of researchers, sponsors and public health authorities involved in HVTs has been hotly debated among academics, scholars, representatives of international organizations and sponsors. However, there is little published on community perceptions. Recent guidance asserts that communities should make inputs into treatment and care decisions. This qualitative study explored a South African community's perceptions of who should provide what to HVT participants as well as how and why this should be done. Twenty‐nine adults working at or attending five primary health care clinics in two rural areas in KwaZulu‐Natal participated in in‐depth interviews. Respondents expressed that researchers should ‘help participants to access’ treatment and care ‘because they are in a position to do so’ and ‘are in a relationship with’ trial participants. Respondents suggested that researchers could help by ‘facilitating referral’ until such time that participants can access care and treatment on their own. We highlight a series of implications for researchers in HVTs, including their need to be aware of prospective participants' considerable trust in and respect for researchers, the responsibility that this places on them, and the need for clear communication with communities so as not to erode community trust.     

AIDS猕猴模型在HIV疫苗研究中的应用

对HIV疫苗的研究一直是国际上艾滋病方面研究的热点和难点。动物模型则为疫苗研究必不可缺少的重要工具,缺乏合适的动物模型很大程度上制约了AIDS疫苗的研究。目前在国际上SIV或SHIV感染的猕猴模型为最常用的AIDS研究模型,受猕猴背景及病毒特性等多种因素的影响,使得以上两种模型在HIV疫苗研究中仍存在一定的局限性。为了更好地发挥猕猴模型在HIV疫苗研究中的巨大潜力,开发理想的AIDS猕猴模型已成为目前HIV疫苗研究的首要任务。本文简要介绍了AIDS疫苗的研发策略、研发概况以及SIV/SHIV猕猴模型在HIV疫苗中的应用,并对其中存在的问题及其应用前景进行了探讨。     

静脉注射吸毒人群HIV／AIDS数学模型分析

建立了四川省西昌市静脉注射吸毒人群HIV／AIDS传播的数学模型,给出了模型的理论分析和数值模拟结果．通过必要的分析,给出了各类平衡点的存在性和稳定性,系统的一致持续生存,以及基本再生数的数学表达式和具体取值．揭示了该静注人群中的HIV／AIDS有进一步蔓延的趋势,但如果采取适当的干预措施,该静注人群中HIV／AIDS流行可得到有效的控制．     

传播的人群生态动力学模型

研究了HIV传播的动力学模型,描述了流行性传染病区域的人群传播规律,特别是利用摄动理论对艾滋病的传播动力学非线性方程作了定量、定性的讨论。     

猕猴模型在HIV疫苗研究中的应用

对HIV疫苗的研究一直是国际上艾滋病方面研究的热点和难点。动物模型则为疫苗研究必不可缺少的重要工具,缺乏合适的动物模型很大程度上制约了AIDS疫苗的研究。目前在国际上SIV或SHIV感染的猕猴模型为最常用的AIDS研究模型,受猕猴背景及病毒特性等多种因素的影响,使得以上两种模型在HIV疫苗研究中仍存在一定的局限性。为了更好地发挥猕猴模型在HIV疫苗研究中的巨大潜力,开发理想的AIDS猕猴模型已成为目前HIV疫苗研究的首要任务。本文简要介绍了AIDS疫苗的研发策略、研发概况以及SIV/SHIV猕猴模型在HIV疫苗中的应用,并对其中存在的问题及其应用前景进行了探讨。     

Jet Riemann-Lagrange几何分析静脉注射吸毒人员HIV/AIDS模型(英文)

介绍并应用Jet Riemann-Lagrange几何,通过解一类Kaldor流方程去分析静脉注射吸毒人员HIV/AIDS模型,我们得到几个有意义的结果.     

Effects of education, vaccination and treatment on HIV transmission in homosexuals with genetic heterogeneity

Genetic studies report the existence of a mutant allele Delta32 of CCR5 chemokine receptor gene at high allele frequencies (approximately 10%) in Caucasian populations. The presence of this allele is believed to provide partial or full resistance to HIV. In this study, we look at the impact of education, temporarily effective vaccines and therapies on the dynamics of HIV in homosexually active populations. In our model, it is assumed that some individuals possess one or two mutant alleles (like Delta32 of CCR5) that prevent the successful invasion or replication of HIV. Our model therefore differentiates by genetic and epidemiological status and naturally ignores the reproduction process. Furthermore, HIV infected individuals are classified as rapid, normal or slow progressors. In this complex setting, the basic reproductive number R0 is derived in various situations. The separate or combined effects of therapies, education, vaccines, and genetic resistance are analyzed. Our results support the conclusions of Hsu Schmitz that some integrated intervention strategies are far superior to those based on a single approach. However, treatment programs may have effects which counteract each other, as may genetic resistance.     

Antiretroviral therapy and demand for HIV testing: Evidence from Zambia

This paper examines the effects of antiretroviral therapy (ART) on demand for HIV testing and of ART-induced testing on demand for risky sexual behavior. I provide a model of sexual behavior decision-making under uncertainty and estimate the structural parameters of the model using nationally representative survey data from Zambia on HIV testing decisions before and after the introduction of ART. The empirical results indicate that although the introduction of ART appears to have increased HIV testing rates by upwards of 50 percent, the ART allocation process may have limited the prevention benefit of ART-induced testing. Simulation results show that eliminating this prevention inefficiency while holding the supply of ART constant would increase the prevention impact of ART-induced testing more than four-fold. More generally, the analysis indicates that existing studies which examine “universal” testing or quasi-experimental testing programs understate the efficacy of standard voluntary counseling and testing programs.     

Estimating vaccine effects on transmission of infection from household outbreak data

This article is concerned with a method for making inferences about various measures of vaccine efficacy. These measures describe reductions in susceptibility and in the potential to transmit infection. The method uses data on household outbreaks; it is based on a model that allows for transmission of infection both from within a household and from the outside. The use of household data is motivated by the hope that these are informative about vaccine-induced reduction of the potential to transmit infection, as household outbreaks contain some information about the possible source of infection. For illustration, the method is applied to observed data on household outbreaks of smallpox. These data are of the form needed and the number of households is of a size that can be managed in a vaccine trial. It is found that vaccine effects, such as the mean reduction in susceptibility and the mean reduction in the potential to infect others, per infectious contact, can be estimated with precision. However, a more specific parameter reflecting the reduction in infectivity for individuals partially responding to vaccination is not estimated well in the application. An evaluation of the method using artificial data shows that this parameter can be estimated with greater precision when we have outbreak data on a large number of small households.     

Mother-to-child transmission of HIV in Botswana: an ethical perspective on mandatory testing

Mother-to-child transmission (MTCT) of HIV represents a particularly dramatic aspect of the HIV epidemic with an estimated 600,000 newborns infected yearly, 90% of them living in sub-Saharan Africa. Since the beginning of the HIV epidemic, an estimated 5.1 million children worldwide have been infected with HIV. MTCT is responsible for 90% of these infections. Two-thirds of the MTCT are believed to occur during pregnancy and delivery, and about one-third through breastfeeding. As the number of women of child bearing age infected with HIV rises, so does the number of infected children. It is apparent that voluntary testing in Botswana has made some valuable inroads in decreasing perinatal HIV transmission, but the statistics showing the increased rate of HIV infection among women 15-24 years of age are not very promising. After reviewing all the pertinent scientific data it is clear that mandatory HIV testing of all pregnant women in conjunction with the implementation of a full package of interventions would save thousands of lives -- mothers, newborns and others who could be infected as a result of these women not being aware of their HIV status. If the protection and preservation of human life is a priority in Botswana, then it is time to allow for mandatory HIV testing of all pregnant women, before it is too late for those who are the most vulnerable. To do less would be medically inappropriate and ethically irresponsible.     

一类总人口在变化的HIV/AIDS传播的动力学模型

建立了HIV/AIDS传播的具有常数移民和指数出生的SI型模型,其中易感人群按照有无不良行为被分为两组.分别对具双线性传染率和具标准传染率的模型讨论了其无病平衡点和地方病平衡点的存在性,并就某些重要的特殊情况进行了平衡点和稳定性的分析.     

Modeling the Population Level Effects of an HIV-1 Vaccine in an Era of Highly Active Antiretroviral Therapy

First generation HIV vaccines may have limited ability to prevent infection. Instead, they may delay the onset of AIDS or reduce the infectiousness of vaccinated individuals who become infected. To assess the population level effects of such a vaccine, we formulate a deterministic model for the spread of HIV in a homosexual population in which the use of highly active antiretroviral therapy (HAART) to treat HIV infection is incorporated. The basic reproduction number R ₀ is obtained under this model. We then expand the model to include the potential effects of a prophylactic HIV vaccine. The reproduction number R _f is derived for a population in which a fraction f of susceptible individuals is vaccinated and continues to benefit from vaccination. We define f ^* as the minimum vaccination fraction for which R _f ≤1 and describe situations in which it equals the critical vaccination fraction necessary to eliminate disease. When R ₀ is large or an HIV vaccine is only partially effective, the critical vaccination fraction may exceed one. HIV vaccination, however, may still reduce the prevalence of disease if the reduction in infectiousness is at least as great as the reduction in the rate of disease progression. In particular, a vaccine that reduces infectiousness during acute infection may have an important public health impact especially if coupled with counseling to reduce risky behavior.     

HIV/AIDS患者CD4水平对甲状腺功能影响的比较研究

目的观察HIV/AIDS患者甲状腺功能的变化,了解HIV对内分泌的影响。方法检测168例HIV/AIDS患者TT4、TT3、FT4、FT3、TSH,并分析不同CD4水平对甲状腺功能影响。结果HIV/AIDS患者甲状腺功能可保持正常,但低CD4组的FT3、TSH水平低于高CD4组。结论HIV/AIDS患者甲状腺功能可保持正常,但HIV感染不同阶段会对内分泌系统有一定影响。HIV感染对甲状腺影响的具体机制尚不十分清楚,利用动物模型进行进一步研究非常必要。     

HIV/AIDS dynamics: Impact of economic classes with transmission from poor clinical settings

We formulate and analyze a nonlinear deterministic HIV/AIDS model with two social classes, namely the poor and the rich including transmission from poor clinical settings with a randomly variable population. Four sub-models are derived from the full model, the disease threshold parameters are computed, and it is shown that the disease will die down if these initial threshold parameters are less than unity and will persist if they exceed unity. The impact of economic classes (along with transmission from poor/inadequate clinical settings) on the disease dynamics is assessed, and we observe that even with a single sexual partner, the reproduction number is slightly greater than unity, implying that the additional transmission can only be from clinical settings. Stability (local and global) of both the disease-free and endemic equilibria are then investigated using various techniques of dynamical systems such as Centre Manifold theory and Lyapunov's second method. Analysis on the bifurcation parameter is carried out to assess the impact of related HIV transmission from poor clinical settings. We estimate some of the model parameter values and numerical simulations of the model are represented graphically. Our results show that the prevalence of HIV in rich communities seems to be higher than that in the poor, but the disease develops faster in impoverished individuals.     

Estimating treatment effects in studies of perinatal transmission of HIV

Fetal loss often precludes the ascertainment of infection status in studies of perinatal transmission of HIV. The standard analysis based on liveborn babies can result in biased estimation and invalid inference in the presence of fetal death. This paper focuses on the problem of estimating treatment effects for mother-to-child transmission when infection status is unknown for some babies. Minimal data structures for identifiability of parameters are given. Methods using full likelihood and the inverse probability of selection-weighted estimators are suggested. Simulation studies are used to show that these estimators perform well in finite samples. Methods are applied to the data from a clinical trial in Dar es Salaam, Tanzania. To validly estimate the treatment effect using likelihood methods, investigators should make sure that the design includes a mini-study among uninfected mothers and that efforts are made to ascertain the infection status of as many babies lost as possible. The inverse probability weighting methods need precise estimation of the probability of observing infection status. We can further apply our methodology to the study of other vertically transmissible infections which are potentially fatal pre- and perinatally.     

HIV感染者/AIDS病人高迁移率族蛋白1的表达及其临床意义

通过检测74例处于不同病期的HIV感染者/AIDS患者和10例健康对照者PBMCs中HMGB1 mRNA的表达水平及其外周血浆HMGB1、TNF-a和IL-2水平,比较各组之间表达水平的差异及其与CD4＋T淋巴细胞的关系.发现HMGB1 mRNA的表达水平及血浆HMGB1含量在AIDS病人组明显高于感染者组和正常对照组（P〈0.05）;AIDS患者经HAART治疗后疗效差组HMGB1 mRNA的表达水平及血浆HMGB1含量也明显高于疗效好组（P〈0.05）;而经HAART治疗后效果好且免疫功能恢复的患者HMGB1 mRNA的表达及血浆HMGB1含量均较治疗前明显下降（P〈0.05）;当CD4＋T细胞数低于200/μL时,血浆HMGB1含量以及PBMCs中HMGB1 mRNA表达水平与CD4＋T细胞数呈负相关.显示HMGB1在HIV/AIDS发病及病情进展过程中可能起重要作用,HMGB1血浆含量及PBMCs中HMGB1 mRNA的表达水平高低与HIV/AIDS患者病情轻重密切相关.     

Ethical and regulatory issues surrounding African traditional medicine in the context of HIV/AIDS

It has been estimated that more than 80% of people in Africa use traditional medicine (TM). With the HIV/AIDS epidemic claiming many lives in Africa, the majority of people affected rely on TM mainly because it is relatively affordable and available to the poor populations who cannot afford orthodox medicine. Whereas orthodox medicine is practiced under stringent regulations and ethical guidelines emanating from The Nuremburg Code, African TM seems to be exempt from such scrutiny. Although recently there have been calls for TM to be incorporated into the health care system, less emphasis has been placed on ethical and regulatory issues. In this paper, an overview of the use of African TM in general, and for HIV/AIDS in particular, is given, followed by a look at: (i) the relative laxity in the application of ethical standards and regulatory requirements with regards to TM; (ii) the importance of research on TM in order to improve and demystify its therapeutic qualities; (iii) the need to tailor-make intellectual property laws to protect traditional knowledge and biodiversity. A framework of partnerships involving traditional healers' associations, scientists, policy makers, patients, community leaders, members of the communities, and funding organizations is suggested as a possible method to tackle these issues. It is hoped that this paper will stimulate objective and constructive debate that could enhance the protection of patients' welfare.