PNAS:构建出抵抗HIV的免疫细胞,有望治愈HIV感染

正在一项新的研究中,来自美国斯克里普斯研究所(TSRI)和中国上海科技大学的研究人员开发一种方法将抵抗人类免疫缺陷病毒(HIV)的抗体附着到免疫细胞表面上,从而产生抵抗HIV的细胞群体。在实验室条件下,他们的实验证实这些抵抗性细胞能够快速地替换被HIV感染的免疫细胞,从而有助潜在地治愈HIV感染者。相关研究结果在线发表在PNAS期刊上。在论文通信作者     

The HIV epidemic in China： history, response, and challenge

The first case of AIDS was reported in 1985 in China, but by the early 21st century, the government estimated that there were 840,000 citizens living with HIV/AIDS. The number is increasing rapidly. The major risk groups are injection drug users （IDUSs; 43%） and former plasma donors （27%）, but rates among heterosexual groups are rising rapidly. Sentinel surveillance was initiated in 1986, and now includes IDUs, men-who-have-sex-with-men, sexually transmitted disease clinic attendees, antenatal women, long-distance truck drivers, and sex workers. Although the government was slow to respond to the epidemic in the late 20th century, it has made a vigorous response in the early 21st century. Components of that response include implementation and evaluation of harm reduction programs for IDUs, education to increase knowledge and reduce stigma, treatment and social support for rural and poor HIV/AIDS patients, widespread testing, and increased funding for HIV/AIDS programs. International agencies have been generous in their support of the government initiatives. To successfully combat the epidemic, China needs to develop and train the necessary infrastructure to implement its intervention programs, particularly in the rural areas, to vigorously combat stigma and discrimination, support research especially in the universities and research institutions other than the China Centers for Disease Control, develop a system for efficient exchange of research and program information, and update legislation to reflect the current situation.     

siRNA, miRNA and HIV： promises and challenges

Small interfering RNA （siRNA） and microRNA （miRNA） are small RNAs of 18-25 nucleotides （nt） in length that play important roles in regulating gene expression. They are incorporated into an RNA-induced silencing complex （RISC） and serve as guides for silencing their corresponding target mRNAs based on complementary base-pairing. The promise of gene silencing has led many researchers to consider siRNA as an anti-viral tool. However, in long-term settings, many viruses appear to escape from this therapeutical strategy. An example of this may be seen in the case of human immunodeficiency virus type-1 （HIV-1） which is able to evade RNA silencing by either mutating the siRNA-targeted sequence or by encoding for a partial suppressor of RNAi （RNA interference）. On the other hand, because miRNA targeting does not require absolute complementarity of base-pairing, mutational escape by viruses from miRNA-specified silencing may be more difficult to achieve. In this review, we discuss stratagems used by various viruses to avoid the cells＇ antiviral si/mi-RNA defenses and notions of how viruses might control and regulate host cell genes by encoding viral miRNAs （vmiRNAs）.     

Estimated HIV Incidence in California, 2006–2009

Introduction

Accurate estimates of HIV incidence are crucial for prioritizing, targeting, and evaluating HIV prevention efforts. Using the methodology the CDC used to estimate national HIV incidence, we estimated HIV incidence in Los Angeles County (LAC), San Francisco (SF), and California’s remaining counties.

Methods

We estimated new HIV infections in 2006–2009 among adults and adolescents in LAC, SF and the remaining California counties using the Serologic Testing Algorithm for Recent Seroconversion (STARHS). STARHS methodology uses the BED HIV-1 capture enzyme immunoassay to determine recent HIV infections by testing remnant serum from persons newly diagnosed with HIV. A population-based incidence estimate is calculated using HIV testing data from newly diagnosed cases and imputing for persons unaware of their HIV infection.

Results

For years 2007–2009, respectively, we estimated new infections in LAC to be 2426 (95% CI 1871–2982), 1669 (CI 1309–2029) and 1898 (CI 1452–2344) (p<0.01); in SF for 2006–2009, 492 (CI 327–657), 490 (CI 335–646), 458 (CI 342–574) and 367 (CI 261–473) (p = 0.14); and in the remaining California counties in 2008–2009, 2526 (CI 1688–3364) and 2993 (CI 2141–3846) respectively. HIV infection rates among men who have sex with men (MSM) in LAC were 100 times higher than other risk populations; the SF MSM rate was 3 to 18 times higher than other demographic groups. In LAC, incidence rates among African-Americans were twice those of whites and Latinos; persons 40 years or older had lower rates of infection than younger persons.

Discussion

We report the first HIV incidence estimates for California, highlighting geographic disparities in HIV incidence and confirming national findings that MSM and African-Americans are disproportionately impacted by HIV. HIV incidence estimates can and should be used to target prevention efforts towards populations at highest risk of acquiring new HIV infections, focusing on geographic, racial and risk group disparities.     

HIV and HCV： from Co-infection to Epidemiology, Transmission, Pathogenesis, and Treatment

Human immunodeficiency virus (HIV) is the infectious agent causing acquired immu-nodeficiency 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.     

HIV Seroprevalence among Tuberculosis Patients in India, 2006–2007

Background

Little information exists regarding the burden of HIV among tuberculosis patients in India, and no population-based surveys have been previously reported. A community-based HIV prevalence survey was conducted among tuberculosis patients treated by the national tuberculosis control programme to evaluate the HIV prevalence among tuberculosis patients in India.

Methodology/Principal Findings

Fifteen districts (total population: 40.2 million) across 8 states were stratified by HIV prevalence in antenatal clinic HIV surveillance sites and randomly selected. From December 2006 to May 2007, remnant serum was collected from patients'' clinical specimens taken after 2 months of anti-tuberculosis treatment and subjected to anonymous, unlinked HIV testing. Specimens were obtained and successfully tested for 5,995 (73%) of 8,217 tuberculosis patients eligible for the survey. HIV prevalence ranged widely among the 15 surveyed districts, from 1% in Koch Bihar, West Bengal, to 13.8% in Guntur, Andhra Pradesh. HIV infection was 1.3 times more likely among male TB patients than among female patients. Relative to smear-positive tuberculosis, HIV infection was 1.4 times more likely among smear-negative patients and 1.3 times more likely among extrapulmonary patients. In 4 higher-HIV prevalence districts, which had been previously surveyed in 2005–2006, no significant change in HIV prevalence was detected.

Conclusions

The burden of HIV among tuberculosis patients varies widely in India. Programme efforts to implement comprehensive TB-HIV services should be targeted to areas with the highest HIV burden. Surveillance through routine reporting or special surveys is necessary to detect areas requiring intensification of TB-HIV collaborative activities.     

Adolescent sexuality and the HIV epidemic in Yaoundé, Cameroon

Adolescents are the focus of many interventions that aim to prevent HIV transmission. In order for these interventions to be effective, it is essential to understand adolescents' sexual behaviour. Using data collected in Yaoundé, Cameroon, in 1997, the study analysed risk exposure and HIV prevalence among 426 men and 510 women aged 15-24. Although risky behaviours seem to be more prevalent among young men, their HIV prevalence remains under 1%. In contrast, HIV prevalence is high among young women (7.5%), even those who report having had few sexual partners. Mixing patterns among sexual partners, and especially the age difference between men and women, do not seem to be sufficient to explain the large male-female discrepancy in HIV prevalence that is evident in these data. The results are therefore probably due to a greater susceptibility to infection of young women than men. This study highlights the necessity of reinforcing prevention campaigns among youth and fighting the obstacles that continue to impede the use of condoms in this population.     

HIV Transmission in a State Prison System, 1988–2005

Introduction

HIV prevalence among state prison inmates in the United States is more than five times higher than among nonincarcerated persons, but HIV transmission within U.S. prisons is sparsely documented. We investigated 88 HIV seroconversions reported from 1988–2005 among male Georgia prison inmates.

Methods

We analyzed medical and administrative data to describe seroconverters'' HIV testing histories and performed a case-crossover analysis of their risks before and after HIV diagnosis. We sequenced the gag, env, and pol genes of seroconverters'' HIV strains to identify genetically-related HIV transmission clusters and antiretroviral resistance. We combined risk, genetic, and administrative data to describe prison HIV transmission networks.

Results

Forty-one (47%) seroconverters were diagnosed with HIV from July 2003–June 2005 when voluntary annual testing was offered. Seroconverters were less likely to report sex (OR [odds ratio] = 0.02, 95% CI [confidence interval]: 0–0.10) and tattooing (OR = 0.03, 95% CI: <0.01–0.20) in prison after their HIV diagnosis than before. Of 67 seroconverters'' specimens tested, 33 (49%) fell into one of 10 genetically-related clusters; of these, 25 (76%) reported sex in prison before their HIV diagnosis. The HIV strains of 8 (61%) of 13 antiretroviral-naïve and 21 (40%) of 52 antiretroviral-treated seroconverters were antiretroviral-resistant.

Discussion

Half of all HIV seroconversions were identified when routine voluntary testing was offered, and seroconverters reduced their risks following their diagnosis. Most genetically-related seroconverters reported sex in prison, suggesting HIV transmission through sexual networks. Resistance testing before initiating antiretroviral therapy is important for newly-diagnosed inmates.     

Late HIV Diagnosis and Determinants of Progression to AIDS or Death after HIV Diagnosis among Injection Drug Users, 33 US States, 1996–2004

Background

The timeliness of HIV diagnosis and the initiation of antiretroviral treatment are major determinants of survival for HIV-infected people. Injection drug users (IDUs) are less likely than persons in other transmission categories to seek early HIV counseling, testing, and treatment. Our objective was to estimate the proportion of IDUs with a late HIV diagnosis (AIDS diagnosis within 12 months of HIV diagnosis) and determine the factors associated with disease progression after HIV diagnosis.

Methodology/Principal Findings

Using data from 33 states with confidential name-based HIV reporting, we determined the proportion of IDUs aged ≥13 years who received a late HIV diagnosis during 1996–2004. We used standardized Kaplan-Meier survival methods to determine differences in time of progression from HIV to AIDS and death, by race/ethnicity, sex, age group, CD4⁺ T-cell count, metropolitan residence, and diagnosis year. We compared the survival of IDUs with the survival of persons in other transmission categories. During 1996–2004, 42.2% (11,635) of 27,572 IDUs were diagnosed late. For IDUs, the risk for progression from HIV to AIDS 3 years after HIV diagnosis was greater for nonwhites, males and older persons. Three-year survival after HIV diagnosis was lower for IDU males (87.3%, 95% confidence interval (CI), 87.1–87.4) compared with males exposed through male-to-male sexual contact (91.6%, 95% CI, 91.6–91.7) and males exposed through high-risk heterosexual contact (HRHC) (91.9%, 95% CI, 91.8–91.9). Survival was also lower for IDU females (89.5%, 95% CI, 89.4–89.6) compared to HRHC females (93.3%, 95% CI, 93.3–93.4).

Conclusions/Significance

A substantial proportion of IDUs living with HIV received their HIV diagnosis late. To improve survival of IDUs, HIV prevention efforts must ensure early access to HIV testing and care, as well as encourage adherence to antiretroviral treatment to slow disease progression.     

狡猾的HIV

世界与我国艾滋病概况艾滋病病毒无疑是人类遇到的最强大的对手之一。到2004年全球累积艾滋病病毒感染者人数为7000多万。其中已经有3000多万人死亡,目前存活的感染者大约为3800万～4200万。由于大多数发达国家重视得比较早,采用宣传教育等干预措施及辅助药物治疗等手段,艾滋病在发达国家的流行势头比较低,而发展中国家则集中了绝大多数艾滋病病毒感染者。美国目前感染者大约为90万,俄罗斯大约为100万,而非洲大约有2000多万,印度约为500多万。     

HIV疫苗研究进展

自从1983年发现人类免疫缺陷病毒(Human immunodeficiency virus,HIV)以来,HIV一直以惊人的速度在全球蔓延,感染HIV的人数也日益增多.到目前为止,因患艾滋病死亡的人数已达到2500万,到2010年这一数字可能会突破8000万,因此研究预防和治疗艾滋病的药物也正日益迫切地摆在人们面前.     

静脉输注免疫球蛋白中病毒(HIV,HBV,VSV和SV)的消除

<正> 人免疫球蛋白是被人们接受的一种最安全的生物制品。最近,美国疾病控制中心和食品药物管理局报告,用乙醇分离法所得的免疫球蛋白制品没有传播AIDS(HIV)的危险,因为提制过程中病毒不稳定。然而,免疫球蛋白制品,特别是静脉注射免疫球蛋白(IVIG)制品,传播非甲非乙(NANB)型肝炎已被注意到。 蛋白酶降解(胃蛋白酶,溶纤酶),化学改制(还原和烷化,磺化),离子交换处理,聚乙二醇(PEG)分离和与温和胃蛋白酶消化结合的pH4处理等法已被应用于制取IVIG制品。这些制备方法中,PEG分离     

HIV疫苗研究进展

自从1983年发现人类免疫缺陷病毒(Human immunodeficiency virus,HIV)以来,HIV一直以惊人的速度在全球蔓延,感染HIV的人数也日益增多。到目前为止,因患艾滋病死亡的人数已达到2500万,到2010年这一数字可能会突破8000万,因此研究预防和治疗艾滋病的药物也正日益迫切地摆在人们面     

Disparities in HIV Screening among Pregnant Women – El Salvador, 2011

Objectives

To provide an accurate estimate of antenatal HIV screening and its determinants among pregnant women in El Salvador and help local authorities make informed decisions for targeted interventions around mother-to-child transmission (MTCT).

Methods

A total sample of 4,730 women aged 15-49 years were interviewed from a random sample of 3,625 households. We collected data on antenatal care services, including HIV screening, during last pregnancy through a pre-established questionnaire. We used a backward elimination multivariate logistic regression model to examine the association between HIV screening and sociodemographic and health care-related factors.

Results

A total of 2,929 women were included in this analysis. About 98% of participants reported receiving antenatal care, but only 83% of these reported being screened for HIV. Screening was lower in geographic areas with higher HIV incidence and ranged from 69.1% among women who were not seen by a physician during antenatal care, to 93.7% among those who attended or completed college. Odds for screening varied also by age, employment status, household economic expenditure, possession of health care coverage, health care settings, and number of antenatal care visits.

Conclusions

We found disparities in HIV screening during antenatal care at the environmental, social, demographic, and structural levels despite a high uptake of antenatal care in El Salvador. Our findings should urge health authorities to tailor and enhance current strategies implemented to eliminate MTCT and reduce inequities and HIV morbidity among women in El Salvador.     

“One People,One Blood”: Public Health,Political Violence,and HIV in an Ethiopian-Israeli Setting

Between 1984 and 1996, public health authorities in Israel maintained a secret policy of discarding blood donations made by Ethiopian-Israeli citizens and immigrants. Officials later attempted to justify this policy on the grounds that immigrants from Ethiopia were subject to high rates of infectious disease (especially HIV). In 1996, this led to an explosive and violent confrontation between Ethiopian-Israeli protestors and agents of the state, including police and public health authorities. This essay explores the cultural and political context of that confrontation, including the discourse of political violence which it occasioned. The conflict between Ethiopian-Israelis and the state was located within a wider set of political contexts, including the Israeli-Palestinian conflict, which was linked to it through a shared trope of spilled blood common to both. Cultural analyses which ignore this dynamic political context are in danger of seriously misrepresenting the meaning of the Blood Affair to its participants. At the same time, this essay also engages a critical analysis of the public health policies which led to the crisis. Public health and nationalist discourse reinforced one another at the expense of Ethiopian immigrants in general, and so-called Feres Mura Ethiopians in particular.