43 例HIV/AIDS 患者抗病毒治疗情况分析

目的:研究来第四军医大学唐都医院传染科就诊的人类免疫缺陷病毒/艾滋病(Human immunodeficiency virus/Acquired immuno deficiency syndrome,HIV/AIDS)患者感染状况及抗病毒治疗效果。方法:采用前瞻性随访研究的方法,收集来我院就诊的HIV/AIDS患者的基本信息,并对其实验室检查结果、治疗方案及后续随访结果进行分析。结果:随访观察的43例HIV/AIDS患者治疗前平均基线CD4+T淋巴细胞计数为(330.74±176.35)cells/μL,CD8+T淋巴细胞计数为(1177.80±321.49)cells/μL,CD4+,CD8+T淋巴细胞比值为0.30±0.19;治疗一年后平均CD4+T淋巴细胞计数为(482.74±217.77)cells/μL,CD8+T淋巴细胞计数为(861.53±282.85)cells/μL,CD4+,CD8+T淋巴细胞比值为0.59±0.28。所有患者治疗一年后血浆HIV-RNA载量均达到检测限以下(500copies/m L)。结论:规范的抗病毒治疗对于改善HIV/AIDS患者预后至关重要;基线CD4+T淋巴细胞计数越低,抗病毒治疗效果越差。     

广西靖西县1997—2012年HIV/AIDS流行病学特征分析

目的了解广西靖西县1997—2012年HIV/AIDS流行病学状况,分析流行趋势,为制定艾滋病防治措施提供科学依据。方法采用描述流行病学分析方法,对靖西县1997—2012年艾滋病疫情监测资料进行分析。结果靖西县1997—2012年累计报告HIV/AIDS 147例,其中HIV感染者60例,AIDS病人47例,死亡40例;男性95例,女性52例,男女性别比为1.83∶1;以20~49岁青壮年为主,这些年龄组发病率为3.24/10万;传播途径以性接触传播为主,占90.48%;其次为静脉注射毒品传播,占6.80%。结论靖西县艾滋病流行近年呈明显上升趋势,艾滋病已经从高危人群向普通人群扩散传播,性接触传播已经成为艾滋病的主要传播途径,应加强对高危人群性行为的干预,遏制艾滋病传播蔓延。     

HIV/AIDS in Asia： The Shape of Epidemics and Their Molecular Epidemiology

The Asia-Pacific region is a home to 60% of the population in the world and to approximately one quarter of people with HIV/AIDS. Close to a million of people has been infected and a half million people died of AIDS annually in Asia,becoming the second largest epicenter of global AIDS epidemic. Molecular epidemiology has been useful tool to track a course of HIV spread. In-depth knowledge from the studies on molecular epidemiology elucidates the dynamics of HIV spread and the interrelationship of epidemics in the different regions in Asia.     

2006—2015年隆安县新报告HIV/AIDS流行病学特征分析

目的分析2006—2015年隆安县新报告HIV/AIDS病例流行病学特征,为艾滋病防控工作提供依据。方法采用描述流行病学方法,分析2006—2015年隆安县新报告HIV/AIDS病例信息资料。结果 2006—2015年新报告HIV/AIDS病例共计1 066例,其中HIV感染者594例,AIDS患者472例,死亡344例。男性占73.64%;职业以农民为主占88.56%;年龄主要集中在≥50岁人群,占72.89%。传播途径以性传播为主,性传播共1 028例,占96.43%。结论 2006—2015年隆安县HIV/AIDS病例主要集中在50岁以上的农民,性传播为主要传播途径。     

接受高效抗逆转录病毒治疗的 HIV/AIDS患者血浆IL 35及其受体水平的动态变化

目的 检测接受高效抗逆转录病毒治疗(HAART)的人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者血浆中白介素(IL) 35及其受体IL12rβ2、糖蛋白130(gp130)水平的动态变化及意义。 方法 选择我院2017年1月至2018年3月收治的41例HIV感染者/AIDS患者为研究对象,选择45例同期健康体检者为对照组。分别采集HIV/AIDS患者接受HAART药物0、1、6、12个月时的外周静脉血,检测血浆中的IL 35及其受体IL12rβ2、gp130水平,同时检测血浆HIV 1 RNA载量,分析IL 35与IL12rβ2、gp130、HIV 1 RNA以及IL12rβ2、gp130与HIV 1 RNA病毒载量的相关性。 结果 与对照组相比,接受HAART(0、1、6个月)时患者血浆中IL 35、IL12rβ2、gp130水平降低(均P结论 接受HAART的HIV/AIDS患者血浆IL 35及其受体IL12rβ2、gp130水平随着接受HAART时间的延长而逐渐升高,且与HIV 1 RNA载量关系密切。血浆IL 35及其受体IL12rβ2、gp130在抗HIV感染中可能发挥一定作用。     

Injection drug use and HIV/AIDS transmission in China

After nearly three decades of being virtually drug free, use of heroin and other illicit drugs has re-emerged in China as a major public health problem. One result is that drug abuse, particularly heroin injection, has come to play a predominant role in fueling China＇s AIDS epidemic. The first outbreak of HIV among China＇s IDUs was reported in the border area of Yunnan province between China and Myanmar where drug trafficking is heavy. Since then drug-related HIV has spread to all 31 provinces, autonomous regions and municipalities. This paper provides an overview to HIV/AIDS transmission through injection drug use in China. It begins with a brief history of the illicit drug trade in China, followed by a discussion of the emergence of drug related AIDS, and a profile of drug users and their sexual partners who have contracted the virus or who are vulnerable to infection. It ends by summarizing three national strategies being used by China to address both drug use and AIDS as major health threats.     

Challenges and Opportunities： the Expanded Government-led HIV/AIDS Programs in China

HIV/AIDS has posed an increasingly serious issue in China. In recent years,Chinese government has taken further intensified efforts to combat HIV/AIDS with high-level political commitment,supportive policy development,increased financial allocation,large-scale of government-led initiatives,expanded international cooperation and great involvement of non-governmental organizations. Meanwhile gaps and challenges coexist impacting the implementation and the results of national HIV/AIDS programs. Thus,further government efforts are needed to improve and tailor the actions to meet the requirement of HIV/AIDS control in China.     

30例流行性乙型脑炎流行病学及临床特征分析

回顾性分析我中心感染科确诊的30 例流行性乙型脑炎住院患者临床资料, 分析流行性乙型脑炎的流行病学特征和临床特点, 提高临床医师对该病的诊疗水平。结果显示, 各年龄组人群均可发病, 但儿童发病率较高。夏、秋季多发, 集中在7 ― 9 月份, 占全年病例的90% 以上。所有患者均有发热、颅内高压症状, 21 例( 70. 0% ) 有意识障碍, 14 例( 46. 7% ) 出现抽搐, 8 例( 26. 7% ) 出现呼吸衰竭。脑膜刺激征阳性20 例( 66. 7% ) , 病理征阳性18 例( 60. 0% ) 。脑脊液检查蛋白增高, 白细胞计数均在300 ×10⁶ /L 以下, 糖和氯化物基本正常。脑脊液乙型脑炎特异性IgM抗体阳性率为100% 。23 例治愈或好转出院( 76. 7% ) , 4 例( 13. 3% )病情加重而自愿出院,3 例( 10. 0% ) 治疗无效死亡。乙型脑炎仍是夏、秋季常见的中枢神经系统感染性疾病,流行区的儿童和青少年是易感人群。血液和脑脊液乙型脑炎特异性IgM抗体检查可明确诊断, 对症支持治疗是治疗的关键。     

横县2008—2014年新报告及晚发现HIV/AIDS流行病学特征

目的分析2008—2014年横县新报告及晚发现HIV/AIDS病例的流行病学特征,旨在了解该县HIV/AIDS防治现状,为今后科学防治艾滋病提供理论依据。方法采用描述流行病学方法,对2008—2014年横县新报告及晚发现HIV/AIDS病例进行流行病学分析。结果 2008—2014年横县新报告HIV/AIDS病例共计3 011例,且每年均有新报告病例,新报告病例数和死亡数均呈先上升后稳定趋势;新报告病例数位居前3位的地区为百合镇(20.26%)、横州镇(12.69%)和云表镇(10.03%);男性高于女性,男、女性别比为2.87∶1;以≥50岁(57.12%)和25~<50岁(38.82%)的人群为主,且25~<50岁人群呈逐年下降趋势,≥50岁人群呈逐年上升趋势;职业以农民为主,占84.59%。2008—2014年晚发现比例呈先上升后稳定趋势,差异均有统计学意义(P<0.05);人群分布男性高于女性;≥50岁人群高于其他年龄组人群。结论 2008—2014年横县新报告HIV/AIDS的发病率及其晚发现比例均呈先上升后稳定趋势,晚发现比例高于全国水平。     

艾滋病患者CD4+T细胞基线值与长期高效抗逆转录病毒治疗免疫重建效果的相关性研究

目的:探讨艾滋病患者CD4~+T细胞基线值与长期高效抗逆转录病毒治疗免疫重建效果的相关性。方法:挑选进行长期高效抗逆转录病毒治疗的艾滋病患者120例,并按CD4~+T淋巴细胞计数基线值分为A组(≤100·μL~(-1))共66例和B组(100·μL~(-1))共54例,对两组患者的CD4~+T以及CD8~+T淋巴细胞计数变化进行定期观察以及统计分析。结果:经抗病毒治疗后,B组患者各个阶段的CD4~+T淋巴细胞计数回升水平明显优于A组,差异具有统计学意义(均P0.001);9个月内,B组CD4~+T淋巴细胞计数回升明显优于A组,差异具有统计学意义(P=0.003,P0.001,P=0.002);12个月后,两组患者CD4~+T淋巴细胞计数增幅并无明显差异,无统计学意义(P=0.061,P=0.219,P=0.738);经抗病毒治疗后,两组组患者各个阶段的CD8~+T淋巴细胞计数回升水平均无明显差异,无统计学意义(P=0.447,P=0.681,P=0.639,P=0.464,P=0.886,P=0.712)。结论:艾滋病患者免疫重建受CD4~+T淋巴细胞基线高低的直接影响,而CD8~+T淋巴细胞计数的回升相对较为缓慢。     

Evaluation of Epstein-Barr Virus Salivary Shedding in HIV/AIDS Patients and HAART Use: A Retrospective Cohort Study

Little data is available on the evaluation of the occurrence rates of Epstein-Barr virus(EBV) in saliva and relationship with highly active antiretroviral therapy(HAART) use in HIV/AIDS patients in China. We conducted a retrospective cohort study of EBV serological tests for HIV/AIDS patients who were treated in the hospitals for infectious diseases in Wuxi and Shanghai, China from May 2016 to April 2017. The EBV-seropositive samples were identified by ELISA. EBV-specific primers and probes were used for the quantitative detection of viral DNA from saliva via quantitative real-time polymerase chain reaction. CD4 cell counts of the HIV/AIDS patients were detected by a flow cytometry. A total of 372 HIV/AIDS patients were ultimately selected and categorized for this retrospective cohort study. For EBV IgG and IgM, the HIV/AIDS HAART use(H) and non-HAART use(NH) groups had significantly higher seropositive rates than the HIV-negative control group. The HIV/AIDS(NH) group had the highest seropositive rate(IgG, 94.27%; IgM, 68.98%) and the highest incidence of EBV reactivation or infection. For salivary EBV DNA-positive rates and quantities, the HIV/AIDS(H)(73.69%) and the HIV/AIDS(NH)(100%) groups showed significantly higher values than the HIV-negative control group(35.79%,[ twofold). Further, the salivary EBV DNA-negative population had significantly higher CD4 cell counts than the EBV DNA-positive population in the HIV/AIDS(H) group and the HIV/AIDS(NH) groups. Thus, HAART use is beneficial in decreasing the EBV salivary shedding in HIV/AIDS patients and indirectly decreases EBV transmission risk.     

35例艾滋病患者高效联合抗反转录病毒治疗后血脂代谢及颈动脉中层厚度的研究

目的 研究获得性免疫缺陷综合征[艾滋病(AIDS)]患者经高效联合抗反转录病毒治疗(Highly active antiretroviral therapy,HAART)后所导致的血脂及心血管方面的副作用.方法 回顾性调查在我院治疗并门诊随访的35例男性人类免疫缺陷病毒1型(HIV-1)感染者,均接受相同HAART方案(d4T+3TC+EFV),平均年龄为38.5±15.3岁,平均抗病毒时间为24.6±17.5月,抗病毒治疗前平均CD4计数为69.5±34.6个/μl,比较抗病毒治疗前、后患者空腹血脂变化(包括三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白)并进行统计学分析.其中22例在本系列研究最后1次血脂测定时接受高分辨B超测定颈动脉内膜中层厚度(IMT)测定.结果 35例AIDS患者HAART前、后血三酰甘油分别为1.44±0.35mmol/L和2.07±0.54mmol/L(P ＜0.001);总胆固醇分别为4.96±0.46mmol/L和6.15±0.83mmol/L(P＜0.001);血高密度脂蛋白分别为1.06±0.01mmol/L和 1.04±0.01mmol/L(P＞0.05);血低密度脂蛋白分别为2.29±0.33 mmol/L和3.11±0.29mmol/L(P＜0.001).22例患者经Philips5000彩色B超仪测定IMT平均为0.86±0.14 mm,明显高于文献报道的正常值0.7±0.2mm.结论 HAART治疗艾滋病患者与血脂代谢异常及部分心血管并发症相关.     

Alterations in the gut microbiota of patients with acquired immune deficiency syndrome

Acquired immune deficiency syndrome (AIDS), caused by infection with human immunodeficiency virus (HIV), is associated with gastrointestinal disease, systemic immune activation and changes in the gut microbiota. Here, we aim to investigate the gut microbiota patterns of HIV‐infected individuals and HIV‐uninfected individuals in populations from South China. We enrolled 33 patients with HIV (14 participants treated with highly active antiretroviral therapy [HAART] for more than 3 months; the remaining 19 individuals had not received treatment) and 35 healthy controls (HC) for a cross‐sectional comparison of gut microbiota using stool samples. Gut microbial communities were profiled by sequencing the bacterial 16S rRNA genes. Dysbiosis was more common among patients with AIDS compared with healthy individuals. Dysbiosis was characterized by decreased α‐diversity, low mean counts of Bacteroidetes, Faecalibacterium, Prevotella, Bacteroides vulgatus, Dialister and Roseburia inulnivorans, and high mean counts of Proteobacteria, Enterococcus, Streptococcus, Lactobacillus, Lachnociostridium, Ruminococcus gnavus and Streptococcus vestibularis. Increased abundance of Bacilli was observed in homosexual patients. Proteobacteria were higher among heterosexual patients with HIV infections. Tenericutes were higher among patients with history of intravenous drug abuse. Restoration of gut microbiota diversity and a significant increase in abundance of Faecalibacterium, Blautia and Bacteroides were found in patients receiving HAART compared to those who did not receive. HIV infection‐associated dysbiosis is characterized by decreased levels of α‐diversity and Bacteroidetes, increased levels of Proteobacteria and the alterations of gut microbiota correlate with the route of HIV transmission. The imbalanced faecal microbiota of HIV infection is partially restored after therapy.     

上海市某医院艾滋病合并梅毒病例特征分析及影响因素探讨

为了解近年来上海市艾滋病合并梅毒患者的特征及变化趋势,探讨艾滋病患者合并梅毒的影响因素,本研究收集了2013—2019年上海市(复旦大学附属)公共卫生临床中心(简称临床中心)诊断为艾滋病合并梅毒的病例作为研究对象。经详细查询研究对象的住院登记资料和病史,本文整理出用于研究的资料,并将研究对象分为艾滋病合并梅毒组和艾滋病不合并梅毒组。结果显示,临床中心艾滋病患者中有10.55%合并梅毒;2013—2019年临床中心艾滋病合并梅毒感染率总体呈上升趋势(χ2＝17.640,P<0.05),每年7—8月份为收治高峰期。患者主要来源于本地居民(占55.49%),男女性别比为14∶1,平均年龄为38±12岁。通过Logistic回归分析发现,影响艾滋病合并梅毒的因素有性别、年龄、病例来源和CD4^＋T细胞计数,其中本地来源、年龄在21～40岁、男性和CD4^＋T细胞计数≤500 /μL是艾滋病患者合并梅毒感染的高危因素。研究提示,上海市艾滋病合并梅毒感染病例数呈上升趋势,重点防控人群是上海市青壮年男性居民,应提高对此类人群的主动监测能力,加大筛查力度,做好健康教育;重点防控时间是每年7、8月份,应精准防控以期取得明显效果。本研究为上海市此类疾病防控提供了一定的科学依据。     

RESPECT FOR PERSONS PERMITS PRIORITIZING TREATMENT FOR HIV/AIDS

I defend a certain claim about rationing in the context of HIV/AIDS, namely, the 'priority thesis' that the state of a developing country with a high rate of HIV should provide highly active anti-retroviral treatment (HAART) to those who would die without it, even if doing so would require not treating most other life-threatening diseases. More specifically, I defend the priority thesis in a negative way, by refuting two influential and important arguments against it inspired by the Kantian principle of respect for persons. The 'equality argument' more or less maintains that prioritizing treatment for HIV/AIDS would objectionably treat those who suffer from it as more important than those who do not. The 'responsibility argument' says, roughly, that to ration life-saving treatment by prioritizing those with HIV would wrongly fail to hold people responsible for their actions, since most people infected with HIV could have avoided the foreseeable harm of infection. While it appears that a Kantian must think that one of these two arguments is sound, I maintain that, in fact, respect for persons grounds neither the equality nor responsibility argument against prioritizing HAART and hence at least permits doing so. If this negative defence of the priority thesis succeeds, then conceptual space is opened up for the possibility that respect for persons requires prioritizing HAART, which argument I sketch in the conclusion as something to articulate and defend in future work.     

Antibody reactivity to HIV-1 Vpu in HIV-1/AIDS patients on highly active antiretroviral therapy

Human immunodeficiency virus type 1 (HIV-1) Vpu protein promotes both extracellular release of viral particles and degradation of CD4 in the endoplasmic reticulum. The correlation of anti-Vpu antibody (Ab) reactivity to Vpu and AIDS disease progression was studied in 162 HIV-1/AIDS patients after they had received highly active antiretroviral therapy (HAART) for 1 year. Anti-Vpu Ab reactivity was analyzed by Western blot using a recombinant Vpu protein. Results showed that at baseline (prior to initiation of HAART), 31.5% of patients (51/162) had anti-Vpu Ab. The proportion of anti-Vpu Ab in patients with CD4 counts > or =500, 200-500 and <200/mm(3) were 40.6, 34.7 and 14.3%, respectively (chi(2) test, p < 0.05). In addition, decreasing levels of anti-Vpu Ab reactivity were significantly correlated with increasing levels of HIV-1 viral load. After receiving HAART for 1 year, 7 of 111 anti-Vpu Ab-negative patients (6.3%) seroconverted (- --> + group) and 8 of 51 anti-Vpu Ab-positive (15.7%) patients became negative (+ --> - group). Among 104 anti-Vpu Ab-negative patients, 40 were selected for analysis of the VPU gene. All of them had an intact VPU gene. Patients were further divided into four groups according to their anti-Vpu Ab serostatus and anti-HIV-1 Ab was measured. The results showed that only the anti-Vpu Ab seroconverted group (- --> +) had increased serum levels of anti-HIV-1 Abs after 1 year of HAART, while the other three groups (+ --> +, - --> - and + --> -) had decreased serum levels of anti-HIV-1 Abs after 1 year of HAART (p < 0.05). In conclusion, the presence of anti-Vpu Ab is associated with improved prognosis following HIV-1 infection, and seroconversion of anti-Vpu Ab in patients on HAART indicates significant recovery of immunity.     

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。