人类免疫缺陷病毒感染者合并丙型肝炎病毒感染的危害性及治疗策略

随着高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)在临床上的广泛开展,HIV/AIDS患者的生存时间显著延长.据估计,如果患者血浆HIV能在治疗后得到完全控制,其预期寿命能超过30～40年甚至更长.目前AIDS已成为一种像高血压或糖尿病那样无法完全根治,但可以在药物治疗下长期存活的慢性疾病.

Objective To investigate if immunological factors associated with rheumatoid arthritis (RA) affect the result of human immunodeficiency virus (HIV) screening by electrochemiluminescence immunoassay (ECLIA) and enzyme-linked immunosorbent assay (ELISA).
Methods 100 RA cases were enrolled from January 2012 to February 2013 into this study. HIV screening was conducted with ECLIA detecting both HIV-1 p24 antigen, HIV-1 and HIV-2 antibodies, with ELISA and colloidal gold method detecting HIV-1 and HIV-2 antibodies. The samples producing positive results were submitted to the Center for Disease Control for confirmation using Western blotting method. The antibody titers of rheumatoid factors (RF) including RF-IgG, RF-IgM, RF-IgA, and CCP-IgG were analyzed by ELISA.
Results The HIV positive-rate determined by ECLIA was significantly higher than that by ELISA and colloidal gold method (P<0.01). The false-positive rate of HIV screening was associated with antibody titers of RF-IgG, RF-IgM, RF-IgA, and CCP-IgG in RA (P<0.01).
Conclusion Immunological factors, including RF and anti-CCP antibody, may influence the screening of HIV by ECLIA, producing false-positive result.

Objective To study the prevalence of skin positivity to purified protein derivative (PPD) in human immunodeficiency virus (HIV)-infected patients in Hong Kong.Methods Consecutive clients of an HIV clinic were administered the PPD test and 2 units of PPD-RT23 were used. The area of induration was then measured in 48 to 72 h. Results were related to patient characteristics and HIV-related parameters.Results Eight (17.0%) out of 47 clients tested positive to the administration of 2 units of PPD-RT23. If the cutoff were raised to 10 mm according to current practice, only two (4.3%) would test positive.Conclusion The prevalence of PPD positivity in HIV-infected patients in Hong Kong is 17%, when a cutoff of 5 mm is used. This figure may form the basis for further studies on the utility of isoniazid preventive therapy in this group of patients.

社区医学之新挑战——物质滥用者艾滋病、B型肝炎及C型肝炎的高发病率

目的至2004年全球有2亿物质滥用者及13.2万静脉毒瘾者,据估计台湾有6万静脉毒瘾者,占成人人口的0.4%.在过去两年台湾被HIV感染的人数急剧增加,年新增感染人数倍增,其中60.0%为静脉毒瘾者,以至于在社区中诊治被感染病患的几率大大增加;另外两种血液传染疾病--B型及C型肝炎,在台湾亦是相当常见.本研究主要研究这些经血液传染疾病在静脉毒瘾者中的发病率.方法收集2005年2～9月在桃园某疗养院戒毒的患者.所有人皆接受HIV、B型肝炎病毒(HBV)、C型肝炎病毒(HCV)及梅毒血清检查.所有人皆取得其签署之同意书.结果总共收案801人,其中36.0%(289人)为一级毒品(海洛因,古柯碱)滥用者,其余64.0%(512人)为二级毒品(安非他命,快乐丸)滥用者;34.2%(274人)有HCV感染,16.8%(135人)有HBV感染,7.6%(61人)有HIV感染.在289位静脉毒瘾者中,71.6%(207人)有HCV感染,17.3%(50人)有HBV感染,17.0%(49人)有HIV感染.有HIV感染者(61人),98.4%(60人)有HCV感染,14.8%(9人)有HBV感染,13.1%(8人)同时有HIV、HCV及HBV感染.所有个案(801人)中,有0.4%(28人)梅毒血清检查为阳性,但大部分(71.4%,20人)是假阳性.结论中国大陆的HIV感染者是以CRF07_BC型为主要的病毒株,毒瘾族群中有82.0%的病患带有此种亚型.台湾HIV感染者,过去是以B型及CRF01_AE型病毒为主,大陆常见的HIV基因重组型CRF01_BC也已随着静脉毒瘾者在台湾蔓延.根据台湾疾病管制局的统计,在过去两年,感染HIV年新增人数每年倍增,而且大多是静脉毒瘾者.本研究发现静脉毒瘾者感染HIV、HCV、HBV,已给社会造成了严重威胁,两岸都必须严正面对这一新挑战.

应用间接免疫荧光试验检测广东部分人群人类免疫缺陷病毒抗体

本文应用间接免疫荧光法,检测了广东部分人群共707份血清标本,了解有无人类免疫缺陷病毒抗体.其血清来源包括(1)海南黎族健康成人206例;(2)连南县瑶族各种患者2ll例;(3)广州地区HBsAg阳性的肝炎患者207例;(4)血友病患者2l例,其中8例曾用过进口的Ⅷ因子治疗;(5)多次输注进口的血清白蛋白治疗的慢性肾炎23例;和(6)多次输血治疗的白血病或淋巴瘤患者39例.结果全部阴性,表明在上述人群中,尚未发现有人类免疫缺陷病毒感染的证据.

医务人员艾滋病职业暴露分析与预防对策

作为江苏省艾滋病定点收治医院,自2001年收治首例艾滋病人以来,我院已诊治携带HIV/AIDS(HIV Human Immunodeficiency Virus人类免疫缺陷病毒/AIDS Acquired Immune Deficiency Syndrome艾滋病,即获得性免疫缺陷综合症)的患者1 510例,其中住院871例(2001-2013.12月),2013年门诊新增病人410人,接受门诊服药治疗的病人达1 300人,住院病人53例.以往HIV病人集中收治在感染病科,但随着HIV感染人群的增加,各种并发症合并症以及骨折、外伤等情况随时发生.外科、妇产科、骨科等手术科室每年都要收治一定比例的HIV病人,医务人员的HIV职业暴露机会也相应增加,一旦感染其后果十分严重.

After more than 30 years of battling a global epidemic, the prospect of eliminating human immunodeficiency virus (HIV) as the most challenging infectious disease of the modern era is within our reach. Major scientific discoveries about the virus responsible for this immunodeficiency disease state, including its pathogenesis, transmission patterns and clinical course, have led to the development of potent antiretroviral drugs that offer great hopes in HIV treatment and prevention. Although these agents and many others still in development and testing are capable of effectively suppressing viral replication and survival, the medical management of HIV infection at the individual and the population levels remains challenging. Timely initiation of antiretroviral drugs, adherence to the appropriate therapeutic regimens, effective use of these agents in the pre and post-exposure prophylaxis contexts, treatment of comorbid conditions and addressing social and psychological factors involved in the care of individuals continue to be important considerations.

The human immunodeficiency virus type 1 (HIV - 1 ) envelope glycoprotein gp41 plays a critical role in the fusion of viral and target cell membranes. The gp41 extracellular domain, which contains fusion peptide (FP), N - and C - terminal hydrophobic heptad repeats (NHR and CHR, respectively). Peptides derived from NHR and CHR regions,designated N- and C- peptides, respectively, can interact with each other to form a six - stranded coiled - coil domain, representing the fusion-active gp41 core. Our previous studies demonstrated that the C- peptides have potent inhibitory activity against HIV- 1 infection.These peptides inhibit HIV- 1 -mediated membrane fusion by binding to NHR regions for preventing the formation of fusion- active gp41 core. One of the C - peptides, T - 20, which is in the phase Ⅲ clinical trails, is expected to become the first peptide HIV fusion inhibitory drug in the near future. However, this peptide HIV fusion inhibitor lacks oral availability and is sensitive to the proteolytic digestion.Therefore, it is essential to develop small molecular non -peptide HIV fusion inhibitors having similar mechanism of action as the C- peptides. We have established an ELISA- based screening assay using a unique monoclonal antibody, NC- 1, which can specifically bind to a conformational epitope on the gp41 core domain. Using this screening assay, we have identified a small molecular anti- HIV- 1 compound,named ADS-Jl, which inhibits HIV- 1- mediated membrane fusion by blocking the interaction between the NHR and CHR regions to form the fusion - active gp41 core. This compound will be used as a lead to design and develop novel HIV fusion inhibitors as new drugs for the treatment of HIV infection and/or AIDS.