中国HIV-1急性期感染25例患者临床特点分析

The clinical characteristics of twenty-five cases of acute HIV-1 infection in China

目的 总结HIV-1感染者在急性期的临床特征、免疫学和病毒学特点,提高对急性期感染者早期诊断的认识.方法 对2006-2013年北京协和医院感染内科门诊就诊的25例HIV-1急性期感染者临床和实验室资料进行回顾性分析.结果 25例患者中,19例（76％）感染途径为性传播途径,其中17例（68％）为同性性传播途径;22例（88％）患者有明显临床表现,最常见的症状和体征包括发热（15例,60％）、颈部淋巴结肿大（8例,32％）、皮疹（6例,24％）、腹泻（5例,20％）、咽痛、咳嗽（各3例,12％）等;少见首诊症状有吉兰-巴雷综合征、上臂蜂窝织炎、头痛呕吐、肛周脓肿（各1例,各占4％）.25例患者中,13例（52％）患者的外周血淋巴细胞比例升高,11例（44％）患者存在轻中度肝功能异常,1例（4％）血小板减少,2例（8％） HIV抗体阴性,依靠血浆病毒载量检测阳性诊断;25例患者血浆病毒载量为（4.68±0.83） lg拷贝/ml;CD4 T细胞计数为473（343,621）个/μl,CD8＋T细胞计数为1 296（997,2 177）个/μl,最高7 984个/μl;CD4/CD8比例为0.33（0.22,0.53）,其中24例（96％）患者呈现明显的倒置现象;CD8＋T细胞表面的免疫激活标记物人类白细胞抗原（HLA）-DR和CD38的表达比例分别为（74.9±16.1）％和（84.9±12.5）％;血浆病毒载量和CD8＋T细胞的HLA-DR和CD38表达比例呈显著正相关.结论 HIV急性期感染者常见的临床表现是发热、颈部淋巴结肿大、皮疹及腹泻;CD8＋T细胞计数显著升高,CD4/CD8倒置明显及明显升高的异常免疫激活有助于早期诊断急性期HIV感染。

Objective To summarize the clinical features,immunological and virological characteristics of HIV-1 infected patients in the acute phase for the sake of improving the understanding of acute HIV-1 infection and early diagnosis.Methods To retrospectively analyze the clinical manifestation and laboratory data of 25 patients with acute HIV infection,who were admitted to the Department of Infectious Diseases,Peking Union Medical College Hospital from 2006 to 2013.Results Among the total 25 patients,19 （76%） patients were sexually transmitted,including 17 （68%） of whom were homosexual.Twenty two （88%） patients presented significant symptoms.Common symptoms consisted of fever （15 patients,60%）,cervical lymphoadenopathy （8 patients,32%）,skin rashes （6 patients,24%）,diarrhea （5 patients,20%）,shortness of breath （3 patients,12%）,sore throat （3 patients,12%）,and cough （3 patients,12%）,while only one case represented as Guillain-Barr＆#233; syndrome,upper arm cellulitis,headache and vomiting,and perianal abscess.Laboratory examination indicated elevated peripheral lymphocytes （13 patients,52%）,abnormal liver function （11 patients,44%）,thrombocytopenia （1 patients,4%）.Notably,2 patients （8%） revealed negative results of HIV antibody,who were diagnosed with positive plasma viral load.The average viral load was （4.68 ± 0.83） lg copies/ml.CD4＋ T cell count was 473 （343,621） cells/μl.CD8＋ T cell count was 1 296 （997,2 177） cells/pl with maximal value of 7 984 cells/μl.The CD4/CD8 ratio was 0.33 （0.22,0.53） including 24 （96%） patients with obvious inverted ratio.The positive rates of immune activation markers HLA-DR and CD38 on the surface of CD8＋ T cells were （74.9 ± 16.1） % and （84.9 ± 12.5） % respectively.The viral load had a significant positive correlation with the expression of HLA-DR and CD38.Conclusions The most common symptoms of acute HIV-1 infection are fever,cervical lymphadenopathy,skin rashes and diarrhea.Significantly elevated CD8＋ T cell count,inverted CD4/CD8 ratio and abnormal immune activation markers contribute to the early diagnosis of acute HIV infection.