44例急性HIV-1感染者临床特征分析

Clinical characteristics of forty-four cases of acute HIV-1 infection

目的 探讨HIV-1急性感染者临床表现、免疫学及病毒学特征,提高HIV-1急性感染诊断水平。方法 回顾性分析2012年1月至2017年6月期间在广州市第八人民医院住院并诊断为急性HIV-1感染者的临床资料。结果 共44例患者纳入研究,当中男性为主(86.4%),感染途径以男男同性传播更常见(59.1%),主要临床症状和体征包括发热(84.1%)、淋巴结肿大(56.8%)等,部分患者可出现中枢神经系统症状(15.9%)。常见合并疾病或病变包括肺部病变22例(50.0%)和口咽念珠菌感染10例(22.7%)。主要实验室结果异常为白细胞降低(22.7%)、CD4+T淋巴细胞计数下降(平均268个/μl)和CD4+/CD8+比例倒置(86.4%)。血浆HIV RNA载量平均(5.9±0.9)lg拷贝/ml,且HIV RNA载量>6lg拷贝/ml患者组较HIV RNA载量≤6lg拷贝/ml组CD4+T细胞计数显著下降(t=-3.724,P=0.001)。结论 急性HIV-1感染者临床表现多样且可合并多种机会性感染,病毒水平高。

Objective To investigate the clinical,immunological and virological characteristics of HIV-1 infected patients in the acute phase,for the sake of improving the diagnosis of acute infection with HIV-1.Methods We retrospectively analyzed the clinical manifestation and laboratory data of patients with acute HIV-1 infection who were admitted to the Center of Infectious Diseases,Guangzhou Eighth People’s Hospital from January 2012 to June 2017.Results Forty-four patients were enrolled into the study,86.4%of them were male.59.1%patients were homosexually transmitted.Clinical symptoms and signs mostly consisted of fever(84.1%),lymphadenopathy(56.8%)and so on,while 15.9%patients had central nervous system symptoms.Most common opportunistic infection included lung infection(50.0%)and oropharyngeal candidiasis(22.7%).Leucopenia(10 patients,22.7%),and decreased CD4+T cell count(267.5 cells/μl),inverted CD4+/CD8+ratio(86.4%)was mostly seen.Compared to patients who had HIV RNA load less than 6 lg copies/ml,the group of patients who had HIV RNA load more than 6 lg copies/ml had lower levels of CD4+T cells(t=-3.724,P=0.001).Conclusions Patients with acute HIV infection have many different kinds of clinical symptoms and can be accompanied by opportunistic infection,and with high viremia.