20例艾滋病病人经高效联合抗病毒治疗后免疫重建研究

Study on the immune reconstitution in 20 AIDS patients under highly active antiretroviral therapy

目的 对接受高效联合抗逆转录病毒治疗 (HAART)后的晚期人类免疫缺陷病毒 1型(HIV 1)感染者的免疫功能重建的可能性和影响因素进行探讨。方法 用开放性前瞻性研究方法 ,对2 0例接受由 1种HIV蛋白酶抑制剂和 2种逆转录酶抑制剂联合组成的HAART的HIV 1病人 ,在治疗前和治疗后 1、3、6、9、12个月时 ,分别测定病人对巨细胞病毒和结核菌抗原的特异性CD4+ T细胞免疫应答反应。结果 经 1年的HAART ,2 0例HIV病人的血浆HIV载量平均下降了 1 5lg拷贝 /ml,CD4+T细胞计数平均上升 6 3个 / μl。开始HAART前 ,仅有 4位患者对特异性抗原有反应 ,治疗 1年后有 10例患者重新恢复了对特异抗原的免疫反应 (P <0 0 0 1)。与无免疫应答者相比 ,免疫应答者血浆HIV载量显著减少 ,并持续维持 ,CD4+ T细胞计数明显增加。结论 HAART治疗能够恢复艾滋病病人CD4+ T细胞抗机会病原体的免疫功能 ,这种恢复与治疗前已破坏的免疫功能严重程度无关 ,而取决于治疗后CD4+ T细胞增加的幅度、病毒复制被控制的程度和持续时间。

Objective Highly active antiretroviral therapy (HAART) decreases viral load and increases CD 4 T-cell counts in patients with advanced HIV-1 infection.Whether HAART can improve CD 4 T-cell function remains unclear.We undertook an open prospective pilot study to address these issues. Methods 20 patients were treated with one protease inhibitor and two reverse transcriptase inhibitors and followed up for 12 months. We measured CD 4-cell proliferation in response to cytomegalovirus and tuberculin antigens and counted subsets of CD 4 cells at baseline and months 1, 3, 6, 9 and 12. Results Four patients had antigen-specific reactivity at baseline compared with 14 at month 12 (P<0.001). Between month 3 and month 12 viral load fell by a median of 1.5 lg copies/ml from baseline and CD 4-cell count increased by a median of 63/μl. Ten patients were immunological responders. They differed significantly from the ten non-responders whose viral-load reduction was sustained for 12 months, the increase in CD 4 count was greater. Conclusions HAART can induce sustained recovery of CD 4 T-cell reactivity against opportunistic pathogens in AIDS patients. This recovery did not depends on baseline values but depended on the amplitude and duration of viral-load reduction and the increase of memory CD 4 T cells.