疟疾疗法对HIV感染者安全性及不良反应

Safety and side-effect management of malariotherapy for HIV-infected patients

目的 观察疟疾疗法 (急性血源间日疟 )治疗人免疫缺陷病毒 (HIV)感染的不良反应或并发症 ,探索疟疾疗法治疗HIV阳性患者的安全操作程序。方法 2 0例HIV阳性患者 (CD4细胞计数基线水平范围为 186 8～ 15× 10 6/L)接受疟疾疗法 ,经 10～ 2 0次疟疾阵发后用氯喹治愈疟疾。于疟疾前、疟疾期和终止疟疾后 10d观察临床表现并做相关的实验室检查。结果 血源间日疟的临床潜伏期为 5～ 17d。所有患者均有每日或隔日的疟疾发热发作 ,均有疟原虫血症。在疟疾期 ,肝和脾肿大分别占 4 / 2 0和 15 / 2 0 ,轻到中度贫血者占 19/ 2 0 ,血小板减少占 6 / 2 0 (但均无出血的表现 ) ,血清丙氨酸转氨酶 (ALT)升高占 2 / 2 0 ,只有在疟疾发热时卡氏 (Karnofsky)评分的分值降低 ,所有这些表现均在终止疟疾后消失或恢复。 1例晚期获得性免疫缺陷综合征 (AIDS)患者经疟疾疗法治疗后机会性感染消失。结论 疟疾疗法治疗HIV/AIDS的不良反应短暂而有限 。

Objective To observe side effects or complications of malariotherapy (hematogenous acute Plasmodium vivax malaria) for human immunodeficiency virus (HIV) infection and to explore the safe procedures of the therapy in treating HIV infected patients. Methods Total 20 HIV infected patients represented a range of CD4 cell baseline levels at 1 868～15×10 6/L received malariotherapy. Chloroquine was used to cure malaria after 10～20 malarial fever episodes. Clinical assessments and related laboratory measurements were made before, during and day 10 after cure of malaria. Results Clinical incubation period of the induced vivax malaria was 5～17 days. All patients developed malarial fever episodes every day or every other day with confirmed parasitemia. During malarial phase, liver and spleen enlargements were seen in 4 of and 15 of 20 patients respectively, mild to medium anemia and thrombocytopenia (but no bleeding) accounted for 19/20 and 6/20 respectively, two patients experienced increase of serum alanine transaminase (ALT), Karnofsky performance worsened only at malarial fever time, all these manifestations disappeared after cure of malaria. Opportunistic infections disappeared after malariotherapy in one patient with full blown AIDS.Conclusions Side effects of malariotherapy for HIV/AIDS were transient and limited. The therapy does not produce severe side effects or complications while improving immunological parameters of HIV infected patients.