Clinical Analysis of 10 AIDS Patients with Malignant Lymphoma

Objective This work summarizes the clinical features and treatment of 10 AIDS patients with malignant lymphoma. Methods A total of 10 AIDS patients with malignant lymphoma seen in Beijing Ditan Hospital since 2009 were enrolled. Clinical manifestations, pathological examinations, immunity levels, Epstein-Barr virus antibody examinations, complications, treatments, and outcomes were retrospectively analyzed. Results The main clinical manifestations of these patients included intermittent fever in 2 cases, neck masses and fever in 3 cases, auxiliary lymph node enlargement in 2 cases, and abdominal pain and bloating with fever in 3 cases. Up to 7 patients were pathologically diagnosed with diffuse large B cell lymphoma （DLBCL）, and 3 patients were pathologically diagnosed with Burkitt＇s lymphoma. Up to 8 patients had CD4 cell counts below 200/μL, and 2 patients had a level of more than 200/μL. Up to 7 patients were negative for EBV-IgM antibodies and 3 patients were not examined. Six patients underwent different chemotherapy and their prognoses were different. One patient with Burkitt＇s lymphoma alternatively took CODOXM and IVAC for 3 turns after VP chemotherapy; 1 patient with liver metastasis took R-CHOP 5 times, then changed therapy regimen to R-MINE and MINE. One patient with adrenal DLBCL took CHOP 6 times. Three patients with DLBCL took CHOP 1 or 2 times. Four patients gave up treatment. Various infections and side effects occurred, including bone marrow suppression, gastrointestinal bleeding, and renal dysfunction during chemotherapy. Six patients took HAARI, and 4 did not. Six patients died, whereas 3 patients got improved; and 1 patient was discharged. Conclusions AIDS patients with malignant lymphoma had various clinical manifestations, were immunocompromised, and had multiple metastases when they were admitted; they were already in the interim or late stage of lymphoma. Chemotherapy was not effective, and additional complications occurred. HAART failed to improve patient prognosis, and the overall prognosis was poor.

Clinical features of AIDS patients with Hodgkin's lymphoma with isolated bone marrow involvement:report of 12 cases at a single institution

Objective： To study the main clinical and histopathological features of 12 patients with Hodgkin＇s lymphoma （HL） diagnosed primarily from bone marrow （BM） involvement. Methods： We included 12 acquired immunodeficiency syndrome （AIDS） patients with HL assisted in the F. J. Mufiiz Infectious Diseases Hospital since January 2002 to December 2013. The diagnosis of ilL with primary BM involvement in patients was confirmed by clinical, histopathological, and immunohistochemical findings. Results： All patients presented ＂B＂ symptoms and pancytopenia. All of them had stage IV neoplasm disease because of BM infiltration. The median of CD4＋ T-cell counts was 114 cells/μL, and mixed cellularity （MC） was the most frequent histopathological subtype of 92% cases. Conclusion： When other causes are excluded, BM biopsy should be performed in AIDS patients with ＂B＂ symptoms and pancytopenia to evaluate BM infiltration by atypical lymphocytes.

住院AIDS患者心理状况分析及护理

目的通过对住院获得性免疫缺陷综合征(AIDS)患者的心理状态分析,使临床护士了解AIDS患者常见的心理问题并予以有效心理干预。方法对54例住院AIDS患者进行观察、评估,找出患者存在的心理问题,采取相应的护理措施。结果绝大多数的AIDS患者都存在着不同程度的心理问题,护理干预有效。结论心理护理在难以治愈的传染病感染患者护理中起着十分重要的作用。

HIV and HCV:from Co-infection to Epidemiology,Transmission,Pathogenesis,and Treatment

Human immunodeficiency virus (HIV) is the infectious agent causing acquired immu-nodeficiency syndrome (AIDS),a deadliest scourge of human society. Hepatitis C virus (HCV) is a major causative agent of chronic liver disease and infects an estimated 170 million people worldwide,resulting in a serious public health burden. Due to shared routes of transmission,co-infection with HIV and HCV has become common among individuals who had high risks of blood exposures. Among hemophiliacs the co-infection rate accounts for 85%; while among injection drug users (IDU) the rate can be as high as 90%. HIV can accelerate the progression of HCV-related liver disease,particularly when immunodeficiency has developed. Although the effect of HCV on HIV infection is controversial,most studies showed an increase in mortality due to liver disease. HCV may act as a direct cofactor to fasten the progression of AIDS and decrease the tolerance of highly active antiretroviral therapy (HARRT). Conversely,HAART-related hepatotoxicity may enhance the progression of liver fibrosis. Due to above complications,co-infection with HCV and HIV-1 has imposed a critical challenge in the management of these patients. In this review,we focus on the epidemiology and transmission of HIV and HCV,the impact of the two viruses on each other,and their treatment.

The Role of HIV Replicative Fitness in Perinatal Transmission of HIV

Perinatal transmission of Human immunodeficiency virus(HIV),also called mother-to-child transmission(MTCT),accounts for 90% of infections in infants worldwide and occurs in 30%-45% of children born to untreated HIV-1 infected mothers.Among HIV-1 infected mothers,some viruses are transmitted from mothers to their infants while others are not.The relationship between virologic properties and the pathogenesis caused by HIV-1 remains unclear.Previous studies have demonstrated that one obvious source of selective pressure in the perinatal transmission of HIV-1 is maternal neutralizing antibodies.Recent studies have shown that viruses which are successfully transmitted to the child have growth advantages over those not transmitted,when those two viruses are grown together.Furthermore,the higher fitness is determined by the gp120 protein of the virus envelope.This suggests that the selective transmission of viruses with higher fitness occurred exclusively,regardless of transmission routes.There are many factors contributing to the selective transmission and HIV replicative fitness is an important one that should not be neglected.This review summarizes current knowledge of the role of HIV replicative fitness in HIV MTCT transmission and the determinants of viral fitness upon MTCT.

HIV抗体抑制病毒感染的免疫效应和机制

在非人灵长类动物和人源化小鼠模型的实验研究中已经证明,人类免疫缺陷病毒(HIV)的广谱中和抗体(bNAbs)具有保护作用。近期bNAbs 3BNC117和VRC01的临床Ⅰ期试验证实,两种中和抗体均可降低未接受抗病毒治疗的HIV感染者的病毒载量。然而,bNAbs目前尚难以通过疫苗诱导产生。在泰国RV144疫苗试验中,疫苗对受试人群的总体保护率为31%,血液样本中未检出bNAbs,表明抗体的其他免疫效应功能在抑制病毒感染和复制的过程中发挥了重要作用。越来越多的研究表明,通过抗体Fcγ受体(FcγR)介导的非中和抑制作用在保护黏膜组织免受HIV感染的过程中可能发挥重要作用。在HIV通过黏膜组织传播的早期,树突状细胞和巨噬细胞表面表达的Fc受体可能起着决定性的作用,已有研究证实它们是HIV通过黏膜组织最初感染的靶细胞。因此,在新的疫苗设计策略中,除了诱导bNAbs产生,具有其他免疫效应功能的非中和抑制性抗体也应纳入疫苗接种评价体系中。