The Effect Evaluation of Highly Active Antiretroviral Therapy to Patients with AIDS in Hubei Province of China

The effects of highly active antiretroviral therapy （HAART） to patients with AIDS in Hubei province of China were investigated in order to provide scientific evidence to reinforce the management of HAART. Self-made questionnaires and descriptive method of epidemiology were used to collect and describe the changes of clinical symptoms, HIV RIgA concentration, and immune function of patients with AIDS. After HAART, the effective rate of fever, cough, diarrhea, lymphadenectasis, weight loss, tetter, debility and fimgous infection was 92.4%, 90.85%, 92.91%, 90.73%, 93.69%, 89.04%, 92.34%, and 83.1%, respectively. Of 117 patients with detected HIV RNA concentration, 41.03% had declined over 0.5 log, and 52.99% less than 0.5 log. CD4^＋T cell count was obviously increased： the average number after HAART for 3 or 6 months was 237μL （26-755μL） and 239μL （17-833μL）, respectively HAART can improve AIDS patients＇ clinical symptoms, reduce HIV RNA concentration, and maintain immune function. It is very important for the effectiveness of HAART to raise clinical adherence of pa- tients with AIDS and have a persistent surveillance.

Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient

Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves’ disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves’ disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/μL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/μL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves’ disease, which was diagnosed when CD4 T-cells increased up to 343 cell/μL. Our patient developed Graves’ disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/μL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.

Highly active antiretroviral therapy dysregulates proliferation and differentiation of human pre-adipocytes

AIM To investigate the mechanism(s) by which potential effects of multi-drug highly-active antiretroviral therapy contributes to lipodystrophy syndrome. METHODS Preadipocytes from healthy donors were assessed for proliferation and differentiation in the presence of nucleoside reverse transcriptase inhibitors(NRTIs), nonnucleoside reverse transcriptase inhibitors(NNRTIs), and protease inhibitors(PIs) individually and in combination. Effects on proliferation were assessed with a 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide assay and effects on differentiation were assessed from glycerol-3-phosphate dehydrogenase(GPDH) activity and quantitation of Oil Red O staining for intracellular lipid. Data were analyzed with a randomized block ANOVA with post-hoc Fisher's Least Significant Difference test. RESULTS Preadipocyte proliferation was inhibited by a combination of NNRTI + NRTI(14% at 48 h, P < 0.001) and PI + NRTI(19% at 48 h, P < 0.001) with additional suppression when ritonavir(RTV) was added(26% at 48 h). The drug combination of atazanavir(ATV) + RTV + emtricitabine(FTC) + tenofovir(TDF) had the greatest inhibitory effect on proliferation at 48 h. Preadipocyte differentiation was most significantly reduced by the efavirenz + FTC + TDF assessed either by GPDH activity(64%) or lipid accumulation(39%), P < 0.001. Combining NRTIs with a PI(ATV + FTC + TDF) significantly suppressed differentiation(GPDH activity reduced 29%, lipid accumulation reduced by 19%, P < 0.01). This effect was slightly greater when a boosting amount of RTV was added(ATV + FTC + TDF + RTV, P < 0.001). CONCLUSION Although combination antiretroviral therapy is clinically more efficacious than single drug regimens, it also has a much greater inhibitory effect on preadipocyte proliferation and differentiation.

T-CELL RESPONSE OF ADVANCED AIDS PATIENTS AFTER HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

Objective To investigate the response on late stage Chinese AIDS patients after highly active antiretroviral therapy （HAART）. Methods From October 2002 to March 2004, 20 cases of late stage Chinese AIDS patients were selected to participate in this opened and randomised study, we purposely chose those with CD4＋ T cell counts 〈 100/mm^3. All of them had one or two opportunistic infections and none had been treated with anti-HIV drugs. All patients were tested with CD4＋ （naive CD4＋ T cell defined by CD45RA＋ and CD62L＋, memory CD4＋ T cell defined by CD45RA-）, CD8＋ T cell, plasma HIV viral load, and clinical manifestations on before, during, and after HAART （5 different regimes） on 1, 3, 6, 9, and 12 months. Before HAART mean CD4＋ T cell counts were 32 ± 31 （range 2-91）/mm^3, and plasma HIV viral load were 5.07 ± 0.85（range 2.04-5.70） log copies/mL. In 1 month＇s time patients treated with HAAT had mean CD4＋ and CD8＋ T cell counts increasing rapidly. After 1 month the increasing speed turned to slow down, but HIV viral load decreased predominantly within the first 3 months. The major part of increasing CD4＋ T cells were memory CD4＋ T cells, as for naive CD4＋ T cells increasing low and slow. Clinical symptoms and signs improved, and opportunistic infections reduced. The quality of life will be far much better than before. Each patient was followed for 12 months, and had finished 12 months＇ HAAT. Conclusion This is the first report in China that late stage Chinese AIDS patients after HAART could have their immune reconstitution. The regular pattern is similar to what had been reported in Western countries and also in China. So it is worth to treat late stage Chinese AIDS patients with HAAT.

To explore patients’ perceptions about motivators and barriers of adherence to highly active antiretroviral therapy among people living with HIV: A qualitative study

Objective:For people living with HIV(PLHIV),strict adherence to highly active antiretroviral therapy(HAART)is the key to effective treatment and retention in human immunodeficiency virus(HIV)care.There are many factors which promote or halt the antiretroviral therapy(ART)adherence practices.Therefore,the present study aimed to examine the HAART adherence levels and to explore patients’views about barriers and facilitators to HIV treatment adherence.Methods:Semi-structured interviews were conducted among 15 PLHIV at the ART clinic of Dr.Ram Manohar Lohia Hospital,New Delhi.Interviews were audio-recorded in the local Hindi language,and bilingual experts(English and Hindi)transcribed verbatim.Qualitative data were coded for themes and subthemes and analyzed using a phenomenological approach as per thematic content analysis.Results:Feeling of hopelessness,delayed ART initiation,difficult initial phase of ART,forget to take ART on time,fear of disclosure of HIV diagnosis,lack of privacy and negative social support,and impact of lockdown due to COVID-19 were revealed as significant barriers to ART adherence.At the same time,commitment to raise and educate children,ART to increase life span,maintain oneself to be physically fit and healthy,only a single pill per day,very supportive counselors and health-care professionals,and hope to give birth to a healthy child were identified as facilitators of HIV retention.Conclusion:Understanding patient’s perception about ART adherence,its motivational and barrier factors which are directly affecting ART adherence and retention of PLHIV in HIV treatment and follow-ups are of utmost importance to improve ART adherence during HIV patient care services.

Factors Affecting Adherence to Highly Active Antiretroviral Therapy among Patients Attending Public Healthcare Facility

The research focused on factors associated with poor adherence to HAART （highly active antiretroviral therapy） among HIV/AIDS. A descriptive cross sectional study was conducted using a standardized questionnaire and face-to-face exit interviews to collect data. Pill-counts were performed and computed adherence rate of ≥ 95% was considered acceptable. Data were analyzed using SPSS 21.0. Univariate factors associated with poor dherence to HAART were assessed with ANOVA （analysis of variance） and logistic regression model excluded confounders determining independent predictors of poor adherence. A P ≤ 0.05 was statistical significant. Of 102 HIV-infected on HAART for 24.68 ± 20.5 months, 83.3% were females and 16.7% males. The mean age （± SD） was 35.09 ± 9.3 years. Univariate factors associated with poor adherence to HAART were： CD4 count 〉 350 cells/mm3 0（2 = 46; P = 0.05）, age 〉 35 years 0（2 = 28.75; P = 0.011）, primary educational background （χ2 = 9.18; P = 0.027）, HAART regimen 1A-TDF （χ2 = 14.37; P = 0.003）, and 〉 4 combined tablets （χ2 = 11.87; P = 0.001）. There was a linear correlation between age and primary educational background （r = 0.538; P 〈 0.001）. After adjusting for univariate confounders, primary educational background （P = 0.020） and 〉 4 combined tablets （P = 0.026） were identified as independent predictors of poor adherence to HAART. Although there is an increase number of HIV-infected receiving HAART, these findings have shown that many of these will not adhere to their treatment once they improve clinically. This could be due to lack of education and complexity of combined ARVs with other drugs.

Effects of Antiretroviral Therapy and HIV Exposure in Utero on Adverse Pregnancy and Infant Outcomes:A Prospective Cohort Study in Guangzhou, China

Objective This study aimed to evaluate the effects of in-utero exposure to HIV and ART on pregnancy outcome and early growth of children.Methods This cohort study enrolled 802 HIV-infected pregnant women between October 2009 and May 2018 in Guangzhou, China. The women were assigned to receive combination ART(c ART) or mono/dual ART or no treatment. The primary outcomes were the combined endpoints of any adverse pregnancy outcome [including ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth, small for gestational age(SGA)] and adverse early growth outcome(including infant death, HIV infection of mother-to-child transmission, and underweight, wasting and stunting of infants at 4 weeks of age).Results Adverse pregnancy outcomes occurred in 202(35.1%) of all enrolled HIV-infected women, and121(31.3%) of all infants exhibited adverse effects on early growth at 4 weeks of age. The rates of adverse pregnancy outcomes, spontaneous abortion, ectopic pregnancy, stillbirth, infant death and perinatal HIV infection were higher among women not receiving ART, compared to those treated with c ART or mono/dual ART(P < 0.05). However, women treated with c ART had a higher rate of SGA,compared to untreated women(P < 0.05). No differences in early infant growth were observed among the different treatment regimens.Conclusion Our findings underscore the essentiality of prioritizing HIV-positive pregnant women for ART, as even mono/dual ART available in resource-limited countries could improve pregnancy outcomes and infant survival.

Impact of antiretroviral therapy on lipid metabolism of human immunodeficiency virus-infected patients: Old and new drugs

For human immunodeficiency virus(HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy(HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.

Cytomegalovirus retinitis in the highly active anti-retroviral therapy era

Cytomegalovirus(CMV)retinitis is an opportunistic infection that has traditionally affected those who have HIV/AIDS or immunosuppressed individuals.CMV retinitis previously infected one-third of AIDS patients in the pre-highly active antiretroviral therapy(HAART)era,but since HAART,Western countries have seen an 80%decrease in the incidence of the disease.More recently,CMV retinitis has been reported in patients who are immunosuppressed,often due to chemotherapy or immunomodulatory medications.The diagnosis of CMV retinitis is often suspected based on clinical findings,with polymerase chain reaction for confirmation of CMV,especially in atypical cases.Highly active antiretroviral therapy and anti-CMV medications(systemic or local)remain the mainstay of treatment.However,for those who are not responsive to HAART,CMV retinitis remains a challenge,and can still lead to significant vision loss.Moreover,a regimen of anti-CMV medications can sometimes lead to viral resistance or organ toxicity.Complications such as immune recovery retinitis and rhegmatogenous retinal detachments continue to threaten the vision of patients who develop CMV retinitis.These complications can arise following initiation of treatment or if patients show disease progression.Proper vision screening for CMV retinitis in immunosuppressed patients at-risk is necessary for early detection and treatment.

Anemia and Its Associated Risk Factors at the Time of Antiretroviral Therapy Initiation in Public Health Facilities of Arba Minch Town, Southern Ethiopia

Background: Anemia is the most common hematologic abnormality in HIV patients and is associated with disease progression and decreased survival. This study aims to describe the prevalence and predictors of anemia in HIV positive patients at the time of ART initiation at public health facilities of Arba Minch town, Southern Ethiopia. Methods: A total of 411 adults (?15 years) HIV positive patients with complete information on hemoglobin levels and CD4 count and clinical characteristics registered from 2006 to 2013 were assessed for anemia prevalence and risk factors at the ART clinic of the Arba Minch hospital and health center. The measurements of Hemoglobin and CD4 + T cell count were performed using standard methodology at baseline of ART initiation. Results: A total of 411 HIV positive patients (195 males and 216 females) with a mean ± SD age of 33.9 ± 9.0 years were assessed. Hemoglobin levels were between 6.0 and 16.5 mg/dL. The overall prevalence of anemia at the time of ART initiation was 52.3%;with 28.1%, 22.9% and 1.3% mild, moderate and severe anemia respectively. The overall prevalence of anemia was 62.4% among males and 46.7% among females (P < 0.001). An increased risk of anemia was seen in males (adjusted OR = 2.78, 95% CI = 1.77 - 4.35);low CD4 cell counts (adjusted OR = 3.48, 95% CI = 2.09 - 5.79);and history of TB (adjusted OR = 2.89, 95% CI = 1.28 - 6.54). Conclusions: Anemia in HIV-positive patients was highly prevalent at the time of ART initiation. Male gender, low CD4 count and history of TB were associated with higher risk of baseline anemia.

Pharmacogenetics as a tool to tailor antiretroviral therapy: A review

Highly active antiretroviral therapy(HAART) has substantially changed human immunodeficiency virus(HIV) infection from an inexorably fatal condition into a chronic disease with a longer life expectancy. This means that HIV patients should receive antiretroviral drugs lifelong, and the problems concerning with a chronic treatment(tolerability, side effects, adherence to treatment) have now become dominant. In this context, strategies for the treatment personalization have taken a central role in optimizing the therapeutic response and prevention of adverse drug reactions. In this setting, the study of pharmacogenetics features could be a very useful tool in clinical practice; moreover, nowadays the study of genetic profiles allows optimizations in the therapeutic management of People Living With HIV(PLWH) through the use of test introduced into clinical practice and approved by international guidelines for the adverse effects prevention such as the genetic test HLA-B*5701 to detect hypersensitivity to Abacavir. For other tests further studies are needed: CYP2B6 516 G > T testing may be able to identify patients at higher risk of Central Nervous System side effects following standard dosing of Efavirenz, UGT1A1*28 testing before initiation of antiretroviral therapy containing Atazanavir may aid in identifying individuals at risk of hyperbilirubinaemia. Pharmacogenetics represents a research area with great growth potential which may be useful to guide the rational use of antiretrovirals.

艾滋病患者采用HAART辅助中药治疗的效果及对免疫功能重建的影响

目的分析艾滋病患者采用高效抗逆转录病毒治疗(HAART)辅助中药治疗的效果及对免疫功能重建的影响。方法选择采用HAART辅助中药治疗的艾滋病感染者30例。比较患者服用中药前、服用中药1个月、停用中药后的CD4+T淋巴细胞计数、血常规、肝功能、肾功能,治疗效果,不良反应发生情况。结果服用中药1个月和停用中药后患者的CD4+T淋巴细胞计数分别为(327.35±21.10)个/mm3、(329.10±21.18)个/mm3,明显高于服用中药前的(278.23±20.03)个/mm3,差异有统计学意义(P<0.05)。服用中药1个月及停用中药后患者的白细胞计数(6.10±1.56)×10^(9)/L、(6.07±1.50)×10^(9)/L,血小板计数(152.12±50.12)×10^(9)/L、(150.09±50.08)×10^(9)/L,血肌酐(511.32±86.79)、(511.30±86.73)μmol/L,血尿素氮(16.77±3.27)、(16.73±3.22)mmoL/L,血β2-微球蛋白(18.12±2.28)、(18.10±2.27)mg/L,明显低于服用中药前的(8.45±1.92)×10^(9)/L、(192.34±70.23)×10^(9)/L、(803.37±120.35)μmol/L、(27.38±5.42)mmol/L、(29.30±5.31)mg/L,淋巴细胞百分比(29.24±6.17)%、(29.27±6.19)%,明显高于服用中药前的(25.34±5.10)%,差异有统计学意义(P<0.05)。服用中药前、服用中药1个月、停用中药后的丙氨酸转氨酶、天冬氨酸转氨酶、直接胆红素水平无明显差异(P>0.05)。停用中药后,CD4+T淋巴细胞疗效:有效7例、稳定20例、无效3例。症状和体征疗效:有效18例、稳定7例、无效5例。治疗过程中未发现严重不良反应,对肝、肾无明显损害。结论HAART辅助中药治疗能够增强和稳定患者免疫功能,提高患者生存质量,部分患者恢复了劳动能力,主要实验室指标趋向良性改变,患者免疫功能(CD4+T淋巴细胞)阶段性上升、长期保持稳定或者延缓其下降速度。

两种HAART方案对HIV/AIDS患者血脂的影响

目的观察两种高效抗逆转录病毒治疗(HAART)方案应用48周对HIV/AIDS患者血脂的影响。方法将102例HIV/AIDS患者根据不同的HAART方案分为司他夫定(D4T)组[D4T联合拉米夫定(3TC)及奈韦拉平(NVP)治疗]和齐多夫定(AZT)组(AZT联合3TC及NVP治疗)。检测基线及HAART后24、48周时的三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。结果配对t检验分析,D4T组患者24周TG、TC和LDL-C均显著升高(P<0.05),48周TC仍持续升高(P<0.05);AZT组24周TC和TG显著升高(P<0.05)。独立t检验分析,24、48周两组间比较血脂各项指标差异无统计学意义(P>0.05)。结论包含D4T和AZT的HAART方案均可导致HIV/AIDS患者血脂异常,主要是TG和TC升高,均以边缘升高为主。应用包含D4T的方案的HIV/AIDS患者TG和TC升高较早,并且TC升高后持续保持在较高的水平。

清毒胶囊对HIV/AIDS患者HAART后不同基线CD_4^+人群免疫重建的影响

目的:探讨高效抗逆转录病毒治疗(HAART)后,不同基线CD_4^+T淋巴计数的HIV/AIDS患者服用清毒胶囊后的免疫功能状态及综合疗效。方法:选择HAART治疗2年以上的128例HIV/AIDS患者,按照患者基线CD_4^+值分为A、B、C、D、E共5组:A组25例,患者CD_4^+基线值≤100个/μL;B组25例,患者CD_4^+基线值在100~200个/μL之间;C组26例,CD_4^+基线值在200~350个/μL之间;D组25例,CD_4^+基线值在350~500个/μL之间,E组27例,CD_4^+基线值在500个/μL以上。各组患者均给予清毒胶囊6粒,2次/d,连服6个月治疗。观察各组患者治疗前后CD_4^+、CD_8^+数值,WHO-HIV生存质量评分,综合疗效水平,并对患者安全性进行评估。结果:治疗3个月起,A、B、C 3组患者的CD_4^+水平较基线值显著升高,差异有统计学意义(P<0.01);D、E两组患者CD_4^+水平较治疗前有一定升高,但差异无统计学意义(P>0.01);比较CD_8^+淋巴细胞计数,各组患者较基线值无统计学意义(P>0.01);与基线时比较,各组患者生存质量评分、综合疗效均明显改善,差异有统计学意义(P<0.05);治疗过程中各组患者均无严重不良事件的发生。结论:清毒胶囊可以有效提高HIV/AIDS患者综合治疗效果,改善生活质量,对基线CD_4^+低于350个/μL患者有良好的促免疫功能重建作用。

HAART对HIV感染者／AIDS病人短期生活质量影响研究

目的探讨艾滋病病毒（HIV）感染者／艾滋病（AIDS）病人接受抗病毒治疗6个月时，生活质量有无变化。方法给予安徽省两地40名HIV感染者／AIDS病人高效抗逆转录病毒治疗（HAART），应用病历报告表的形式收集参加治疗病人的人口学信息、流行病学、临床及实验室检查信息，同时采用MOS-HIV量表，对病人治疗前和治疗6个月时生活质量进行调查，对相关数据进行统计分析。结果40名HIV感染者／AIDS病人平均年龄（42．2±8．8）岁（26～62岁），治疗前CD4平均为（197±41）个／μl（94～271），治疗6个月时体重平均增加（5．1±4．5）kg（t=7．24，P〈0．01），CD4平均增加（122±109）个/μl（t=7．07，P〈0．01）。采用MOS-HIV量表评定，病人躯体状况及精神状况在治疗后均有显著改善；维度分析显示，在健康感知、认知功能、疼痛、精神健康、精力与劳累、健康压力、生活状况、健康的变化方面，治疗前后的差异有显著的统计学意义（P〈0．01）。结论抗病毒治疗6个月时病人CD4细胞计数明显升高、体重增加、生活质量改善，躯体及精神状况均有所提高。

HAART治疗20例艾滋病患者疗效评估

目的 评价高效抗逆转录病毒疗法（Highly active antiretroviral therapy,HAART）对我国艾滋病（AIDS）患者的疗效.方法 对20例接受免费HAART治疗1～2年（平均18个月）的HIV-1感染的晚期患者进行横断面调查,检测HIV-RNA病毒载量、CD4^＋T淋巴细胞绝对计数、HIV特异性细胞毒性T淋巴细胞（CTL）应答、常规生化检验和临床指标观察.结果 所有观察对象在HAART治疗1～2年（平均18个月）后,临床症状明显改善：大部分患者病毒复制得到有效抑制,80%患者血浆中HIV-RNA载量在检测水平以下,CD4^＋T淋巴细胞绝对计数平均356.9±155.7/mm^3,其中8例（40%）大于400/mm^3;CTL应答频率和效应在每个蛋白区都有应答,对Nef蛋白应答较为突出.结论 HAART治疗对我国HIV/AIDS患者疗效显著,能提高HIV-1感染者的生活质量,降低机会性感染,并使部分免疫功能重建,具有较高的安全性和耐受性.

两种不同HAART方案对HIV母婴传播及孕妇、新生儿免疫和造血功能影响的对比研究

目的:研究高效抗逆转录病毒治疗(HAART)方案预防HIV母婴传播的安全性和有效性,探讨两种不同HAART方案对妊娠结局,以及孕妇和胎儿造血、免疫功能的影响。方法:将71例HIV感染孕妇按HAART方案分为含齐多夫定组(AZT组)40例、不含AZT组31例。选取40例健康孕妇为对照组。HIV阳性孕妇自妊娠14周开始抗病毒治疗,AZT组的HAART方案为AZT+拉米夫定(3TC)联合克力芝(LPV/r)或依非那仑(EFV)或奈韦拉平(NVP),不含AZT组为替诺福韦(TDF)+3TC联合LPV/r或EFV或NVP。采集抗病毒开始治疗时和分娩前孕妇肘静脉血、脐带血,测定血细胞参数和CD4^+、CD8^+T淋巴细胞。收集并分析孕妇和新生儿的基本信息,婴儿出生后4~6周及4个月进行HIV-1-DNA核酸测定。结果:分娩前,与正常对照组比较,AZT组孕妇的RBC、Hb、HCT、N降低,MCV、MCH、RDW增高(P<0.05)。与不含AZT组比较,AZT组的RBC、L降低,MCV、MCH、RDW增高(P<0.05)。各组间WBC和PLT比较无统计学差异(P>0.05)。3组孕妇的轻度贫血发生率比较,差异无统计学意义(P>0.05);AZT组孕妇的中度贫血发生率高于其他两组(P<0.05)。与对照组比较,AZT组新生儿脐带血中RBC、Hb、HCT、N显著降低,MCV、MCH、RDW、L、PLT显著增高(P<0.05)。两HAART组相比,AZT组新生儿脐带血中RBC、Hb、HCT显著降低,但MCV、RDW显著增高(P<0.05)。各组间WBC无统计学差异(P>0.05)。HAART暴露的两组新生儿轻度贫血发生率较对照组高(P<0.05);AZT组新生儿轻度、中度贫血较不含AZT组更多见(P<0.05)。结论:长疗程HAART治疗后,HIV母婴传播率0.3%,孕期HAART治疗安全、有效。孕期采用长疗程含AZT的HAART方案有助于孕妇的免疫重建;孕期含AZT的HAART暴露导致孕妇及新生儿巨幼红细胞性贫血和中性粒细胞减少,新生儿血小板增多。

HIV/HBV合并感染者经含拉米夫定的HAART治疗后YMDD变异

目的探讨HIV/HBV合并感染者接受含拉米夫定(3TC)的高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)后诱导乙型肝炎病毒YMDD变异的情况和变异影响因素,从而为合并感染者的治疗提供研究基础.方法采用Singer法DNA直接测序法对64例HIV/HBV合并感者HBV YMDD序列进行检测.结果 20例HIV/HBV合并感染者血清标本中,检测出存在HBV YMDD变异8例,检出率40%,其中YIDD 2例(25%),YVDD 6例(75%),且均伴rt L180M位点变异.在YMDD变异株中发现其他几个高频变异位点:rt Y221F,rt T222A,rt V224I,rt N238H,rt I269L等.YI/VDD+L180M变异中有7例同时伴随Y221F+V224I+N238+I269L变异,检出率87.5%.在HIV/HBV合并感染者中,YMDD变异组的抗病毒治疗时间显著长于未变异组(P<0.05),而在患者的社会人口学特征、HIV感染的途径和时间、抗病毒治疗前的肝功(ALT、AST)和免疫状态(CD4、CD8)、是否合并HCV感染、当前HBV-DNA含量以及最近1次随访的肝功和CD4、CD8细胞学计数中2组差异无统计学意义(P>0.05).结论在HIV/HBV合并感染者中,HBV YMDD的变异率发生较高,变异的类型较为复杂.YMDD变异随含3TC的HAART治疗时间的延长,耐药的发生率增高,因此动态监测YMDD变异情况,有助于治疗过程中及时发现变异情况,以调整治疗方案.YMDD变异对疾病的影响尚不清楚,对于发生YMDD变异的患者应密切观察其肝功能变化,及时加强保肝治疗.

HAART治疗1年对HIV/AIDS患者免疫重建效果观察

目的研究高效抗反转录病毒治疗(HAART)1年,对HIV/AIDS患者免疫重建效果的影响。方法确认人免疫缺陷病毒(HIV)感染者35例,检测CD4+T淋巴细胞<350/μL,开始HAART治疗,并于治疗0、6、12个月时分别检测其病毒载量及CD4+T淋巴细胞、CD8+T淋巴细胞、CD4+童贞细胞、CD4+记忆细胞、CD8+激活细胞计数。结果治疗前,HIV RNA处于高复制水平,平均(4.62±1.09)×106copies/mL,HAART治疗6个月及12个月时均低于检测下限。患者的CD4+T淋巴细胞、CD4+童贞细胞和CD4+记忆细胞均明显增加,12个月时,各组细胞计数[分别为(312±109.22)/μL、(150±57.34)/μL、(212±48.06)/μL]与基线[分别为(183±83.73)/μL、(73±20.40)/μL、(119±30.42)/μL]比较,差异有统计学意义(P<0.01),但仍低于健康对照组[分别为(768±146.41)/μL、(424±87.06)/μL、(442±61.40)/μL](P<0.05);CD8+T淋巴细胞计数(427±99.79)/μL较基线(597±111.43)/μL明显下降(P<0.05),但仍高于健康对照组(208±37.39)/μL(P<0.05)。结论 HAART能快速抑制HIV复制,治疗1年能部分恢复HIV/AIDS患者免疫功能。

高效抗反转录病毒治疗(HAART)对艾滋病患者血清炎性标志物水平影响研究

目的观察艾滋病患者高效抗反转录病毒治疗(HAART)对其血清炎性标志物(TNF-α、Ang-Ⅱ、hs-CRP)水平影响,并与正常人水平比较。方法监测36例HIV/AIDS患者(观察组)接受高效抗反转录病毒治疗(HAART)前和治疗后(6、12个月)的血清高敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、肿瘤坏死因子(tumor necrosis factor,TNF-α)、血管紧张素-Ⅱ(angiotensinⅡ,Ang-Ⅱ)水平,并与36例健康体检者(对照组)相应血清炎性标志物比较。以流式细胞计数法检测CD4+T细胞数、CD4+T/CD8+T值。结果 AIDS接受HAART组治疗前、治疗后6、12个月及正常人静脉hs-CRP、TNF-α、Ang-Ⅱ水平分别为7.37±1.55ml/L,0.75±0.24ng/L,97.2±7.6pg/L、4.65±1.48ml/L,0.48±0.20ng/L,90.0±8.2pg/L、3.82±1.45ml/L,0.40±0.16ng/L,87.2±7.4pg/L和2.68±1.08ml/L,0.32±0.16ng/L,64.2±10.5pg/L。与治疗前比较,治疗6、12个月后的hs-CRP、TNF-α、Ang-Ⅱ水平均有明显降低(P均<0.05);CD4+T细胞数、CD4+T/CD8+T比值升高。结论高效抗反转录病毒治疗可以降低艾滋病患者血清hs-CRP、TNF-α、Ang-Ⅱ等炎性指标水平,提高机体免疫系统功能,控制艾滋病疾病发展。