2019—2020年苏州市男男性行为人群获得性耐药与亚型分析

目的 了解苏州市男男性行为(MSM)人群HIV感染者抗病毒治疗(ART)后获得性耐药情况及亚型分布。方法 对2019—2020年苏州市ART≥6个月、病毒载量(VL)≥1 000 copies/mL的MSM HIV感染者进行基因型耐药突变位点和亚型检测。结果 共纳入134例MSM HIV感染者,113例成功扩增,有79例(69.91%)发生耐药。共有9种亚型流行,其中CRF01＿AE亚型人数最多(48.67%),其次B+C(18.58%)、A(9.73%)。耐药单因素研究发现,基线CD4计数<200个/mm³获得性耐药比例较高,初始治疗方案为AZT(齐多夫定)+3TC(拉米夫定)+EFV(依非韦伦),HIV-1亚型为B+C混合亚型的获得性耐药比例均较低。耐药多因素研究未发现获得性耐药的发生与变量相关(P值均>0.05)。结论 苏州市MSM HIV感染者ART治疗失败者中获得性耐药占比较高,流行亚型种类较多,以CRF01＿AE亚型最多;获得性耐药与基线CD4计数<200个/mm³有正向关联,与B+C混合亚型、AZT+3TC+E...     

病毒量及其它标志物对临床艾滋病的预测价值

人免疫缺陷病毒Ⅰ型(HIV-1)感染后有CD4~+细胞逐渐下降的特征,而CD4~+细胞计数<200/μl是临床发展为艾滋病的指征。因此,在CD4~+达该阈值前,临床上根据生物学和临床参数鉴别艾滋病高危者非常重要。本研究旨在评价CD4~+细胞<200/μl前后病毒量及其它标志物对HIV-1感染者发展为艾     

河南省84例艾滋病患者更换治疗方案6个月后的随访分析

目的 分析河南省更换抗病毒治疗方案的艾滋病患者治疗状况.方法 选择84例接受国家免费一线抗病毒治疗5年以上即将更换治疗方案的艾滋病患者进行基线调查,6个月后随访.调查项目主要包括CD4+T淋巴细胞计数、病毒载量和基因型耐药.结果 基线调查时84例患者均使用早期一线方案(DDI+ AZT+ NVP),一周内31例患者开始使用后期一线方案(3TC+AZT+NVP),53例患者开始使用二线方案(3TC+TDF+LPV/r).6个月后随访发现84例患者CD4T淋巴细胞中位数从基线的374.00 cell/HI上升至406.50 cell/μl (P=0.005),其中更换二线方案患者CD4+T淋巴细胞中位数从基线时的267.00 cell/μl上升至365.00 cell/μl(P=0.015),而更换后期线方案患者的CD4+T淋巴细胞中位数则无显著变化(P=0.158). 84例患者的病毒载量中位数从基线时的3.61 log10copies/ml下降至6个月后的0.00 log10copies/ml( P=0.000),更换不同方案的两组患者随访时病毒载量中位数相比基线时也都有所下降(后期一线方案:P=0.007;更换二线方案:P=0.000).随访时有13例患者体内病毒载量＞1000 copies/ml,其中5例检测到3个以上胸苷类似物耐药突变,另4例患者前后两次调杳的病毒载量无明显变化(＜3倍)且未检测到任何耐药突变.结论 长时间接受治疗的艾滋病患者,在更换治疗方案6个月后机体健康状况有所改善,但合适的调整方案、及时有效的耐药检测以及随访仍不容忽视.     

2011年宁波艾滋病感染者抗病毒治疗效果及耐药分析

目的:研究2011年宁波艾滋病毒(HIV)感染者高效抗逆转录病毒治疗(HAART)效果及耐药变异。方法:收集272例HAART的HIV-1感染者抗凝血,检测CD4+T淋巴细胞和HIV-1病毒载量,病毒载量>1000 copies/ml的样品扩增HIV-1的pol区,测序结果使用斯坦福大学HIV耐药数据库分析。结果:CD4+T淋巴细胞绝对值为311±160个/μl。19份样品病毒载量>1000 copies/ml。10条序列出现耐药突变,总耐药率为3.73%(10/268)。8条产生针对核苷酸类反转录酶抑制剂(NRTI)和非核苷酸类反转录酶抑制剂(NNRTI)的突变。2条只产生了针对NNRTI的突变。结论:宁波HIV抗病毒治疗人群耐药毒株流行处于较低水平,该人群对目前使用的抗病毒药物敏感。但耐药突变呈多样化趋势,应加强耐药监测的研究以减少耐药突变株的产生与传播。     

四川省艾滋病抗病毒治疗6~12个月病毒学失败患者耐药性分析

目的 分析四川省接受艾滋病抗病毒治疗6~12个月病毒学失败患者的耐药影响因素和耐药特征。方法 对2016—2019年接受治疗6~12个月且病毒学失败患者进行HIV-1基因型耐药检测,采用统计学logistic回归和卡方检验分析病毒学失败患者耐药发生的影响因素,以及不同地区和亚型毒株间耐药突变特征。结果 3626例患者符合调查标准,成功获得序列2915例（80.39%）,其中1246（42.74%）例耐药,多因素logistic回归分析发现,注射吸毒者的耐药突变是异性性传播患者的1.90倍;艾滋病的耐药突变是HIV感染者的1.75倍;基线CD4+T淋巴细胞计数≥350个/μl和200~349个/μl的耐药突变是CD4+T淋巴细胞计数＜200个μl的0.76和0.64倍;初始治疗方案含洛匹那韦/利托那韦（LPV/r）的二线治疗方案的耐药突变是是含齐多夫定的0.37倍;感染CRF01_AE亚型毒株的耐药突变是感染CRF07_BC亚型毒株的1.34倍。成都平原、川东北、川西北、川南和攀西地区耐药率分别为45.41%、37.47%、54.84%、43.38和34.34%,卡方检验有统计学意义（P＜0.05）;主要流行亚型CRF07_BC、CRF01_E、CRF08_BC和CRF85_BC耐药率分别为39.60%、48.55%、34.17%和44.27%,卡方检验有统计学意义（P＜0.05）。结论 四川治疗6~12个月艾滋病患者病毒学失败的耐药率较高,耐药突变状况复杂多样,感染途径、基线CD4+T淋巴细胞计数、病程、感染毒株亚型、初始治疗方案是治疗6~12个月病毒学失败患者发生耐药的影响因素,且各地区耐药发生和各亚型耐药突变特征不同。     

艾滋病抗病毒治疗对HIV-1感染者肠道微生态的影响

目的分析联合抗反转录病毒治疗(cART)对HIV-1感染者肠道微生态的影响。方法采集2018—2019年在杭州市西溪医院感染二科治疗的HIV-1感染者粪便标本,对DNA进行扩增和纯化,通过测序平台对肠道微生物物种进行鉴别和分类,比较c ART治疗组与c ART未治疗组间、CD4细胞计数200个/mm~3组与≥200个/mm~3组间的α多样性和β多样性差异。结果纳入cART未治疗组21例,c ART治疗组29例;c ART治疗组中CD4细胞计数200个/mm~318例,≥200个/mm~3 11例。α多样性分析显示,与cART未治疗组比较,cART治疗组的Simpson指数降低(P0.05);与CD4细胞计数200个/mm~3组比较,CD4细胞计数≥200个/mm~3组的Observed species和Chao1指数升高(P0.05)。β多样性分析显示,各组间差异均无统计学意义(P0.05)。物种分析发现c ART治疗组与c ART未治疗组变形菌门和蓝细菌构成差异有统计学意义(P0.05),埃希菌属、链球菌属和罗氏菌属构成差异有统计学意义(P0.05);CD4细胞计数200个/mm~3组与≥200个/mm~3组蓝细菌构成差异有统计学意义(P0.05)。结论 c ART治疗的HIV-1感染者肠道菌群物种减少,微生态紊乱加重;高CD4细胞水平者拥有相对较多的微生物种类以及较为健康的菌群构成。     

深圳口岸国际旅行人员中HIV-1感染者耐药基因型检测分析

目的对深圳口岸1996—2008年已确诊的68例人类免疫缺陷病毒(HIV-1)感染者进行耐药性突变分析,以了解深圳口岸国际旅行者HIV-1耐药性毒株的流行情况。方法应用巢式RT-PCR扩增HIV-1聚合酶基因,对所获得的PCR产物直接测序,再将所获得的序列与国际耐药数据库比对,辨别耐药性突变位点。结果在68例HIV-1感染者中,经巢式RT-PCR扩增并获得聚合酶基因序列68份。耐药分析结果表明,本研究人群未检测到蛋白酶抑制剂(PI)原发耐药突变;11例感染者发生反转录酶抑制剂(RTI)耐药基因突变,基因突变率为16.17%;其中核苷类和非核苷类反转录酶抑制剂的耐药突变率分别为7.35%(5/68)和8.82%(6/68)。结论本研究分析了深圳口岸国际旅行者HIV-1感染者耐药突变的流行情况,这对于我国的艾滋病预防和控制工作具有重要指导意义。     

新疆静脉吸毒者HIV-1原发耐药分析

目的研究新疆伊犁州经静脉吸毒(IDU)感染人类免疫缺陷病毒1型(HIV-1)未经抗病毒治疗者原发耐药株的流行情况。方法于2009年12月—2010年3月收集新疆伊犁州77例IDU HIV-1感染者血样及流行病学信息,提取血浆病毒RNA,逆转录聚合酶链反应(RT-PCR)和巢式PCR方法扩增pol基因区1.3 kb片段并测序;构建系统进化树分析病毒亚型,提交斯坦福大学HIV耐药数据库进行耐药性分析。结果 77例感染者中,76例(98.7%)为CRF07_BC亚型,1例(1.3%)为B亚型;蛋白酶区未检出主要耐药突变,耐药相关次要突变主要出现在第10、58和71位;其中71位氨基酸突变发生频率最高(11/77),其次为第10位(6/77)和第58位(3/77);第71位氨基酸由野生型的A突变为V者7例,突变为T者3例,突变为I者1例;第10位氨基酸由野生型的L突变为I者5例,突变为V者1例;第58位氨基酸由野生型的Q突变为E者3例;1例病例逆转录酶区同时存在Y181C及M184V耐药突变。结论新疆伊犁州未接受抗病毒治疗的IDU感染者中检出原发耐药株,原发耐药率处于较低水平,但应加强该地区IDU感染者的耐药监测,防止耐药株产生和流行。     

2020年福州市免费艾滋病抗病毒二线治疗药品使用情况分析

目的了解掌握现有艾滋病患者的二线免费药物治疗情况,为制定防控治疗方案提供依据。方法由"艾滋病抗病毒治疗信息系统"中导出研究对象的基本人口学信息、治疗信息、药品使用情况,建立数据库,利用SPSS 22.0进行数据分析。结果福州市现有免费抗病毒治疗HIV感染者/AIDS患者3 033例,其中应用二线药品治疗的278例、占9.16%;二线药品治疗患者中,男性226例(81.29%),女性52例(18.71%);确证年龄中位数36.50岁;在治二线用药患者中,18.41%(37/278)初始治疗即用二线药物,原因全部为不良反应,相较由于耐药而使用二线药物的差异有统计学意义(P0.01);在一线药物应用治疗后3个月内,有4例(5.19%)患者因耐药而更换二线药物治疗,远低于因不良反应更换为二线药物的患者74例(46.34%)(P0.01);在以3个月为时间节点来看,94.81%的一线药物耐药患者在3个月后才更换使用二线药物,远高于因不良反应的患者43.78%(P0.01);患者在3个月内更换为二线药物治疗的不良反应中皮疹(85.36%)发生率高于肾功能损坏症状(10.00%)(P0.01),在3个月后才更换使用二线药物的患者比例其他毒副作用(59.09%)高于皮疹(12.77%)发生(P0.01)。结论抗病毒治疗定点医院应加强指导HIV感染者/AIDS病人按时定量规律服药的依从性,减少抗病毒药物耐药发生,定期监测病毒载量与CD4数值变化。     

新确认HIV-1感染者耐药相关基因位点突变研究

目的了解北京市朝阳区新确认HIV-1感染者耐药相关位点突变的情况。方法选取2014年朝阳区新确认的HIV-1感染者125例,提取血浆中的病毒RNA,用反转录PCR和套式PCR扩增HIV病毒的pol区,并进行序列测定及耐药分析。结果 92份标本扩增成功,扩增阳性样本亚型分布以CRF01_AE亚型为主,占58.70%,31例(33.70%)为CRF07_BC亚型,6例(6.53%)为B亚型,1例(1.07%)为CRF08_BC亚型;经耐药相关位点分析,27例出现了至少一种耐药相关突变;11例(11.96%)患者携带的耐药相关突变位点可能会引起不同程度的耐药。结论朝阳区新确认HIV-1感染者原发性耐药处于相对较高的水平,与新确认的感染者中以男男性接触人群为主有关,同时提示应当对HIV原发性耐药监测常规化。     

Identification of factors influencing the response of antiretroviral treatment

OBJECTIVE: The authors had an aim to define the ideal patient profile by determining the factors responsible for an initial variation of CD4 lymphocytes and viral load, and the effect of these factors on the therapeutic response after 12 months of treatment in HIV infected patients. PATIENTS AND METHOD: A retrospective study was made on data concerning the clinical stage, the HIV phenotype strain, the therapeutic status, and the type of treatment. This data was compared to the CD4 count and the viral load before and after 12 months of treatment. RESULTS: Initially, CD4 lymphocytes values were low in case of: phenotype SI (p = 0.012), patient in clinical stage C (p < 0.0001), or treated with protease inhibitor (p < 0.0002). The viral loads were high for patients in stage C (p < 0.0002) and treated with protease inhibitor (p < 0.0001). After 12 months of treatment, the increase of CD4 count was lower in patients with phenotype SI (p = 0.05). Furthermore, the viral load was statistically more important in naive patient (p < 0.0001). CONCLUSION: According to our study, the ideal patient is naive and presents with phenotype NSI.     

Policy dilemmas in providing antiretroviral treatment in Brazil

This paper addresses institutional constraints that have affected Brazilian politics regarding provision of anti-retroviral treatment (ART) to HIV/Aids patients. We analyzed the normative conflict resulting from international agreements on intellectual property rights, especially patent protection, and the constitutional rights of Brazilian patients to universal and free access to ART. These constraints have not substantially changed the Brazilian public policy yet, but they may impact the future sustainability of this policy. As the main barrier to the production of patented drugs is not technological but institutional, Brazilian government faces a dilemma. It may either abide by existing monopolistic restrictions or it may incite competitiveness of domestic industries and developing countries in the pharmaceutical market.     

AIDS treatment in Africa: the risk of antiretroviral resistance

--In recent years, implementation of antiretroviral therapy in developing countries with a high prevalence of HIV-1 has been recognised as a public health priority. Consequently, the availability ofantiretroviral combination therapy for people with HIV is increasing rapidly in sub-Saharan Africa. --HIV treatment programmes are implemented according to the standardised, simplified public health guidelines developed by the World Health Organization (WHO). --However, the implementation of treatment programmes in Africa is hindered by several factors, including the lack of adequate immunological and virological laboratory monitoring, insufficient support for adherence to therapy, vulnerable health care systems and the use of suboptimal drug combinations. --These suboptimal treatment conditions increase the risk that resistant virus strains will emerge that are less susceptible to standard first-line combination therapy, thus threatening the long-term success of the treatment programmes. --The WHO has initiated HIVResNet, an international expert advisory board that has developed a global strategy for surveillance and prevention of antiretroviral drug resistance. --The Dutch initiative known as 'PharmAccess African studies to evaluate resistance' (PASER) is contributing to this strategy by creating a surveillance network in sub-Saharan Africa.     

Low serum carnitine in HIV-infected children on antiretroviral treatment

OBJECTIVE: HIV-infection and antiretroviral therapies are associated with energy dysfunction and lipid metabolism in adults. Our aim was to detect a possible carnitine deficiency in HIV-infected children on antiretroviral treatments. We analysed the relation among serum carnitine, its amino-acid precursors (methionine and lysine), clinical evaluation and antiretroviral therapy. DESIGN AND SETTING: Cross-sectional study performed in a tertiary care hospital. SUBJECTS: A total of 79 HIV-infected children on antiretroviral therapy, monitored prospectively in our hospital. INTERVENTIONS: Antiretroviral therapy included nucleoside analogues plus protease inhibitors and/or non-nucleoside analogues. Carnitine was analysed by an enzymatic-spectrometric procedure, and amino acids by ion exchange chromatography. Reference values of carnitine and amino acids were established in apparently healthy children who underwent presurgical analysis for minor surgery. RESULTS: Serum free and total carnitine, acylcarnitines, methionine and lysine were significantly lower in HIV-infected children compared with our reference values for similar ages (P<0.0001; Student's t-test). Low carnitine values were observed in 37% of our HIV-infected children. A significantly positive correlation was observed between serum total carnitine and methionine or lysine (P<0.0001 and P=0.005, respectively; Pearson test). No relation was observed between serum carnitine and clinical stage of HIV infection, immunological or nutritional status or lipodystrophy. Free and total carnitine were significantly lower (P=0.002 and 0.033, respectively) in HIV-infected patients on protease inhibitors (N=56) compared with those on other treatments (N=23). CONCLUSIONS: Low serum carnitine concentration was observed in 37% of our HIV-infected children on antiretroviral therapy. Malabsorption or defective synthesis may also account for the low serum carnitine values detected in these patients.     

祥云县艾滋病抗病毒治疗取得明显成效原因分析

[目的]通过对祥云县艾滋病抗病毒治疗工作取得明显成效的原因进行分析，探讨出基层开展抗病毒治疗工作的有效方法，全面推进艾滋病抗病毒治疗工作。[方法]通过考察学习、召开会议、制定方案、协调部门配合、落实责任到人等一系列措施，祥云县艾滋病抗病毒治疗工作不断取得新进展。[结果]2005年开展抗病毒治疗2例；2006年开展抗病毒治疗9例；2007年开展抗病毒治疗41例，治疗覆盖面从2005年的33．33％上升到2007年的87．23％，顺利完成省级下达的任务指标。[结论]领导重视、方法得当、措施得力，是艾滋病抗病毒治疗工作不断取得新进展的关键。     

Approaches to rationing antiretroviral treatment: ethical and equity implications

Despite a growing global commitment to the provision of antiretroviral therapy (ART), its availability is still likely to be less than the need. This imbalance raises ethical dilemmas about who should be granted access to publicly-subsidized ART programmes. This paper reviews the eligibility and targeting criteria used in four case-study countries at different points in the scale-up of ART, with the aim of drawing lessons regarding ethical approaches to rationing. Mexico, Senegal, Thailand and Uganda have each made an explicit policy commitment to provide antiretrovirals to all those in need, but are achieving this goal in steps--beginning with explicit rationing of access to care. Drawing upon the case-studies and experiences elsewhere, categories of explicit rationing criteria have been identified. These include biomedical factors, adherence to treatment, prevention-driven factors, social and economic benefits, financial factors and factors driven by ethical arguments. The initial criteria for determining eligibility are typically clinical criteria and assessment of adherence prospects, followed by a number of other factors. Rationing mechanisms reflect several underlying ethical theories and the ethical underpinnings of explicit rationing criteria should reflect societal values. In order to ensure this alignment, widespread consultation with a variety of stakeholders, and not only policy-makers or physicians, is critical. Without such explicit debate, more rationing will occur implicitly and this may be more inequitable. The effects of rationing mechanisms upon equity are critically dependent upon the implementation processes. As antiretroviral programmes are implemented it is crucial to monitor who gains access to these programmes.