CAJ | 학술논문

目的了解MSM人群急性HIV感染者的临床特征、CD4+、CD8+T淋巴细胞计数、HIVRNA水平及其与疾病进展的相关性.方法定期随访观察100例急性HIV感染者,采用核酸依赖性扩增法(NASBA)检测血浆HIV RNA;流式细胞术检测CD4+、CD8+T淋巴细胞计数;ELISA法检测HBsAg和抗-HCV;快速血清反应素环状卡片试验法初筛梅毒螺旋体,对阳性梅毒螺旋体以明胶凝集试验方法确证.结果 100例患者中年龄20～50岁96例.HBsAg阳性9例,抗-HCV阳性4例,合并梅毒感染40例.感染HIV后第1、3个月CD4+T淋巴细胞计数分别为510、499/μL;感染第1、3、6、24个月时,HIV RNA分别为4.37、4.00、4.31和4.43 lg拷贝/mL.各随访时间点CD8+T淋巴细胞计数基本无变化.38例快速进展者的初始CD4+T淋巴细胞计数为(358.0±134.6)/μL,非快速进展者的CD4+T淋巴细胞计数为(559.2±203.4)/μL;快速进展者初始HIV RNA为4.71 lg拷贝/mL,非快速进展者的HIV RNA为4.18 lg拷贝/mL.快速进展者与非快速进展者初始CD8+T淋巴细胞计数分别为1 250.1、1 247.2/μL.结论 MSM人群HIV感染者呈年轻化,急性期的初始CD4+T淋巴细胞计数、HIV RNA水平可以预测疾病进展.
목적 료해MSM인군급성HIV감염자적림상특정、CD4+、CD8+T림파세포계수、HIVRNA수평급기여질병진전적상관성.방법 정기수방관찰100례급성HIV감염자,채용핵산의뢰성확증법(NASBA)검측혈장HIV RNA;류식세포술검측CD4+、CD8+T림파세포계수;ELISA법검측HBsAg화항-HCV;쾌속혈청반응소배상잡편시험법초사매독라선체,대양성매독라선체이명효응집시험방법학증.결과 100례환자중년령20～50세96례.HBsAg양성9례,항-HCV양성4례,합병매독감염40례.감염HIV후제1、3개월CD4+T림파세포계수분별위510、499/μL;감염제1、3、6、24개월시,HIV RNA분별위4.37、4.00、4.31화4.43 lg고패/mL.각수방시간점CD8+T림파세포계수기본무변화.38례쾌속진전자적초시CD4+T림파세포계수위(358.0±134.6)/μL,비쾌속진전자적CD4+T림파세포계수위(559.2±203.4)/μL;쾌속진전자초시HIV RNA위4.71 lg고패/mL,비쾌속진전자적HIV RNA위4.18 lg고패/mL.쾌속진전자여비쾌속진전자초시CD8+T림파세포계수분별위1 250.1、1 247.2/μL.결론 MSM인군HIV감염자정년경화,급성기적초시CD4+T림파세포계수、HIV RNA수평가이예측질병진전.
Objective To describe the clinical characteristics,CD4+ and CD8+ T cell counts as well as human immunodeficiency virus (HIV) RNA of acute HIV infection in men who have sex with men,and their correlations with the disease progression.Methods One hundred cases of acute HIV infection were followed up.Nuclear acid sequence-based amplification (NASBA) was used for plasma HIV RNA screening.Flow cytometry was served to test the CD4+ and CD8+ T cell counts.Hepatitis B surface antigen (HBsAg) and anti-hepatits C virus (HCV) antibody were detected using enzyme-linked immunosorbent assay.Rapid plasma reagin was applied to screen for Treponema pallidum antibody.Antibody positive specimens were tested with Treponema pallidum particle assay for validation.The positive results were identified as infection.Results Ninety-six cases were aged between 20 and 50 years old.Among 100 cases,9 were HBsAg-positive; 4 were anti-HCV positive; 40 were co-infected with syphilis.During the follow-up period,the median CD4+ T cell counts in the 1st and 3rd month were 510/μL and 499/μL,respectively.The median HIV RNA in 1st,3rd,6th and 24th month were 4.37,4.00,4.31 and 4.43 lg copy/mL,respectively.CD8+ T cell counts did not show significant change during the study.Among 38 rapid progressors,the initial mean CD4+ T cell counts was (358.0± 134.6)/μL,which was significantly lower than that of the non-rapid progressors with a mean CD4+ T cell counts of (559.2±203.4)/μL.Meanwhile,the initial mean HIV RNA of the rapid progressors was 4.71 lg copy/ mL,while that of the non rapid progressor was 4.18 lg copy/mL.The initial CD8+ T cell counts of the rapid progressors and non rapid progressors were 1 250.1/μL and 1 247.2/μL,respectively.Conclusions Acute HIV-1 infected men who have sex with men tend to be young.The initial CD4+ T cell counts and HIV RNA during acute infection could be used to predict the disease progress.