高效抗逆转录病毒治疗病毒学抑制对HIV-1嗜性转换的影响  

Effect of highly active antiretroviral therapy on HIV-1 Tropism in HIV-infected individuals with undetectable viraemia

作　　者：黄英秀[1] 周海卫[2] 李彦媚[1] 张雯[2] 苏文晶[1] 田云飞[2] 宋川[2] 郜桂菊[2] 韩宁[2] 杨涤[2] 肖江[2] 曾辉[2] 赵红心[1] 

机构地区：[1]北京大学地坛医院教学医院,北京100015 [2]首都医科大学附属北京地坛医院

出　　处：《中华实验和临床感染病杂志（电子版）》2014年第1期31-35,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：北京市朝阳区艾滋病和病毒性肝炎等重大传染病综合防治示范区建设研究(No.2012ZX10004-904)

摘　　要：目的探讨高效抗逆转录病毒治疗(HAART)病毒学抑制后HIV-1嗜性的转换。方法提取治疗前和治疗48周患者的外周血单个核细胞中基因组DNA,对HIV-1 env基因的C2-V5区进行(nested-PCR)扩增和测序。基于V3区碱基序列,通过Geno2pheno软件预测HIV-1的嗜性。结果经HAART 48周后,其中11例患者病毒得到完全抑制,血浆病毒载量低于检测下限(20拷贝/ml),CD4+T淋巴细胞计数显著增加(均值自208 cells/ml上升至48周的418 cells/ml,Z=-2.934,P=0.001)。其中1例患者出现病毒嗜性由CCR5向CXCR4的转换,另外10例患者保持CCR5嗜性,V3环所带正电荷(Z=-1.000,P=0.317)和净电荷(Z=-1.000,P=0.317)均未发生显著性改变。结论 HAART后病毒获得抑制,可能延缓CXCR4嗜性病毒株的出现,这些患者可考虑使用CCR5拮抗剂作为优化方案的选择。Objective To investigate the effect of suppressive highly active antiretroviral therapy （HAART） on viral tropism during HIV-1 infection. Methods Genomic DNA was extracted from peripheral blood mononuclear cells （PBMCs） of 11 patients before HAART and at week 48 after HAART, respectively. C2-V5 regions of HIV-1 env were amplified by nested-PCR and sequenced. Viral tropism was predicted by online software Geno2pheno based on V3 sequence. Results After 48 weeks for HAART, the CD4＋ T cell counts were signiifcantly increased （ Z= -2.934, P=0.001 ）, plasma viral loads were undetectable. The tropism of one patient shift from CCR5 to CXCR4, the other kept CCR5-tropic stable;and the positive charges （ Z= - 1.000, P=0.317 ） and net charges （ Z= - 1.000, P=0.317 ） of V3 loop showed no signiifcant changes. Conclusions HIV tropism switches under suppressive HAART are rare. Patients may beneift from suppressive HAART by delaying the emergence of X4 tropic strains.

关 键 词：高效抗逆转录病毒治疗 病毒抑制 嗜性 Highly active ANTIRETROVIRAL THERAPY (HAART) 

分 类 号：R512.91[医药卫生—内科学]