高效抗逆转录病毒治疗后HIV感染者/AIDS患者精液质量及HIV RNA水平研究  

Semen quality and HIV RNA level in HIV/AIDS male patients after treated by highly active antiretroviral therapy

作　　者：朱郇荣[1] 李凌华[2] 范立新[1] 李宝金[3] 兰芸[4] 李锋 郑师凌 钟活麟[2] 何瑞英 杨柳平[1] ZHU Xun-rong;LI Ling-hua;FAN Li-xin;LI Bao-jin;LAN Yun;LI Feng;ZHENG Shi-ling;ZHONG Huo-lin;HE Rui-ying;YANG Liu-ping(Department of Urology;Department of Infectious Diseases;Department of Surgery;Research Institute for Communicable Diseases, Guangzhou Eighth People＇s Hospital, Guangzhou, Guangdong 510070, China)

机构地区：[1]广州市第八人民医院泌尿外科,广东广州510070 [2]广州市第八人民医院感染科,广东广州510070 [3]广州市第八人民医院外科,广东广州510070 [4]广州市第八人民医院传染病研究所,广东广州510070

出　　处：《中华男科学杂志》2018年第5期414-418,共5页National Journal of Andrology

基　　金：国家自然基金(81561128007);广东省医学科学技术研究基金(A2016462);广东省省级科技计划项目(2014A020212425)~~

摘　　要：目的:高效抗逆转录病毒治疗(HAART)可以显著延长HIV感染者的寿命并提高其生活质量,越来越多的男性HIV单阳的夫妻希望完成做父母的愿望,本研究通过检测HAART治疗后男性HIV/AIDS患者精液HIV-1 RNA水平与精液指标,评估潜在传播风险和精液质量,为优生优育提供依据。方法:20例有生育要求且接受HAART超过6个月的男性HIV携带者/AIDS患者,用精子动态图像分析系统检测其精子浓度、存活率、总活力、正常形态精子百分率,用COBAS Amplicor检测精液HIV RNA载量及流式细胞仪技术计数血液CD4+T细胞。结果:20例患者年龄25~40(30.7±5.05)岁,接受HAART治疗6(14.24±12.26)个月以上,治疗前基线CD4+细胞226~965 cells/ul(422.38±200.86),检测时CD4+细胞341~1 058 cells/ul(535.76±212.02)。除1例外精液量均高于正常参考值(≥2 ml);14例患者精子总活力低于正常值(≥40%),18例患者前向运动精子百分率低于正常参考值(≥32%),2例精子浓度低于正常参考值(≥15×106/ml);有5例精子存活率低于正常参考值(58%);有6例正常形态精子百分率≤4%。20例患者外周血HIV-1 RNA均<20拷贝/ml,18例精浆HIV-1RNA也<20拷贝/ml,但2例>20拷贝/ml,分别为4.70×101拷贝/ml和2.2×102拷贝/ml。4例与配偶无保护措施同房超过半年,女方定期查HIV抗体均阴性,其中1例自然怀孕生育,母子HIV-1 RNA均为阴性。结论:HAART治疗后仍有部分患者精液中HIV RNA水平高于血浆中HIV RNA水平,提示精液仍可能存在少量HIV,具有潜在传染风险,因此对男性HIV感染者/AIDS患者常规检查精液HIV-1 RNA可以降低女性感染风险。同时发现,HIV感染者/AIDS患者精子总活力与浓度低于正常参考值,生育能力降低。Objective： To evaluate the semen quality of the HIV/AIDS male patients after treated by the highly active antiretroviral therapy(HAART） and their potential of transmitting HIV/AIDS and provide some evidence for this cohort of males who wish for parenthood. Methods： We collected semen samples from 20 HIV/AIDS male patients who had been treated by HAART for over 6 months and wished for parenthood. We examined sperm concentration,viability and total motility and the percentage of morphologically normal sperm(MNS） using the computer-assisted semen analysis system,measured the HIV-1 RNA loads in the semen by the Cobas Amplicor Monitor test,and counted CD4＋T cells in the peripheral blood by flow cytometry. Results： The patients were aged 25-40(30. 7 ± 5. 05） years. After treated by HAART for 6-26(14. 24 ± 12. 26） months,the count of blood CD4＋T cells was significantly increased(341-1 058 [535. 76 ± 212. 021]/μl） in comparison with the baseline(226-965 [422. 38 ± 200. 86]/μl）.Compared with the normal value,the semen volume was increased except in 1 case(≥2 ml） while total sperm motility was decreased in 13 cases(≥40%）,and so were sperm concentration in 2 cases(≥15 × 106/ml）,sperm viability in 5(58%）,the percentage of progressively motile sperm in 18(≥32%）,and the percentage of MNS in 6(≤4%）. HIV-1 RNA in the peripheral blood was 20 copies/m L in all the cases and that in the seminal plasma was also 20 copies/ml in 18 cases but 20 copies/m L in the other 2([4. 70 × 101]and [2. 2 × 102]copies/ml,respectively）. Of the 4 couples that had sex without protective measures for over 6 months,all the 4 female partners exhibited negative HIV antibodies in regular follow-up examinations and 1 achieved spontaneous pregnancy and healthy birth,with negative HIV-1 RNA in both the mother and the baby. Conclusion： The HIV RNA level is higher in the semen than in the blood of the HIV/AIDS male patients after HAART,which indicates the potential risk of their semen transmitting HIV/AI

关 键 词：艾滋病 精液 精子总活力 精液HIV RNA 

分 类 号：R759[医药卫生—皮肤病学与性病学]