含多替拉韦方案治疗人类免疫缺陷病毒急性感染1例并文献复习

doi:10.19871/j.cnki.xfcrbzz.2020.03.012

新发传染病电子杂志 ›› 2020, Vol. 5 ›› Issue (3): 195-197.doi: 10.19871/j.cnki.xfcrbzz.2020.03.012

含多替拉韦方案治疗人类免疫缺陷病毒急性感染1例并文献复习

蒙志好¹, 覃善芳¹, 刘爱梅¹, 沈银忠²

1.广西壮族自治区龙潭医院感染科,广西柳州 545005;
2.上海市公共卫生临床中心感染和免疫科,上海 201508

收稿日期:2019-09-18 出版日期:2020-03-20 发布日期:2020-10-12
通讯作者: 沈银忠,Email: shenyinzhong@shphc.org.cn
基金资助:
1.国家科技重大专项（2017ZX10202101-002-002）；2.广西壮族自治区卫生健康委重点课题（重2011067）；3.广西科学研究与技术开发计划项目（桂科攻1598011-9）

Dolutegravir for rapid viral suppression in acute HIV infection

Meng Zhihao¹, Qin Shanfang¹, Liu Aimei¹, Shen Yinzhong²

1. Department of Infectious Disease, Longtan Hospital of Guangxi Autonomous Region, Guangxi Liuzhou 545005, China;
2. Department of Infectious and Immunology Disease, Public Health Clinical Center, Shanghai 201508, China

Received:2019-09-18 Online:2020-03-20 Published:2020-10-12

摘要/Abstract

摘要： 目的探讨人类免疫缺陷病毒(HIV)急性感染的早期诊断和治疗方法。方法对1例HIV急性感染者的临床表现、诊疗经过和预后情况进行分析。结果患者高危行为1周后出现发热、乏力、头痛等症状,15d后HIV抗体初筛试验阳性,确认试验不确定,HIV-1RNA 8 847 000拷贝/ml,CD4⁺T淋巴细胞计数173/mm³,诊断HIV急性感染,给予替诺福韦+拉米夫定+多替拉韦的方案抗病毒治疗,4周后HIV-1 RNA3303拷贝/ml,3个月HIV-1 DNA150拷贝/百万细胞,6个月CD4⁺T淋巴细胞计数530/mm³,HIV-1 RNA75拷贝/ml。结论及时进行RNA检测对HIV-1急性感染的诊断有极大帮助,使用含整合酶抑制剂方案进行治疗,可以快速有效降低病毒载量,提升CD4⁺T淋巴细胞数量,降低HIV-1 DNA到极低水平。

关键词: 急性人类免疫缺陷病毒感染, 整合酶抑制剂, 多替拉韦

Abstract: Objective To explore the early diagnosis and treatment for acute HIV infection. Methods A patient with acute HIV infection were analyzed in the aspect of clinical manifestations, treatment course and prognosis. Results One week after high-risk behavior, the patient developed fever, fatigue, headache, etc. 15 days later, this patient's HIV antibody screening test was positive, but confirmation test was uncertain. This patient's HIV-1 RNA was 8 847 000 copies/ml with CD4⁺T cell count of 173/mm³, indicating the diagnosis of acute HIV infection. TDF+3TC+DTG regimen was given as initial antiviral treatment. After 4 weeks, HIV-1 RNA was 3303 copies/ml and was dropped to 150copies/million cells after 3 months. After 6 months of antiviral treatment, CD4⁺T cell count was increased to 530/mm³ with viral load decreased to 75copies/ml. Conclusion RNA testing is helpful for the diagnosis of acute HIV-1 infection. Early initiation of antiviral therapy with Integrase Inhibitor during acute HIV infection stage can rapidly reduce the viral load, enhance CD4⁺T cells recovery and reduce the HIV-1 DNA load to an extremely low level.

Key words: Acute human immunodeficiency virus infection, Integrase Inhibitor, Dolutegravir

蒙志好, 覃善芳, 刘爱梅, 沈银忠. 含多替拉韦方案治疗人类免疫缺陷病毒急性感染1例并文献复习[J]. 新发传染病电子杂志, 2020, 5(3): 195-197.

Meng Zhihao, Qin Shanfang, Liu Aimei, Shen Yinzhong. Dolutegravir for rapid viral suppression in acute HIV infection[J]. Electronic Journal of Emerging Infectious Diseases, 2020, 5(3): 195-197.

参考文献

[1] 中国疾病预防控制中心,性病艾滋病预防控制中心. 国家免费艾滋病抗病毒药物治疗手册[M]. 4版. 北京: 人民卫生出版社, 2019: 22.
[2] 中华医学会感染病学分会艾滋病丙型肝炎学组,中国疾病预防与控制中心. 中国艾滋病诊疗指南(2018版)[J]. 新发传染病电子杂志,2019,4(2):65-84.
[3] 李敬云. HIV急性感染诊断方法与应用[J].传染病信息,2007, 20(6):352-356.
[4] Bienvenu AL, Traore K, Plekhanova I, et al.Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients[J]. Int J Infect Dis, 2016, 46: 11-17.
[5] 宋冰冰,翁文佳,李海燕,等. HIV感染急性期表现[J]. 临床皮肤科杂志,2017,46(4):293-295.
[6] James B, Alison L, Srisowmya, et al. Rapid seeding of the viral reservoir prior to SIV viraemia in rhesus monkeys[J]. Nature, 2014, 512(7512):74-77.
[7] Gibert CL.Treatment guidelines for the use of antiretroviral agents in HIV-Infected adults and adolescents: an update[J]. Fed Pract, 2016, 33(Suppl 3): 31S-36S.
[8] Walmsley SL, Antela A, Clumeck N, et al.Dolutegravir plus abacavir-lamivudine for the treatment of HIV-1 infection[J].N Engl J Med,2013,369(19):1807-1818.
[9] Sáez-Cirión A, Bacchus C, Hocqueloux L, et al.Post-treatment HIV-1 controllers with a long-term virological remission after the interruption of early initiated antiretroviral therapy ANRS VISCONTI Study[J]. PLoS Pathog,2013,9(3):e1003211.
[10] Luzuriaga K, Gay H, Ziemniak C, et al.Viremic relapse after HIV-1 remission in a perinatally infected child[J].N Engl J Med,2015,372(8):786-788.
[11] Persaud D, Gay H, Ziemniak C, et al.Absence of detectable HIV-1 viremia after treatment cessation in an infant[J]. N Engl J Med,2013,369(19):1828-1835.
[12] 岳永松,李太生. HIV感染者体内DNA储存库的临床研究进展[J].中华内科杂志,2017,56(7):529-531.
[13] Almeida JM, Letang E, Nhampossa T, et al.Rapid suppression of HIV-RNA is associated with improved control of immune activation in Mozambican adults initiating antiretroviral therapy with low CD4 counts[J]. AIDS Res Hum Retroviruses,2011,27(7):705-711.
[14] Krebs SJ, Ananworanich J.Immune activation during acute HIV infection and the impact of early antiretroviral therapy[J]. Curr Opin HIV AIDS,2016,11(2):163-172.
[15] Gantner P, Lee GQ, Rey D, et al.Dolutegravir reshapes the genetic diversity of HIV-1 reservoirs[J]. J Antimicrob Chemother, 2018,73(4):1045-1053.
[16] 宋爱心,杨小东,黄晓婕,等.HIV-1急性感染期抗病毒治疗研究进展[J].中国艾滋病性病,2018,24(11):1174-1177.

含多替拉韦方案治疗人类免疫缺陷病毒急性感染1例并文献复习

Dolutegravir for rapid viral suppression in acute HIV infection

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