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目的 对接受高效联合抗逆转录病毒治疗 (HAART)后的晚期人类免疫缺陷病毒 1型(HIV 1)感染者的免疫功能重建的可能性和影响因素进行探讨。方法 用开放性前瞻性研究方法 ,对2 0例接受由 1种HIV蛋白酶抑制剂和 2种逆转录酶抑制剂联合组成的HAART的HIV 1病人 ,在治疗前和治疗后 1、3、6、9、12个月时 ,分别测定病人对巨细胞病毒和结核菌抗原的特异性CD4+ T细胞免疫应答反应。结果 经 1年的HAART ,2 0例HIV病人的血浆HIV载量平均下降了 1 5lg拷贝 /ml,CD4+T细胞计数平均上升 6 3个 / μl。开始HAART前 ,仅有 4位患者对特异性抗原有反应 ,治疗 1年后有 10例患者重新恢复了对特异抗原的免疫反应 (P <0 0 0 1)。与无免疫应答者相比 ,免疫应答者血浆HIV载量显著减少 ,并持续维持 ,CD4+ T细胞计数明显增加。结论 HAART治疗能够恢复艾滋病病人CD4+ T细胞抗机会病原体的免疫功能 ,这种恢复与治疗前已破坏的免疫功能严重程度无关 ,而取决于治疗后CD4+ T细胞增加的幅度、病毒复制被控制的程度和持续时间。
Objective To explore the possibility and influential factors of immune function reconstruction in patients with advanced stage human immunodeficiency virus type 1 (HIV 1) after high-activity combined antiretroviral therapy (HAART). Methods Using an open-label prospective study, 20 HIV-1 patients receiving HAART, a combination of one HIV protease inhibitor and two reverse transcriptase inhibitors, were treated before and after treatment with 1,3,6, At 9 and 12 months, the patient’s specific CD4 + T cell immune response responses to cytomegalovirus and Mycobacterium tuberculosis antigen were determined. Results After 1 year of HAART, the HIV load of 20 patients with HIV decreased by an average of 151 copies / ml and the average CD4 + T cell count increased by 6 3 / μl. Only 4 patients responded to specific antigens before starting HAART, and 10 patients regained immune response to specific antigens after 1 year of treatment (P <0.01). Compared with non-immune responders, immune response to plasma HIV load significantly decreased, and continued to maintain, CD4 + T cell count was significantly increased. Conclusions HAART treatment can restore immune function of anti-opportunistic pathogens of CD4 + T cells in AIDS patients. This recovery has nothing to do with the severity of immune function destroyed before treatment, but depends on the extent of CD4 + T cell increase after treatment and the extent to which virus replication is controlled And duration.