第32章2 逆转录病毒.ppt

Human immunodeficiency virus (HIV) Scanning electron micrograph of HIV-1 (in green) budding from cultured lymphocyte. Multiple round bumps on cell surface represent sites of assembly and budding of virions. AIDS-related opportunistic infections.  Kaposi’s sarcoma HIV vaccine failure prompts Merck to halt trial The latest trial began in 2004 and enrolled 3,000 people considered to be at high risk of infection. But a group of 741 volunteers who received the vaccine saw 24 HIV infections, compared with the control group of 762 people who saw 21 infections. Furthermore, the vaccine did not reduce the amount of HIV in the bloodstream of those infected. Nature 449, 390 (27 September 2007) | doi:10.1038/449390c; Published online 26 September 2007 For First Time, AIDS Vaccine Shows Some Success： Published in New York Times, September 24, 2009 检测目的 AIDS的诊断； 指导抗病毒药物治疗； 筛查和确认HIV感染者，以阻断HIV的传播途径。 三、微生物学检查法 * 检测病毒抗体：ELISA 筛查 Westernblot 确认 检测病毒抗原：检测HIV p24抗原 早期辅助诊断/后期预后不良 * 检测病毒核酸：定量RT-PCR：治疗效果 * 病毒分离：特征性细胞病变为融合细胞,一般不用于临床常规诊断 三、微生物学检查法 治疗HIV感染的药物 逆转录酶抑制剂：包括核苷类逆转录酶抑制剂（NRTI）和非核苷类逆转录酶抑制剂（NNRTI）； 蛋白酶抑制剂（PI）； 病毒入胞抑制剂：包括融合抑制剂（FI）和 CCR5 拮抗剂； 整合酶抑制剂（INSTI） 四、防治原则 治疗原则：联合用药（“鸡尾酒”疗法） * 高效抗逆转录病毒治疗（highly active anti-retrovial therapy, HAART) 联合应用2种核苷类药 ＋1种非核苷类药或蛋白酶抑制剂 四、防治原则 The vaccine — known as RV 144, a combination of two genetically engineered vaccines, neither of which had worked before in humans — was declared a qualified success after a six-year clinical trial on more than 16,000 volunteers in Thailand. Those who were vaccinated became infected at a rate nearly one-third lower than the others. [30% effective] WHO：Although this result is not enough to qualify the vaccine for licensure, RV144 has provided very useful pointers for a way forward. Several trials are planned incorporating lessons from RV 144. If the required efficacy can be shown in any of the trials, an HIV/AIDS vaccine could become available from 2020. 2014年3月19日发表在《科学-转化医学》（Science Translational Me