Puas yog TESTOSTERONE INTAKE AFFECT DIAGNOSING PRIMARY HIV INFECTION?
Jul 20, 2023
TSAB NTAWV
Kev kuaj pom tus kab mob HIV thawj zaug tuaj yeem cuam tshuam los ntawm ntau yam, suav nrog cov tshuaj xws li exogenous steroids. Peb tshaj tawm cov xwm txheej tsis tshua muaj tshwm sim ntawm tus txiv neej muaj hnub nyoog 37- tus neeg mob tau txais kev kho mob testosterone vim yog Klinefelter syndrome. Nws nthuav tawm cov tsos mob ntawm kub taub hau, qaug zog, thiab raws plab ntev li 2 lub lis piam. Nws kuj tau mus pw hauv tsev kho mob ob zaug ua ntej nws kuaj tau tus kab mob HIV. Qhov thib plaub tiam ELISA HIV kuaj tsis zoo. Kev kuaj mob HIV real-time polymerase saw cov tshuaj tiv thaiv tau ua thiab pom tias muaj cov kab mob plasma siab heev, tshaj 107 daim ntawv / ml. Peb tham txog kev sib txuas ntawm androgen hloov kho siv hauv Klinefelter syndrome thiab kev kuaj mob ntawm PHI. Cov ntaub ntawv no qhia txog qhov tseem ceeb ntawm kev tau txais cov ntaub ntawv ntxaws ntxaws txog kev kho mob, tshwj xeeb tshaj yog cov kab mob thiab cov tshuaj noj thiab siv cov kev kuaj mob uas tsim nyog.
Nyem rau cistanche tubulosa hmoov rau mob raum
1 Taw qhiaauction
Tus kab mob HIV Primary HIV (PHI) yog ib yam mob uas tshwm sim mus txog rau lub hlis tom qab tus kab mob human immunodeficiency virus (HIV). Raws li European AIDS Clinical Society (EACS) cov lus qhia, ob hom tuaj yeem paub qhov txawv: mob thiab tsis ntev los no. Tus kab mob no yuav yog asymptomatic, ntxiv nyuaj rau kev kuaj mob HIV, lossis cov tsos mob [1].
Txawm li cas los xij, txawm tias cov tsos mob tshwm sim tsis yog qhov tshwj xeeb vim nws muaj ntau yam kev kho mob tshwm sim (xws li mob khaub thuas) xws li kub taub hau, lymphadenopathy, pharyngitis, maculopapular daim tawv nqaij pob, mob taub hau, mob raws plab, mob nqaij, lossis qaug zog [2]. Qhov no feem ntau ua rau muaj qhov tsis txaus ntseeg ntawm tus kab mob ua pa sab sauv, tsis yog kab mob HIV. Thaum lub sij hawm tus kab mob no, kev paub yog nyuaj vim tsis muaj cov tsos mob tshwj xeeb thiab cov teeb meem kuaj mob.
Hauv kev kuaj enzyme-linked immunosorbent assay (ELISA), cov txiaj ntsig tsis zoo tuaj yeem tshwm sim, xws li vim muaj kab mob autoimmune, cev xeeb tub, lossis kab mob xws li mob malaria [3-5]. Tsis tas li ntawd, cov txiaj ntsig tsis tseeb-tsis zoo raug tshaj tawm hauv kev koom tes nrog agammaglobulinemia thiab kev sim hauv lub sijhawm lub qhov rais. Txawm li cas los xij, lawv tuaj yeem tshwm sim nyob rau theem pib kis kab mob HIV vim tias cov tshuaj tiv thaiv kab mob tseem tuaj yeem tsis tuaj [6]. Tias yog vim li cas cov txiaj ntsig tsis zoo lossis tsis ntseeg siab rau cov tshuaj tiv thaiv kab mob HIV tsis tuaj yeem yog lub hauv paus rau kev tsis suav nrog tus kab mob [2].
Txhawm rau txhim kho qhov kev kuaj mob, Fiebig nplai tau tsim. Raws li Fiebig et al. uas paub qhov txawv rau theem ntawm PHI, tus nqi ntawm cov ntawv luam ntawm HIV ribonucleic acid (RNA) nce nyob rau theem I txog III. Thaum lub sij hawm kuv nrog undetectable p24 antigen thiab HIV Immunoglobulin M (IgM), qhov siab tshaj plaws viremia yog nyob nruab nrab ntawm 104 mus rau 105 daim ntawv / ml [7]. Nyob rau theem no, kev txiav txim siab ntawm HIV RNA tej zaum yuav yog qhov tseem ceeb vim tias nws tshwm sim thawj zaug tus kab mob hauv thawj kaum hnub [7,8]. Lub ncov viremia (ntau tshaj 106 daim ntawv / ml) tshwm sim ntawm theem III, uas yog thaum cov tshuaj tiv thaiv seroconversion tshwm sim [9].
Qhov no kuj yog thaum cov tsos mob yuav pib [10]. Ntau lub tswv yim zoo li tseem ceeb hauv kev tswj lub cev tiv thaiv kab mob ntawm tus neeg mob HIV. Lawv suav nrog kev tsim tawm ntau ntxiv ntawm interleukine-2 (IL-2), interferon-1 (IFN-1), thiab interferon- (IFN-), pawg sib txawv 4 ntxiv (CD4. ntxiv rau ) T-cell proliferative teb thiab ib pawg ntawm kev sib txawv 8 ntxiv (CD8 ntxiv) T-cell kev ua. Lawv kuj nce cov synthesis ntawm CD8 ntxiv rau T-cell suppressive yam thiab -chemokines, antibody-mediated mechanisms nyob ntawm Fc receptors (FcRs) (xws li antibody-dependent cell-mediated cytotoxicity), yuav tsum tau natural killer cells (NK-cells), macrophages. los yog neutrophils, NK-cell mediated lysis [10,11].
Raws li tau hais dhau los, kev kuaj mob HIV tuaj yeem cuam tshuam los ntawm lwm yam kab mob, cev xeeb tub, kab mob autoimmune, tshuaj, thiab exogenous steroids coj los ntawm tus neeg mob [3,12,13]. Exogenous testosterone yog dav siv los ntawm cov tib neeg uas txo qis cov tshuaj hormones, xws li hauv Klinefelter Syndrome, thiab cov neeg uas xav txhim kho lawv cov leeg nqaij thiab lub cev duab. Nws cuam tshuam rau lub cev tiv thaiv kab mob tsis tuaj yeem tsis quav ntsej. Androgens, suav nrog testosterone, paub tias muaj lub luag haujlwm tiv thaiv kab mob [14].
Lawv ua lub luag haujlwm tseem ceeb hauv kev kis kab mob HIV vim lawv cuam tshuam rau cov txheej txheem tseem ceeb uas tau siv los tawm tsam nws. Lawv txo qis kev ua kom cov hlwb dendric thiab macrophages, tsim cov cytokines tso tawm los ntawm macrophages, T pab 1 (Th1) T-cells, IFN-1, IFN- , thiab interleukine -12 (IL{{6}). }). Lawv kuj cuam tshuam T thiab B cell txoj kev loj hlob thiab tswj tus naj npawb ntawm cov tshuaj tiv thaiv kab mob neutrophils.
Ntxiv mus, nws tau pom tias, piv rau cov poj niam, plasmacytoid dendric hlwb hauv cov txiv neej tsim tsawg dua IFN-1 hauv cov tshuaj tiv thaiv kab mob HIV, uas ua rau muaj kab mob ntau dua thiab muaj feem cuam tshuam rau anabolic steroids [15]. 2. Cov ntaub ntawv nthuav qhia Peb xav nthuav tawm cov ntaub ntawv ntawm tus neeg mob, ib tug txiv neej muaj hnub nyoog 37- xyoo nrog txiv neej pw (MSM) uas tau noj exogenous testosterone rau kaum plaub xyoos vim yog Klinefelter syndrome. Nws tau ntsib kev sib deev tsis muaj kev tiv thaiv uas tau tshwm sim ob lub lis piam ua ntej. Txawm hais tias tus neeg mob tau pom cov tsos mob ntawm tus kab mob retroviral mob hnyav thiab muaj cov kab mob ntshav plasma siab, tsis muaj kev kuaj HIV thib peb thiab thib plaub lossis Western blot tau lees paub tus kabmob.
Peb tus neeg mob tuaj rau Lub Tsev Haujlwm Saib Xyuas Kev Kub Ntxhov nthuav tawm raws plab, tsis muaj zog, thiab kub taub hau (txog 38.5C) kav ntev li kaum plaub hnub. Nws muaj keeb kwm kho mob ntawm Klinefelter syndrome kho nrog exogenous testosterone (100 mg intramuscular / ib zaug ib lub lim tiam), tab sis tsis muaj ntaub ntawv ntxiv txog kev kho mob endocrine tau siv tau. Cov kev kuaj kuaj pom pom tias thrombocytopenia ({3}} G/l) thiab leukopenia (2.5x103 / mm3 ). Tus neeg mob tsis tau tso cai mus pw hauv tsev kho mob. Tom qab tsib hnub, nws tau mus rau lwm lub tsev kho mob vim nws qhov kev tsis zoo. Kev kuaj kuaj tau ua tiav thiab pom tias thrombocytopenia (115 000 G / l) thiab leukopenia (3.3x103 /mm3) ib zaug ntxiv.
Ob qhov kev ntsuam xyuas HIV thib peb sib law liag tau ua, tab sis ob qho tib si tsis meej thiab nyuaj rau kev txhais. Txawm li cas los xij, cov qib siab ntawm qee lub siab transaminases tau hais txog, xws li alanine transaminase (ALT): 181 U / l, aspartate transaminase (AST): 316 U / l, thiab gamma-glutamyltranspeptidase (GGTP): 233 U / l thiab creatine kinase (CK): 1449 U/l. Vim tias muaj qhov tsis txaus ntseeg ntawm kab mob siab ntawm qhov tsis meej etiology, tus neeg mob raug xa mus rau lub tsev kho mob kis kab mob txhawm rau tshawb xyuas ntxiv.
Nyob ntawd, lub chaw kuaj pom tus kab mob siab A (HAV), kab mob siab B (HBV) (anti-HBc-tag nrho cov tshuaj tiv thaiv tsis zoo, cov tshuaj tiv thaiv HBs: 48 mIU / ml), kab mob siab C (HCV) (anti-HCV). IgM tsis zoo), Epstein-Barr virus (EBV), thiab Cytomegalovirus (CMV) (anti-CMV IgM tsis zoo, anti-CMV IgG zoo) kab mob tsis zoo.
Tus neeg mob tau txhaj tshuaj tiv thaiv kab mob siab B ntau xyoo ua ntej. Thawj qhov kev sim ntawm plaub tiam VIDAS®HIV DUO Ultra kev soj ntsuam tsis zoo. Vim yog kev noj cov tshuaj testosterone, cov tsos mob hauv tsev kho mob, thiab kev sib deev tsis muaj kev tiv thaiv, nws tau txiav txim siab tias qhov kev ntsuam xyuas VIDAS®HIV DUO Ultra yuav tsum rov ua dua, txawm tias qhov tshwm sim tsis zoo. Qhov kev sim thib ob tau ua ob hnub tom qab thiab tau ua tsis zoo rau p24 antigen. Antibodies tseem tsis tau qhia. Kev kuaj mob HIV Western blot pom zoo yog qhov tsis zoo. HIV kab mob kis tau raug soj ntsuam thiab nthuav tawm ntau dua 107 daim ntawv luam / ml, lees paub los ntawm lub sijhawm tiag tiag polymerase saw tshuaj tiv thaiv (PCR).
CD4 T-cell suav yog 351 hlwb/ul, CD8 T-cell suav yog 680 cells/ul, thiab CD4/CD8 piv yog 0.52. Tsis muaj qhov txawv txav hauv nws qhov kev kuaj mob lossis kuaj mob plab thiab plab hnyuv, tshwj tsis yog rau qhov loj me me. Thaum nws nyob hauv tsev kho mob, tus neeg mob kuj tau kuaj mob herpes labialis thiab pib kho (aciclovir). Tom qab kuaj pom tus kab mob HIV, nws tau txais kev kho mob antiretroviral (ART) (emtricitabine, tenofovir disoproxil, raltegravir).
Kev kho mob tau zoo zam. Hauv ob peb hnub, cov tsos mob tau txo qis, thiab qib transaminase txo qis. Tus neeg mob tau tawm hauv tsev kho mob. Tom qab plaub lub hlis ntawm kev kho cov tshuaj tiv thaiv kab mob, cov kab mob kis tau txo qis qis dua 20 daim ntawv luam / ml (piv txwv li tsis tuaj yeem kuaj pom) thiab CD4 T-cell suav tau nce mus rau 580 hlwb / ul. Kev soj ntsuam ntawm plab plab ultrasound qhia tau hais tias tus po tus po tseem loj, txawm tias muaj kev kho mob antiretroviral.
3. Kev sib tham
Peb cov ntaub ntawv tshaj tawm qhia txog qhov tseem ceeb ntawm kev ua keeb kwm kho mob kom zoo los tiv thaiv PHI tsis raug. Txawm hais tias nyob rau hauv Fiebig txoj kev tshawb fawb, nyob rau theem II thiab III p24 antigen tau kuaj pom nyob rau hauv tag nrho cov qauv, peb tus neeg mob muaj qhov tsis zoo VIDAS®HIV DUO Ultra kuaj tau rau antigen p24 thiab HIV antibodies. Txawm hais tias qhov kev kuaj antigen p24 yuav tsum muaj qhov zoo tom qab kwv yees li kaum xya hnub ntawm kev kis tus kab mob HIV, nws tau pom tsis muaj zog heev tom qab peb lub lis piam txij li cov tsos mob tau pib [7].
Qhov no ua rau muaj kev xav tias qhov kev tshawb pom ntawm tus kab mob tau qeeb qeeb. Ntxiv mus, raws li Ananworanich li al., tus naj npawb ntawm CD4 ntxiv ua ntej ART yog siab dua ntawm theem I dua li tom qab theem (508 vs. 340 hlwb/mm3) thiab yog li CD4. ntxiv /CD8 ntxiv piv (1.1 vs. 0.7) [16]. Txawm li cas los xij, peb tus neeg mob muaj tsawg CD4 ntxiv cov hlwb suav (351 hlwb / mm3) thiab qis CD4 ntxiv / CD8 ntxiv piv (0.52). Raws li Koçar txoj kev tshawb fawb, androgen deficiency txhim kho B-cell teb, whereas androgen hloov kho inhibits immunoglobulin (IgG, IgM, IgA) synthesis.
Tsis tas li ntawd, testosterone hloov kho hauv cov neeg mob Klinefelter syndrome ua rau txo qis tsis yog cov tshuaj tiv thaiv kab mob nkaus xwb tab sis kuj interleukins IL-2, IL-4, thiab tag nrho T thiab B cell theem. Tsis tas li ntawd, nws txo qis tus naj npawb ntawm CD4 ntxiv thiab CD4 ntxiv / CD8 ntxiv piv [17]. Xav txog cov yam ntxwv ntawm kev tiv thaiv kab mob ntawm exogenous testosterone siv los ntawm tus neeg mob ua tus neeg mob Klinefelter syndrome, peb xav tias qhov no yuav ua rau muaj qhov txawv txav ntawm tus neeg mob lub cev tiv thaiv kab mob rau thawj tus kab mob HIV uas ua rau muaj kab mob siab thiab muaj CD4 tsawg. ntxiv cell. Cov kev kuaj pom no tuaj yeem cuam tshuam nrog qhov hnyav ntawm tus neeg mob cov tsos mob [18].
Cov tib neeg uas muaj PHI chaw nres nkoj siab ntawm viremia uas ua rau muaj kev pheej hmoo kis tus kabmob [19]. Kev kuaj mob ntxov thiab kev kho mob ntawm cov neeg tshiab uas muaj tus kab mob HIV yuav ua rau muaj txiaj ntsig ntawm kev cog qoob loo tsawg dua ntawm cov kab mob hauv cov neeg mob thiab txo qis kev kis tus kab mob ntxiv [20]. Raws li peb cov ntaub ntawv tau pom, qhov kev kuaj mob ntawm tus kab mob HIV thawj zaug tuaj yeem nyuaj kom tau, xws li kev siv tshuaj anabolic steroid. Testosterone qhov cuam tshuam rau lub cev tiv thaiv kab mob tiv thaiv kab mob HIV tsis tuaj yeem tsis quav ntsej.
4. Cov lus xaus
Kev kuaj PHI ntawm cov neeg mob uas tau txais testosterone yuav tsum tau saib xyuas tshwj xeeb. Txhawm rau tiv thaiv kev kuaj mob tsis raug, nws yuav tsum tau txiav txim siab ua qhov kuaj xyuas PCR tiag tiag thaum pib kuaj kab mob HIV raws li VIDAS®HIV DUO Ultra kuaj thiab Western blot tej zaum yuav tsis zoo. Cov kws kho mob yuav tsum nco ntsoov tias qhov hnyav ntawm tus kab mob HIV thawj zaug txawv nyob ntawm tus neeg mob lwm yam kab mob thiab kev kho mob.
Cov ntaub ntawv
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