Highly active antiretroviral therapy(HARRT) is considered the best effective way of HIV/AIDS current treatments,and it has fundamentally changed the process of human HIV infection.Individual differences between the phannacokinetics of drugs and many other factors play a role in the body in the course multi-drug combination.In order to improve treatment outcomes,to reduce toxicity,to increase efficacy,TDM help to adjust the individual dose.

The hallmarks of HIV infection include progressive CD4+T cell depletion and chronic immune activation.Effective antiretroviral therapy (ART) can restore CD4 +T cell counts and related immune responses to various opportunistic pathogens.On some occasions,improvement in the immune system leads to immune reconstitution inflammatory syndrome shortly after ART initiation.On the other hand,some patients fail to achieve a normal CD4 + T cell count despite long-term suppressive ART.Multiple studies have demonstrated that persistent immune activation and inflammation are closely associated with suboptimal immune recovery although the underlining mechanisms remain widely debated.

Objective To supply the foundation of Shuyuwan as drug curing on wounded stress disease, by exploring its immunity pharmacology. Methods The effect of the Shuyuwan upon the wounded stress mice IL-2 mRNA and IL-2R mRNA gene expression were detected by Q-RT-PCR. Results The Shuyuwan used in the wounded stress mice can improve IL-2 mRNA and IL-2R mRNA level significantly (P

Objective To study the clinical features of a heterogeneous immunodeficiency disease,common vailable immunodeficiency(CVID),and to enhance the understanding of it.Methods 12 cases of CVID treated in Peking Union Medical College Hospital from January 1990 to March 2007 were analyzed retrospectively,including the clinical characteristics,laboratory results,treatment and prognosis.Results Among the 12 patients,the ratio of male to female Was 2:1,the average onset age(26±9)years old and the median time from onset to diagnosis 18 months.The main symptoms were fever(with a percentage of 67.0%),recurrent Cough and expectoration(58.3%)and diarrhea(41.6%).Anemia and leukocytopenia were the common laboratory changes.All the cases were diagnosed due to the presence of hypo- immunoglobulinemia.The tests available for subtypes of lymphocytes in 9 patients showed that B cells and CD4+ T cells decreased obviously,with an inverse ratio of CD4/CD8,indicating T cell dysfunction.Clinical improvement was demonstrated after treatment with intravenously administered immunoglobulin(IVIG)in 10 cases.Conclusions CVID is a heterogeneous group of immunologic disorders of unknown etiology,characterized by impaired antibody responses and recurrent airway and/or gastrointestinal infection and accompanied with autoimmune diseases or cancer.Hypo-immunoglobulinemia is the main evidence of its diagnosis.IVIG as a replacement therapy is an effective way of management.

Objective:To investigate the clinical features and their relationship with mortality of coronavirus disease 2019 (COVID-19) in people living with human immunodeficiency virus (HIV).Methods:A thorough literature review was conducted about peer-reviewed publications including cohort study, cross-sectional research, and case series on HIV/2019 novel coronavirus (2019-nCoV) coinfection from January to August 2020. Systemic review and meta-analysis were used to investigate the correlation between mortality and clinical features including age, comorbidities, CD4 + T lymphocyte count, HIV RNA level, and anti-retroviral therapy. Stata 15.0 software was used for meta-analysis. Results:Twenty-four articles were included with a total of 939 HIV/2019-nCoV coinfected patients. Overall mortality was 10.3% (97/939). Advanced age and comorbidities, including hypertension, diabetes mellitus, renal insufficiency, chronic obstructive pulmonary disease/asthma and tumor were all significantly associated with mortality (95% confidence interval 0.005-0.050, 0.042-2.294, 0.390-2.754, 0.513-2.848, 0.348-3.743 and 1.943-7.101, respectively, P=0.021, 0.043, 0.012, 0.008, 0.022 and 0.005, respectively). There were no correlations between mortality and CD4 + T lymphocyte count <200/μL or >500/μL, HIV RNA was below the lower limit of detection, or anti-retroviral drug (including tenofovir) (all P>0.05). Conclusions:The overall prognosis of COVID-19 in people living with HIV is similar to general population. Increased mortality correlates with advanced age and comorbidities including hypertension, diabetes mellitus, renal insufficiency, chronic obstructive pulmonary disease/asthma and tumor. Low CD4 + T lymphocyte count does not affect mortality. Preliminary results indicate that anti-retroviral drugs have no protective effect on COVID-19.

Objectives To investigate the T cell subsets changes in hemorrhagic fever with renal syndrome (HFRS) patients. Methods 22 HFRS patients who were diagnosed in Qin Huang Dao Third Hospital from April 2005 to July 2005 were enrolled in this study and divided into two groups according to clinical manifestations. T cell subsets of the 22 patients were monitored at week 1, 4 and 12. Another 56 subjects were enrolled as healthy controls. Results B cell count was normal during the 12 weeks in all the subjects. NK cell decreased significantly at week 1, and recovered at week 4 rapidly. CD4+ T cell count was normal throughout the course of the disease, but the percentage of memory phenotypy increased at week 1and4, reaching(64.1±17.5)% and (59.9±10.1)%, but recovered at week 12. CD4+CD28+T cells were normal throughout the entire study. CD8+ T cell count increased dramatically at week 1 and 4, but finally recovered at week 12. The count of CD8+ CD28-T cells increased significantly at week 1 in low-grade goup, but in median-grade group, this increase lagged to week 4 and was not as significant as in low-grade group. The percentage of CD38+ or HLA-DR+ subsets of CD8+ T cell increased at week 1, 4. Conclusion The results confirmed the relationship between HFRS progression and cellular immunity. It revealed that, at the early stage of HFRS, rapid and effective cytotoxicity T lymphocyte response my contribute to clear Hantavirus away and improve HFRS symptom.

Objective To improve the diagnosis and treatment of Q fever endocarditis.Methods From 2008 to 2013,four cases of Q fever endocarditis were diagnosed in Peking Union Medical College Hospital.Clinical features,laboratory test,management and prognosis were analyzed with literature review.Result All four cases had long period of fever and heart murmur.Two patients represented with respiratory symptom and one with non-specific rash.General laboratory tests including complete blood cell count,ESR,C-reactive protein(CRP),liver function and radiology of lung did not show specific abnormalities.Signs of endocarditis were shown by ultrasound and important for diagnosis.Repeated blood culture was negative.All of the diagnoses were confirmed by serum antibody detection and the patients recovered well with treatment based on doxycycline or minocycline.Conclusions Endocarditis is the most common form of chronic Q fever,which is easily misdiagnosed because its blood culture is negative and may accompanied with varied manifestation such as pneumonia and liver injury.For the patients with chronic fever and blood culture negative endocarditis,chronic Q fever should be considered as differential diagnosis.The confirmatory method for diagnosis is serum antibody detection.Early and sufficient treatment may improve the prognosis.

ObjectiveTo analyze the clinical characteristics of Behcet's disease with intracardiac thrombus.MethodsThe data of 8 patients diagnosed as Behcet's disease with intracardiac thrombus in Peking Union Medical College Hospital from January,1990 to January,2011 were studied retrospectively.ResultsBehcet's disease with intracardiac thrombus was found in 8 patients (5 men and 3 women) with a median age of 28.5 years.Most of them were young men.Thrombus was mostly found in the right side of the heart.Most of the patients had pulmonary thromboembolism with negative anticardiolipid antibody and basically normal C-reactive protein and erythrocyte sedimentation rate.ConclusionIntracardiac thrombus associated with Behcet's disease most commonly occurs in young men and usually involves the right side of the heart.

Objective To improve the diagnosis and treatment of infective endocarditis(IE)by exploring its causes,pathogenic microorganism and clinicsI characteristics.Methods The clinical data of 120 IE patients treated in Peking Union Medical College Hospital from October 1997 to September 2007 were analyzed retrospectively.Results Of the 120 consecutive cascs diagnosed as IE according to the Duke's new criteria,79 were male and 41 female with a average age of(43.2±16.7)years old.Twelve cases were prosthetic valve endocarditis(PVE)and 108 cases native valve endocarditis(NVE)and there were no previously known heart diseases in 29 of the cases.Seventy-nine of the 108(73.1%)NVE patients had basic cardiac abnormalifies before IE diagnosis,such as congenital cardiovascular disease(30 cases),idiopathic mitral valve prolapse(23 cases)and rheumatic heart disease(11 cases).Fever(100.0%),anemia(54.2%)and embolism(48.3%)were the most common clinical manifestations in the IE development.Of the 83 patients who had a positive blood culture result,Streptococcus vividaus(51.8%)was the most common isolated microorganism.Conclusions Congenital cardiovascular diseases and idiopathic mitral valve prolapse are the two most commonly heart diseases in IE.Blood culture and echocardiogram should always be done to exclude IE,especially presenting with fever of unknown reasons.

Objective To determine the immunophenotypic features of peripheral lymphocytes in adult patients with Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM) and chronic active EBV infection (CAEBV).Methods Eighteen IM patients,12 CAEBV patients and 18 healthy donors were included.Lymphocyte subsets including CD3-CD+19 B cells,CD3-CD+16/56 NK cells,CD4+ and CD8+T cells in peripheral blood were measured by flow cytometry.The expression of activation markers (HLA-DR and CD38) on CD8+T cells and CD28 expression on T cells were also determined.Kruskal-Wallis H and MannWhitney U tests were used to compare variables among groups.Results IM patients had dramatically increased CD8+T cell counts than healthy donors (5.22 × 109/L vs 0.54 × 109/L,P ＜ 0.001).B cell counts moderately reduced in patients with IM than in healthy donors.No difference was found in absolute CD4+T cell and NK cell counts between IM and healthy donors.The levels of HLA-DR and CD38 on CD8+T cells significantly increased in IM patients compared with those in healthy controls.The intensity of CD28 on CD8+T cells significantly decreased,which was not seen on CD4+T cells.The median cell counts of B,NK,CD4+T and CD8+T subsets in CAEBV patients were 0.02 × 109/L,0.06 × 109/L,0.26 × 109/L and 0.21 ×109/L respectively,which were significantly lower than those in healthy donors (0.22 × 109/L,0.38 ×109/L,0.78 × 109/L,0.54 × 109/L) and IM patients (0.12 × 109/L,0.40 × 109/L,0.91 × 109/L,5.22 ×109/L).The positive rates of HLA-DR and CD38 on CD8+T cells in CAEBV patients were higher than those in healthy controls,but lower than those in IM patients.Conclusions The immunophenotypic pattern in adult patients with IM is characterized by a dramatic increase of extensively activated CD8+ T cells,a moderate reduction of CD+19B cells and no significant change of CD4+T cells and CD+16/56NK cells.CAEBV is featured by an immunosuppression status as demonstrated by significantly decreased B,NK,CD4+T and CD8+T subsets.