Volume 04 · Issue 04 · 2024

自1984年首次发现和分离人类免疫缺陷病毒（HIV）以来，四十年已经过去了。^[1,2]截至2022年底，全球约有8560万人感染了该病毒，4040万人死于获得性免疫缺陷综合征（AIDS）相关疾病。^[3]据估计，全世界有3900万人感染艾滋病毒（PLH）。^[3]2021年，联合国发布了新的《关于艾滋病毒/艾滋病的政治宣言》，承诺采取紧急和变革性的行动，到2030年终结艾滋病。^[4]该政治宣言敦促各国向95%的艾滋病毒高危人群提供以人为本的有效艾滋病毒预防方案，并确保到2025年95%的PLH人知道自己的艾滋病毒状况，95%的PLH人知道自己的艾滋病毒状况，95%的PLH人接受艾滋病毒治疗，95%的接受艾滋病毒治疗的PLH人实现病毒抑制（“95-95-95-95”目标）。^[4]

今年标志着中国婴儿呼吸道合胞病毒（RSV）预防的新纪元，因为这是自RSV发现以来，我们首次拥有长效单克隆抗体nirsevimab来预防感染和相关疾病负担。我们高度支持最近的中国专家共识，该共识推荐nirsevimab作为预防第一个RSV季节之前或期间出生的婴儿RSV感染的新策略，无论他们是否患有使他们处于严重RSV疾病更高风险的风险状况。^[1]

慢性乙型肝炎病毒（HBV）感染是导致肝硬化和肝细胞癌的主要全球健康问题。目前可用的治疗方法在完全根除病毒方面具有有限的功效。^[1]HBV的持续存在很大程度上是由于病毒诱导CD8+T细胞功能障碍状态的能力。其中一个关键问题是为什么HBV特异性CD8+T细胞变得功能障碍以及如何逆转这种功能障碍。^[2,3]

Although COVID-19 no longer constitutes a "public health emergency of international concern", which still has being spreading around the world at a low level. Small molecule drugs are the main antiviral treatment for novel coronavirus recommended in China. Although a variety of small-molecule antiviral drugs against COVID-19 have been listed in China, there is no specific drug recommendation for special populations. Society of Bacterial Infection and Resistance of Chinese Medical Association, together with the National Clinical Research Center for Respiratory Disease, and the National Center for Respiratory Medicine, organized domestic experts in various fields such as respiratory, virology, infection, critical care, emergency medicine and pharmacy to release Expert Consensus on the Clinical Application of Oral Small-Molecule Antiviral Drugs against COVID-19. The main content of this consensus includes the introduction of seven small-molecule antiviral drugs against COVID-19, focusing on the drug recommendations for 14 special groups such as the elderly, patients with complicated chronic diseases, tumor patients, pregnant women, and children, and providing suggestions for clinicians to standardize drug use.

International Practice Guideline Registration for Transparency (PREPARE-2023CN617)

Since infections can lead to adverse outcomes in autoimmune bullous diseases (AIBD), this study aimed to analyze infection characteristics in AIBD, predict infection risk factors and provide probable suggestions to infection prevention, which will spot a light on early discovery and prevention of infections in AIBD patients.

This is a retrospective study of the medical records of inpatients diagnosed with AIBD at the Department of Infectious Diseases and Dermatology, Huashan Hospital from January 2017 to December 2021. We collected patients’ clinical manifestations and laboratory examination results. Risk factors for infections were evaluated using multivariate logistic regression.

A total of 263 AIBD patients were included in the study. The overall incidence of infection was 42.2% (111/263). Pemphigus had a higher infection rate (74/142, 52.1%) than bullous pemphigoid (37/121, 30.6%). Among the patients with infections, 49.5% (55/111) had bacterial infections, 13.5% (15/111) had fungal infections, 2.7% (3/111) had virus infections, and 34.2% (38/111) had mixed infections. Staphylococcus aureus and Candida were the most common pathogens in localized infections, while Cryptococcus and Candida were predominant in systemic infections. In the multivariate logistic model, pemphigus (odds ratio [OR] = 2.56, 95% confidence interval [CI] 1.41-4.63), hypoalbuminemia (OR = 3.78, 95% CI 1.68-8.50), and systemic glucocorticoid treatment (OR = 4.67, 95% CI 2.51-8.68) were independent risk factors for infection in AIBD patients. Bullous pemphigoid (OR = 3.99, 95% CI 1.03-15.45), high-dose (average > 24 mg/day) compared to low-dose (average ≤ 6 mg/day) and medium-dose (average 6-24 mg/day) systemic glucocorticoid treatment (OR = 19.31, 95% CI 3.32-112.28, and OR = 5.71, 95% CI 1.37-23.79) were associated with increased risk factors of systemic infection in AIBD patients with systemic glucocorticoid treatment. A methylprednisolone dose averaging 14 mg/day over the past three months had a 75.0% positive predictive value for infections in AIBD patients.

The incidence of infection in AIBD patients is high, with a broad spectrum of pathogens and infection locations. AIBD patients undergoing systemic glucocorticoid treatment, especially those receiving high doses in the previous three months, should be cautious about infection.

While some studies have reported the impact of COVID-19 vaccines on immune recovery and human immunodeficiency virus (HIV) reservoirs in persons living with HIV (PLWH), their findings remain inconsistent. Furthermore, limited data exist on the safety of multiple COVID-19 vaccines among PLWH. This study aimed to investigate the safety of heterological COVID-19 vaccine administration in PLWH receiving antiretroviral treatment (ART) and its effects on HIV reservoirs and immune recovery. Such an investigation can help provide a basis for vaccinations against COVID-19 in PLWH.

In this cross-sectional study, PLWH receiving ART were recruited from the outpatient clinic of the Department of Infectious Diseases at the Fifth Medical Center of the Chinese PLA General Hospital from September 1, 2021 to December 31, 2021. Fifty-three PLWH receiving ART were vaccinated against COVID-19, with 35 receiving an inactivated vaccine (IN group) and 18 receiving a recombinant protein (CHO cells) vaccine (CHO group) as the third dose. We assessed the changes in liver and kidney functions, blood lipids, and other laboratory parameters at 0, 1, 2, 4, 7, 8, 10, and 13 months after the first vaccination dose. We also monitored CD4⁺ and CD8⁺ T cell counts using flow cytometry at 0, 1, 2, 4, 7, 8, 10, and 13 months after the first vaccination dose, as well as levels of cell-associated HIV DNA (CA HIV DNA) and cell-associated HIV RNA (CA HIV RNA) in peripheral blood using the corresponding quantitative detection kits at 0, 2, and 8 months after the first vaccination dose.

No severe adverse events related to either type of COVID-19 vaccine were observed in HIV patients, irrespective of their CD4⁺ T cell levels. Both the IN and CHO groups showed significant increases in CD4⁺ T cell counts during follow-up, CD4⁺ T cells increased from 438 ± 45 cells/μL to 557 ± 48 cells/μL in the CHO group, while in the IN group, it increased from 448 ± 34 cells/μL to 572 ± 39 cells/μL (both P < 0.001). CA HIV DNA initially decreased and then increased in both groups. CA HIV RNA levels showed significantly decreased in both group after three doses of vaccination (P < 0.01 in CHO group and P < 0.001 in IN group). CD8⁺ T cells increased from 608 ± 77 cells/μL to 812 ± 116 cells/μL in the CHO group (P < 0.01), while in the IN group, it increased from 702 ± 71 cells/μL to 852 ± 68 cells/μL(P < 0.001) from baseline to the 13 month of following up.

Our data suggest that the SARS-CoV-2 booster vaccine is safe for PLWH on ART, although it may affect HIV reservoirs and CD8⁺ T cell counts.

Schistosomiasis is a prevalent health issue in numerous countries in Africa, Asia, and South America. Data regarding the coinfection of schistosomiasis with hepatitis C virus (HCV) is limited, yet this coinfection is prevalent in regions where schistosomiasis is endemic. The extent of the coinfection issue is evident in countries with a high prevalence of both diseases, such as Egypt. Coinfections with schistosomiasis result in more pronounced liver damage compared with an HCV infection alone. Schistosomiasis has been found to disrupt HCV-specific T-cell responses, resulting in high viral load, increased likelihood of HCV chronicity, and accelerated development of comorbidities in individuals with coinfection. Introducing new, directly acting antivirals for HCV treatment resulted in a marked shift in the disease landscape. This shift may have an impact on the incidence of coinfection with schistosomiasis. This review emphasizes the notable influence of schistosomiasis on the vulnerability to HCV coinfection, the gravity of the consequent liver pathology, and the effectiveness of HCV antiviral therapy.

Chimeric antigen receptor T (CAR-T) cell therapy, renowned for its successes in cancer treatment, is now entering the field of human immunodeficiency virus (HIV) therapy, presenting both opportunities and challenges. With the emergence of broadly neutralizing antibodies, multi-target CARs, and T cell receptor-like antibodies aimed at increasing specificity in targeting HIV reservoirs, CAR-T therapy is synergizing with other cutting-edge treatments, including gene-editing technologies, therapeutic vaccines, and latency-reversing agents, in pursuit of a potential functional cure. In this review, we delve into the role of CAR-T therapy in HIV treatment, highlighting its potential to overcome clinical obstacles. We discuss advancements in targeting strategies within CAR constructs and the intricate regulation of T cell proliferation and chemotaxis. Moreover, we explore the use of diverse immune cells, such as gamma-delta T cells and natural killer cells. We review advanced biotechnologies, manufacturing innovations, viral mechanisms, and immune microenvironments. We also discuss the current research landscape and potential future applications of CAR-T therapy against HIV, which remains a critical global health challenge.

西尼罗河病毒(WNV)是一种影响动物和人类的重要虫媒病毒。它是黄病毒科的黄病毒成员，主要通过库蚊蚊子。WNV的主要地方性循环发生在鸟类和蚊子之间，马和人类是死胡同宿主。虽然大多数人类感染是不明显的，但该病毒可导致流感样不适（20%）和严重的神经侵袭性疾病（<1%），并且没有特定的治疗方法或批准的人用疫苗。^[1]WNV于1937年在乌干达西尼罗河地区的一名发热妇女中首次被报道。几十年来，WNV在世界范围内引起了多次疫情，从轻微的发热性疾病到严重的脑膜脑炎，尤其是在老年人中。^[2]