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Implementation Science of Integrating Pre-Exposure Prophylaxis in Pharmacist-Led Services in the United States. 美国将暴露前预防纳入药剂师主导服务的实施科学。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-01 Epub Date: 2024-05-22 DOI: 10.1007/s11904-024-00700-5
Christina Chandra, Alexis F Hudson, Daniel I Alohan, Henry N Young, Natalie D Crawford

Background: Racial inequities in HIV in the United States (US) are pervasive. Pre-exposure prophylaxis (PrEP) is one of the most effective yet underutilized HIV prevention strategies, and stark inequities in PrEP uptake exist. Lack of access to PrEP clinics is a major barrier to access that could be overcome by integrating pharmacists into the provision of PrEP services including prescribing and dispensing.

Methods: A number of reviews have shown promise in folding pharmacies into the expansion of PrEP services, but this review extends those by examining the implementation science evidence of pharmacist-led PrEP services in the US. We reviewed literature over the past five years of the implementation science of pharmacist PrEP services (2018-2023) and present seminal findings in this area.

Results: Only two studies are anchored within an implementation science framework despite all studies assessing common implementation science constructs. Overwhelming evidence supports feasibility and adoption of PrEP services in pharmacies yet gaps in workflow integration, scalability and sustainability exist.

Conclusion: Continuing to build the implementation science evidence of pharmacy-based PrEP services is critical to standardize our measures across varying contexts and inform policy efforts that support pharmacy-based PrEP services.

背景:在美国,艾滋病毒的种族不平等现象十分普遍。暴露前预防(PrEP)是最有效的艾滋病预防策略之一,但却未得到充分利用,而在 PrEP 的使用方面却存在着明显的不平等。无法到 PrEP 诊所就诊是阻碍人们接受 PrEP 的一个主要障碍,而将药剂师纳入 PrEP 服务(包括处方和配药)的提供范围,则可以克服这一障碍:许多综述都显示了将药房纳入 PrEP 服务的前景,但本综述通过研究美国药剂师主导的 PrEP 服务的实施科学证据,对这些综述进行了扩展。我们回顾了过去五年(2018-2023 年)药剂师 PrEP 服务实施科学方面的文献,并介绍了该领域的开创性发现:尽管所有研究都评估了共同的实施科学构建,但只有两项研究立足于实施科学框架。大量证据支持药房提供 PrEP 服务的可行性和采用率,但在工作流程整合、可扩展性和可持续性方面仍存在差距:结论:继续建立药房 PrEP 服务的实施科学证据对于在不同情况下统一我们的衡量标准以及为支持药房 PrEP 服务的政策工作提供信息至关重要。
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引用次数: 0
Challenges and Opportunities in Big Data Science to Address Health Inequities and Focus the HIV Response. 大数据科学在解决健康不平等问题和集中应对艾滋病毒方面的挑战与机遇。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-01 Epub Date: 2024-06-25 DOI: 10.1007/s11904-024-00702-3
Katherine Rucinski, Jesse Knight, Kalai Willis, Linwei Wang, Amrita Rao, Mary Anne Roach, Refilwe Phaswana-Mafuya, Le Bao, Safiatou Thiam, Peter Arimi, Sharmistha Mishra, Stefan Baral

Purpose of review: Big Data Science can be used to pragmatically guide the allocation of resources within the context of national HIV programs and inform priorities for intervention. In this review, we discuss the importance of grounding Big Data Science in the principles of equity and social justice to optimize the efficiency and effectiveness of the global HIV response.

Recent findings: Social, ethical, and legal considerations of Big Data Science have been identified in the context of HIV research. However, efforts to mitigate these challenges have been limited. Consequences include disciplinary silos within the field of HIV, a lack of meaningful engagement and ownership with and by communities, and potential misinterpretation or misappropriation of analyses that could further exacerbate health inequities. Big Data Science can support the HIV response by helping to identify gaps in previously undiscovered or understudied pathways to HIV acquisition and onward transmission, including the consequences for health outcomes and associated comorbidities. However, in the absence of a guiding framework for equity, alongside meaningful collaboration with communities through balanced partnerships, a reliance on big data could continue to reinforce inequities within and across marginalized populations.

审查目的:大数据科学可用于务实地指导国家艾滋病项目中的资源分配,并为优先干预措施提供信息。在本综述中,我们讨论了大数据科学立足于公平和社会正义原则的重要性,以优化全球艾滋病应对措施的效率和效果:在艾滋病研究中,大数据科学的社会、伦理和法律因素已被确定。然而,减轻这些挑战的努力却很有限。其后果包括艾滋病毒领域内的学科孤岛、缺乏与社区的有意义接触和所有权以及分析可能被误解或挪用,从而可能进一步加剧健康方面的不平等。大数据科学可以通过帮助确定以前未被发现或研究不足的艾滋病毒感染和继续传播途径中的差距,包括对健康结果和相关合并症的影响,来支持艾滋病毒应对工作。然而,如果没有一个公平的指导框架,同时通过平衡的伙伴关系与社区开展有意义的合作,那么对大数据的依赖可能会继续加剧边缘化人群内部和之间的不公平。
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引用次数: 0
Policies and Practices Facilitating Access to and Uptake of HIV Testing Services among Adolescents in Sub-Sahara Africa: A Narrative Review. 促进撒哈拉以南非洲青少年获得和接受 HIV 检测服务的政策与实践:叙述性综述》。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-01 Epub Date: 2024-05-30 DOI: 10.1007/s11904-024-00701-4
Dorothy Serwaa Boakye, Emmanuel Kumah, Samuel Adjorlolo

Purpose of review: Expanding access to HIV testing services and linking newly diagnosed positive adolescents to antiretroviral therapy is critical to epidemic control. However, testing coverage and treatment initiation rates continue to lag behind adult counterparts. This article synthesizes evidence on facilitative policies and service delivery practices focused on adolescents to inform programming.

Recent findings: Our narrative review found that national policies are growing more adolescent-inclusive but barriers around the age of consent, waiver frameworks and dissemination constrain translate into practice. Facility-based provider-initiated testing through integrated sexual health services and dedicated youth centres demonstrates uptake effectiveness if confidentiality and youth-friendly adaptations are assured. Supportive policies, youth-responsive adaptations across testing models and strengthening age-disaggregated monitoring are vital to improving adolescents' engagement across the HIV testing and treatment cascade. Further implementation research is imperative to expand the reach of adolescent HIV testing in sub-Saharan Africa.

审查目的:扩大艾滋病毒检测服务的覆盖面,并将新确诊的阳性青少年与抗逆转录病毒治疗联系起来,对于控制疫情至关重要。然而,检测覆盖率和治疗启动率仍然落后于成人。本文综述了以青少年为重点的促进性政策和服务提供实践的证据,以便为计划制定提供参考:我们的叙述性综述发现,国家政策越来越多地将青少年纳入其中,但在同意年龄、豁免框架和传播方面存在的障碍制约了这些政策在实践中的转化。通过综合性健康服务机构和专门的青年中心进行的基于医疗机构的主动检测,如果能确保保密性和对青年友好的适应性,就能显示出其有效性。支持性政策、在各种检测模式中对青年做出相应调整以及加强按年龄分类的监测,对于提高青少年参与整个艾滋病检测和治疗过程至关重要。要在撒哈拉以南非洲扩大青少年艾滋病检测的覆盖面,进一步的实施研究势在必行。
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引用次数: 0
Getting HIV Pre-exposure Prophylaxis (PrEP) into Private Pharmacies: Global Delivery Models and Research Directions. 将艾滋病毒暴露前预防疗法(PrEP)引入私人药房:全球交付模式与研究方向》。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-03-22 DOI: 10.1007/s11904-024-00696-y
Stephanie D Roche, Daniel Were, Natalie D Crawford, Angela Tembo, Jillian Pintye, Elizabeth Bukusi, Kenneth Ngure, Katrina F Ortblad

Purpose of review: To provide an overview of the current state of HIV pre-exposure prophylaxis (PrEP) delivery via private sector pharmacies globally, to discuss the context-specific factors that have influenced the design and implementation of different pharmacy-based PrEP delivery models in three example settings, and to identify future research directions.

Recent findings: Multiple high- and low-income countries are implementing or pilot testing PrEP delivery via private pharmacies using a variety of delivery models, tailored to the context. Current evidence indicates that pharmacy-based PrEP services are in demand and generally acceptable to clients and pharmacy providers. Additionally, the evidence suggests that with proper training and oversight, pharmacy providers are capable of safely initiating and managing clients on PrEP. The delivery of PrEP services at private pharmacies also achieves similar levels of PrEP initiation and continuation as traditional health clinics, but additionally reach individuals underserved by such clinics (e.g., young men; minorities), making pharmacies well-positioned to increase overall PrEP coverage. Implementation of pharmacy-based PrEP services will look different in each context and depend not only on the state of the private pharmacy sector, but also on the extent to which key needs related to governance, financing, and regulation are addressed. Private pharmacies are a promising delivery channel for PrEP in diverse settings. Countries with robust private pharmacy sectors and populations at HIV risk should focus on aligning key areas related to governance, financing, and regulation that have proven critical to pharmacy-based PrEP delivery while pursuing an ambitious research agenda to generate information for decision-making. Additionally, the nascency of pharmacy-based PrEP delivery in both high- and low-and-middle-income settings presents a prime opportunity for shared learning and innovation.

综述目的:概述全球通过私营药店提供艾滋病暴露前预防(PrEP)服务的现状,讨论影响在三个实例环境中设计和实施基于药店的不同 PrEP 服务模式的具体因素,并确定未来的研究方向:最新研究结果:多个高收入和低收入国家正在实施或试点测试通过私营药店提供 PrEP,并根据具体情况采用了多种提供模式。目前的证据表明,以药房为基础的 PrEP 服务是有需求的,而且普遍为客户和药房提供者所接受。此外,有证据表明,通过适当的培训和监督,药房提供者有能力安全地启动和管理 PrEP 的客户。在私人药店提供 PrEP 服务也能达到与传统诊所类似的 PrEP 启动和持续水平,而且还能惠及诊所服务不足的人群(如年轻男性、少数民族),这使药店在提高 PrEP 的总体覆盖率方面处于有利地位。以药房为基础的 PrEP 服务的实施将因地制宜,不仅取决于私营药房行业的状况,还取决于与治理、融资和监管相关的关键需求的解决程度。在不同的环境下,私营药店是 PrEP 的一个很有前景的提供渠道。那些拥有强大的私营药房行业和艾滋病高危人群的国家应将重点放在与治理、融资和监管相关的关键领域,这些领域已被证明对药房提供 PrEP 至关重要,同时推行雄心勃勃的研究议程,为决策提供信息。此外,在高收入和中低收入环境中,以药房为基础的 PrEP 服务刚刚起步,这为共同学习和创新提供了绝佳机会。
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引用次数: 0
Digital Strategies Supporting Social Network Approaches to HIV Testing: A Scoping Review. 支持艾滋病毒检测社交网络方法的数字战略:范围审查。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-05-11 DOI: 10.1007/s11904-024-00699-9
Zhuoheng Yin, Yumeng Du, Weibin Cheng, Weiming Tang

Purpose of review: This review captured how digital strategies support social network approaches to promote HIV testing.

Recent finding: Overall, 29 studies were identified by searching PubMed and Embase for studies published up to June 2023. Existing studies revealed three types of digital strategies (social media (n = 28), online information channels (n = 4), and multifunctional digital platforms (n = 4)) split into four major modes of digital strategy-supported social-network-based HIV testing promotion: 1) Online outreach and recruiting, 2) gathering and identifying key populations for HIV testing, 3) communicating and disseminating online HIV testing health interventions, and 4) assisting and facilitating HIV testing uptake and distribution. Social network approaches supported by digital strategies yielded advantages in HIV testing education and distribution, which increases HIV testing coverage among key populations. Studies are needed on how to facilitate the use of digital strategies for social network-based HIV testing, as well as how to integrate them with existing HIV testing approaches.

综述目的:本综述记录了数字策略如何支持社交网络方法来促进艾滋病检测:通过搜索 PubMed 和 Embase 上截至 2023 年 6 月发表的研究,共发现了 29 项研究。现有研究揭示了三种类型的数字策略(社交媒体(n = 28)、在线信息渠道(n = 4)和多功能数字平台(n = 4)),分为基于社交网络的艾滋病检测推广的四种主要数字策略支持模式:1) 在线推广和招募,2) 收集和确定 HIV 检测的关键人群,3) 在线交流和传播 HIV 检测健康干预措施,4) 协助和促进 HIV 检测的接受和传播。在数字战略支持下的社会网络方法在艾滋病病毒检测教育和分发方面产生了优势,从而提高了艾滋病病毒检测在重点人群中的覆盖率。需要研究如何促进数字策略在基于社会网络的艾滋病毒检测中的应用,以及如何将其与现有的艾滋病毒检测方法相结合。
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引用次数: 0
Synthetic Controls for Implementation Science: Opportunities for HIV Program Evaluation Using Routinely Collected Data. 实施科学的合成控制:利用常规收集的数据进行艾滋病项目评估的机会。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-03-13 DOI: 10.1007/s11904-024-00695-z
Sara Wallach, Suzue Saito, Harriet Nuwagaba-Biribonwoha, Lenhle Dube, Matthew R Lamb

Purpose of review: HIV service delivery programs are some of the largest funded public health programs in the world. Timely, efficient evaluation of these programs can be enhanced with methodologies designed to estimate the effects of policy. We propose using the synthetic control method (SCM) as an implementation science tool to evaluate these HIV programs.

Recent findings: SCM, introduced in econometrics, shows increasing utility across fields. Key benefits of this methodology over traditional design-based approaches for evaluation stem from directly approximating pre-intervention trends by weighting of candidate non-intervention units. We demonstrate SCM to evaluate the effectiveness of a public health intervention targeting HIV health facilities with high numbers of recent infections on trends in pre-exposure prophylaxis (PrEP) enrollment. This test case demonstrates SCM's feasibility for effectiveness evaluations of site-level HIV interventions. HIV programs collecting longitudinal, routine service delivery data for many facilities, with only some receiving a time-specified intervention, are well-suited for evaluation using SCM.

审查目的:艾滋病服务项目是世界上资金投入最大的公共卫生项目之一。对这些项目进行及时、高效的评估,可以通过旨在估算政策效果的方法得到加强。我们建议使用合成控制法(SCM)作为实施科学工具来评估这些艾滋病项目:最近的研究结果:SCM 是在计量经济学中引入的,在各个领域的实用性日益增强。与传统的基于设计的评估方法相比,该方法的主要优势在于通过对候选的非干预单位进行加权,直接逼近干预前的趋势。我们将 SCM 用于评估一项公共卫生干预措施的有效性,该干预措施针对的是近期感染人数较多的艾滋病医疗机构,评估的是暴露前预防疗法(PrEP)的注册趋势。该测试案例证明了 SCM 在现场级 HIV 干预有效性评估中的可行性。艾滋病项目收集了许多机构的纵向、常规服务提供数据,其中只有部分机构接受了规定时间的干预措施,因此非常适合使用 SCM 进行评估。
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引用次数: 0
The Impact of Cannabis Use on Cognition in People with HIV: Evidence of Function-Dependent Effects and Mechanisms from Clinical and Preclinical Studies 使用大麻对 HIV 感染者认知能力的影响:来自临床和临床前研究的功能依赖效应和机制证据
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-04-11 DOI: 10.1007/s11904-024-00698-w
Samantha M. Ayoub, Breanna M. Holloway, Alannah H. Miranda, Benjamin Z. Roberts, Jared W. Young, Arpi Minassian, Ronald J. Ellis

Purpose of Review

Cannabis may have beneficial anti-inflammatory effects in people with HIV (PWH); however, given this population’s high burden of persisting neurocognitive impairment (NCI), clinicians are concerned they may be particularly vulnerable to the deleterious effects of cannabis on cognition. Here, we present a systematic scoping review of clinical and preclinical studies evaluating the effects of cannabinoid exposure on cognition in HIV.

Recent Findings

Results revealed little evidence to support a harmful impact of cannabis use on cognition in HIV, with few eligible preclinical data existing. Furthermore, the beneficial/harmful effects of cannabis use observed on cognition were function-dependent and confounded by several factors (e.g., age, frequency of use).

Summary

Results are discussed alongside potential mechanisms of cannabis effects on cognition in HIV (e.g., anti-inflammatory), and considerations are outlined for screening PWH that may benefit from cannabis interventions. We further highlight the value of accelerating research discoveries in this area by utilizing translatable cross-species tasks to facilitate comparisons across human and animal work.

综述目的大麻可能对艾滋病病毒感染者(PWH)具有有益的抗炎作用;然而,鉴于这一人群的持续神经认知障碍(NCI)负担较高,临床医生担心他们可能特别容易受到大麻对认知的有害影响。在此,我们对评估大麻素暴露对 HIV 认知影响的临床和临床前研究进行了系统的范围界定综述。最新研究结果研究结果显示,几乎没有证据支持使用大麻会对 HIV 的认知产生有害影响,符合条件的临床前数据也很少。此外,所观察到的使用大麻对认知的有益/有害影响与功能有关,并受多种因素(如年龄、使用频率)的影响。摘要研究结果与大麻对艾滋病认知的潜在影响机制(如抗炎)一起进行了讨论,并概述了筛选可能受益于大麻干预的艾滋病感染者的注意事项。我们进一步强调了通过利用可转化的跨物种任务来促进人类和动物工作之间的比较,从而加快该领域研究发现的价值。
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引用次数: 0
A 5-Year Review of the Impact of Lottery Incentives on HIV-Related Services 彩票奖励对艾滋病相关服务影响的五年回顾
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-04-04 DOI: 10.1007/s11904-024-00694-0

Abstract

Purpose of review

Lottery incentives are an innovative approach to encouraging HIV prevention, treatment initiation, and adherence behaviours. This paper reviews the latest research on lottery incentives’ impact on HIV-related services, and their effectiveness for motivating behaviours to improve HIV service engagement and HIV health outcomes.

Recent findings

Our review of ten articles, related to lottery incentives, published between 2018 and 2023 (inclusive) shows that lottery incentives have promise for promoting HIV-related target behaviours. The review highlights that lottery incentives may be better for affecting simpler behaviours, rather than more complex ones, such as voluntary medical male circumcision. This review recommends tailoring lottery incentives, ensuring contextual-relevance, to improve the impact on HIV-related services.

Summary

Lottery incentives offer tools for improving uptake of HIV-related services. The success of lottery incentives appears to be mediated by context, the value and nature of the incentives, and the complexity of the target behaviour.

摘要 审查目的 彩票奖励是鼓励艾滋病预防、开始治疗和坚持治疗行为的一种创新方法。本文回顾了有关彩票激励对艾滋病相关服务的影响的最新研究,以及彩票激励对改善艾滋病服务参与度和艾滋病健康结果的行为激励效果。 最新研究结果 我们对2018年至2023年(含2023年)期间发表的10篇与彩票激励相关的文章进行了回顾,结果显示彩票激励有望促进艾滋病相关目标行为。综述强调,彩票激励措施可能更适合影响较简单的行为,而不是较复杂的行为,如自愿包皮环切手术。本综述建议调整彩票激励措施,确保与实际情况相关,以提高对艾滋病相关服务的影响。 总结 彩票激励措施为提高艾滋病相关服务的吸收率提供了工具。彩票激励措施的成功与否似乎取决于环境、激励措施的价值和性质以及目标行为的复杂性。
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引用次数: 0
Complex Decisions in HIV-Related Cryptococcosis: Addressing Second Episodes of Cryptococcal Meningitis. 艾滋病相关隐球菌病的复杂决策:应对隐球菌性脑膜炎的二次发作。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-04-01 Epub Date: 2024-02-24 DOI: 10.1007/s11904-024-00691-3
Abdu Musubire, Enock Kagimu, Timothy Mugabi, David B Meya, David R Boulware, Nathan C Bahr

Purpose of review: This review highlights the difficulties in diagnosing and treating persons with a prior history of cryptococcal meningitis who improve but suffer from a recurrence of symptoms. This scenario is well known to those who frequently care for patients with cryptococcal meningitis but is not well understood. We highlight major gaps in knowledge.

Recent findings: We recently summarized our experience with 28 persons with paradoxical immune reconstitution inflammatory syndrome (IRIS) and 81 persons with microbiological relapse. CD4 count and cerebrospinal fluid white blood cell count were higher in IRIS than relapse but neither was reliable enough to routinely differentiate these conditions. Second-episode cryptococcal meningitis remains a difficult clinical scenario as cryptococcal antigen, while excellent for initial diagnosis has no value in differentiating relapse of infection from other causes of recurrent symptoms. Updated research definitions are proposed and rapid, accurate diagnostic tests are urgently needed.

综述的目的:本综述强调了在诊断和治疗曾患隐球菌脑膜炎但病情好转但症状复发的患者时所遇到的困难。经常护理隐球菌性脑膜炎患者的人都知道这种情况,但对其了解不多。我们强调了知识方面的主要差距:我们最近总结了 28 例矛盾性免疫重建炎症综合征(IRIS)患者和 81 例微生物复发患者的经验。IRIS患者的CD4计数和脑脊液白细胞计数高于复发患者,但两者都不足以可靠地常规区分这两种情况。二次发作的隐球菌脑膜炎仍然是一种临床难题,因为隐球菌抗原虽然对初步诊断非常有效,但在区分感染复发和其他原因引起的症状复发方面没有价值。我们提出了最新的研究定义,并迫切需要快速、准确的诊断测试。
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引用次数: 0
HIV-1 Myeloid Reservoirs - Contributors to Viral Persistence and Pathogenesis. HIV-1 髓细胞储库--病毒持续存在和发病机制的贡献者。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-04-01 Epub Date: 2024-02-27 DOI: 10.1007/s11904-024-00692-2
Edna A Ferreira, Janice E Clements, Rebecca T Veenhuis

Purpose of review: HIV reservoirs are the main barrier to cure. CD4+ T cells have been extensively studied as the primary HIV-1 reservoir. However, there is substantial evidence that HIV-1-infected myeloid cells (monocytes/macrophages) also contribute to viral persistence and pathogenesis.

Recent findings: Recent studies in animal models and people with HIV-1 demonstrate that myeloid cells are cellular reservoirs of HIV-1. HIV-1 genomes and viral RNA have been reported in circulating monocytes and tissue-resident macrophages from the brain, urethra, gut, liver, and spleen. Importantly, viral outgrowth assays have quantified persistent infectious virus from monocyte-derived macrophages and tissue-resident macrophages. The myeloid cell compartment represents an important target of HIV-1 infection. While myeloid reservoirs may be more difficult to measure than CD4+ T cell reservoirs, they are long-lived, contribute to viral persistence, and, unless specifically targeted, will prevent an HIV-1 cure.

审查目的:艾滋病毒储库是治愈的主要障碍。作为主要的 HIV-1 库,CD4+T 细胞已被广泛研究。然而,大量证据表明,HIV-1 感染的髓样细胞(单核细胞/巨噬细胞)也对病毒的持续存在和发病机制做出了贡献:最近对动物模型和 HIV-1 感染者的研究表明,髓系细胞是 HIV-1 的细胞储库。据报道,在循环单核细胞和来自大脑、尿道、肠道、肝脏和脾脏的组织驻留巨噬细胞中存在 HIV-1 基因组和病毒 RNA。重要的是,病毒增殖试验对单核细胞衍生巨噬细胞和组织驻留巨噬细胞中的持续感染病毒进行了量化。髓系细胞是 HIV-1 感染的一个重要目标。虽然髓系细胞储库可能比 CD4+ T 细胞储库更难测量,但它们寿命长,有助于病毒的持续存在,除非有针对性,否则将阻碍 HIV-1 的治愈。
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引用次数: 0
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Current HIV/AIDS Reports
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