Silver S, Wahl S M, Orkin B A, Orenstein J M
Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA.
J Hum Virol. 1999 Jan-Feb;2(1):52-7.
To determine CD4+ T-cell count and circulating and tissue levels of HIV before and after surgery in a patient with recent-onset ulcerative colitis.
STUDY DESIGN/METHODS: CD4 lymphocytes and circulating and tissue HIV RNA levels were measured in an HIV-infected patient with ulcerative colitis before and after proctocolectomy.
Approximately 3 weeks prior to surgery for ulcerative colitis that was unresponsive to corticosteroids, the patient's CD4 count was 930 cells/mm3 and fell to 313 cells/mm3 within 10 days; the viral burden was approximately 80,000 RNA copies/mL. Tissue macrophages and lymphocytes in biopsy and resection specimens were shown to express high levels of HIV RNA by in situ hybridization. Five days postoperatively, the patient became asymptomatic and was discharged on tapering prednisone without antiretroviral agents. After surgery, the patient's CD4 count progressively rose, while viral RNA levels precipitously dropped. At 3, 6, and 15 weeks postoperatively, CD4 and viral RNA counts were 622 cells/mm3 and 31,300 RNA copies/mL, 843 cells/mm3 and 11,400 RNA copies/mL, and 747 cells/mm3 and 1500 RNA copies/mL, respectively.
Circulating levels of HIV and CD4+ cells, as well as tissue expression of HIV, apparently can be influenced by localized inflammatory processes such as those occurring in inflammatory bowel disease.
确定一名近期发病的溃疡性结肠炎患者手术前后的CD4+ T细胞计数以及HIV的循环水平和组织水平。
研究设计/方法：对一名患有溃疡性结肠炎的HIV感染患者在直肠结肠切除术前和术后测量CD4淋巴细胞以及HIV RNA的循环水平和组织水平。
在因溃疡性结肠炎接受手术（对皮质类固醇无反应）前约3周，患者的CD4计数为930个细胞/mm3，并在10天内降至313个细胞/mm3；病毒载量约为80,000 RNA拷贝/mL。活检和切除标本中的组织巨噬细胞和淋巴细胞通过原位杂交显示出高水平的HIV RNA表达。术后5天，患者无症状，在逐渐减量的泼尼松治疗下出院，未使用抗逆转录病毒药物。术后，患者的CD4计数逐渐上升，而病毒RNA水平急剧下降。术后3周、6周和15周时，CD4和病毒RNA计数分别为622个细胞/mm3和31,300 RNA拷贝/mL、843个细胞/mm3和11,400 RNA拷贝/mL、747个细胞/mm3和1500 RNA拷贝/mL。
HIV的循环水平和CD4+细胞，以及HIV的组织表达，显然会受到局部炎症过程（如炎症性肠病中发生的那些过程）的影响。
