| Objective:At present, the AIDS epidemic situation is still grim, HAART has made great achievements, despite limitations still existed. It was proved that effect of traditional Chinese medicine (TCM) in the treatment of AIDS. What aspects we can treat AIDS by traditional Chinese medicine? What are the advantages of TCM treatment of AIDS? What effects of HAART combined with traditional Chinese medicine on HIV-1proviral DNA of HIV/AIDS individuals with HIV-1RNA suppressed? In this paper, we found fields TCM treatment of AIDS from HAART treatment database of Yunnan province. The change of immune cells and relative counts of HIV-1pro virus DNA through Randomized double-blind trial of HAART combined with TCM.Methods:First, the databases of HAART of Tengchong and Xiangyun counties were reviewed, including CD4+T cell counts, CD8+T cell counts, copies of HIV-1load, and et al. The general linear model multivariate analysis was applied for investigated the factors of recovery of CD4+T cell counts. T the risk factors of death after HAART were analyzed by the Kaplan-Meier analysis.Second, we explored correlation between T absolute count and duration time of HAART and correlation between T cell and HIV-1proviral DNA in AIDS individuals with persistently undetectable plasma HIV-1RNA levels.Finally, copies of env, gag, pol gene of HIV-1proviral DNA were simultaneously detected by GeXP multiple genetic analysis system, the average copies of3structural genes as copies of HIV-1previous DNA, thereby, the effect of HIV-1proviral DNA by HAART combined with TCM was researched.Results:1. The databases of HAART of Tengchong and Xiangyun counties were reviewed, we found:(1) The median CD4+T cell count increased to287cells/μl (interquartile range,204-378cells/μl) among patients with a baseline CD4+T cell count<200cells/μl, to513cells/μl (interquartile range,469-522cells/μl) among those with a baseline CD4+T cell count>200cells/μ, the median CD4+T cell count were statistically higher in the≥200cells/μl group during the follow-up except at51months (P＜0.05), the significant increases of CD4+T cell count were seen in the first12months in each group, until24months it reached plateau.(2) It weren’t that the median CD8+T cell count hadn’t significantly increase or decrease in all patients included or different groups.The median CD8+T cell count were statistically lower in the≥200cells/μl group than CD4+T cell count<200cells/μl group during the follow-up except in24and42months(P<0.05).(3) The percentage of all patients who achieved a CD4+T cell count500cells/μl low25%, or350cells/μl after receiving60months of HAART were62.5%. The percentage who reached CD4+T cell count of500cells/μl were significant difference between CD4+T cell count<200cells/μl and CD4+T cell count≥200cells/μl groups except45months and54months (P＜0.05), and the percentage who reached CD4+T cell count of350cells/μl were significant difference between groups divided by baseline CD4+T cell count.(4) After60months HAART initiation, the percentage of HIV-1RNA under50copies/ml was74.4%.At48months,100%of treated individuals had undetectable plasma HIV-1RNA levels The percentage of patients reaching HIV-1RNA levels below50copies/ml during0to48months was no difference between the CD4+T cell count<200cells/μl and CD4+T cell count>200cells/μl groups (P>0.05).(5) In the multivariate model sex, the mode of HIV transmission, baseline CD4+T cell count and HIV-1RNA baseline load were correction with the recovery median count of CD4+T cell (P＜0.05). Age, HIV-1disease WTO category, baseline CD8+T cell, HCV and HBV positive were not independently associated with the was an independent factor of increase of CD4T-lymphocyte at60months (P>0.05).(6). There were significant differences in CD4+T cell subgroups (100,101-199,200-299,>300cell/ml). Univariate and multivariate analyses using Cox proportional hazards regression showed that age and HIV-1disease WTO category were the factors associated with death after HAART. Patients50years or older at HAART initiation had more than3.114fold risk of death relative to those younger than50years of age. WHO HIV-1higher category was3.464times than lower category. HAART duration and HIV-1transmission category were protection factors, the death of heterosexual HIV-1transmission and duration of HAART exceed12months reduced to0.159and0.078, respectively.(7) During60months of HAART follow-up, the abnormal percents of white blood cell were not significantly decreased, remained above95%, however, the percentages of less than normal were declined; the percentages less than the normal of total lymphocyte were downward trend; abnormal percentages of platelet declined, percentages of platelets less than normal also were decreased; hemoglobin were slowly increased, the percents less than normal hemoglobin were decline, the proportions greater than the normal were upward.(8) After HAART, the biochemistry immunity appeared unusual. Druing HARRT60months follow-up, the percentages of blood CREA been smaller than normal value rised gradually, the percentages of blood CREA been higher than normal decreased gradually; the unusual percentages of BUN were not obvious change; the abnormal percentages of TGL were gradually increased; The unusual percentages of Total cholesterol TC were gradually up; the rates of abnormality of BA were unobviously; the unusual percentages of AST were gradually deceased, the unusual percentage of ALT been bigger than normal value were decreased; the change of TC were not obviously.2. Study on correlations between T cells, duration of HAART and HIV-1proviral DNA, we found:(1) Duration time of HAART was positive related to CD4+CD28+CD4+CD45RA+、CD4+CD45RO+T cells absolute counts.(2) It was shown that correlation of HAART duration to frequency of CD8+CD38+CD3+, CD8+T cells were inverse correlation, however, there was positive correlation with frequency of CD38+(3) CD4+absolute count was positively related to the frequency of CD4+CD28+CD4+CD45RO+T cells. It was inversly correlated with the proportion of CD8+CD38+T cells.(4) Log copies of HIV-1proviral DNA was positive related to CD4+CD45RA+T cell absolute and relative counts. It was shown that correlation of Log copy of HIV-1proviral DNA to CD38+T cell was positive correlation.(5) Duration time of HAART was no correlation to HIV-1proviral DNA.3.126HIV/AIDS with HIV-1RNA suppressed under detection threshold undivided by HAART+placebo group and the HAART plus TCM (Kang ai bao sheng concentrated pill) group, the T lymphocyte subgroup, the NK cell, cytokine and HIV-1proviral DNA were examined during12months, the results:(1) The differences of CD4+T cells and CD4+CD45RO+T cell relative counts of two groups were significant at3months(P=0.029, P=0.028), The differences of CD8+CD38+T cell relative counts of two groups were significant(P=0.029) at6months.(2) From the9months, NK cell absolute counts of HAART plus TCM were higher than the HAART+placebo group, NK cell absolute counts of two groups were significant difference (P=0.032) at12months.(3) after6months, CD4+T absolute counts of HIV/AIDS individuals with CD4+T cells baseline <200cells/μl treated by HAART combined with TCM were higher than HAART+placebo group, there is no significantly statistical difference (P=0.015).(4) IL-1, IL-10were no significant difference between HAART combined with TCM and HAART+placebo groups.(5)At3months,the relative counts of HIV-1proviral DNA pol gene of HAART plus TCM group were lower than HAART+placebo group (P＜0.050). HIV/AIDS CD4+T cells baseline<200cells/μl when introlled treated by HAART plus TCM, the relative counts of HIV-1proviral DNA of HAART group were significant differences than HAART+placebo group,at3months(P<0.05).Conclusion:1. We can choose the following aspects of TCM of treatment of AIDS:HIV/AIDS patients with not compatible with antiviral treatment standard; HIV/AIDS individuals with incompletedmmunologic reconstitution and HIV virus suppression after HAART; abnormal blood lipid metabolism, liver and kidney in HIV/AIDS individuals when infected HIV and during HAART; HIV-1proviral DNA.2. HIV-1proviral DNA persisted exited although long-term HAART, it was no correlation with CD4+T cells and counts of HIV-1proviral DNA.3.The advantages of HAART combined with TCM was HIV/AIDS patients with HIV-1RNA suppressed and CD4+T cells<200个/μl although HAART intitation. The advantages and characteristic are interrelated with multiple target effect, so we should study the effect target and mechanism from many angles in future. |
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