协和医学杂志

2019, v.10(03) 197-200

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HIV感染真的被“治愈”了吗?
Is HIV Infection Really Cured?

秦岭;李太生;
QIN Ling;LI Tai-sheng;Department of Infectious Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Clinical Immunology Center,Chinese Academy of Medical Sciences;Center for AIDS Research,Chinese Academy of Medical Sciences;School of Medicine,Tsinghua University;

摘要(Abstract):

人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染靶细胞需要识别细胞表面CD4分子及其辅助受体,C-C趋化因子受体5 (C-C chemokine receptor type 5,CCR5)和C-X-C趋化因子受体4 (C-X-C-motif receptor 4,CXCR4)是HIV识别靶细胞的两种重要辅助受体。CCR5Δ32基因突变使得HIV无法识别CCR5受体,从而阻止嗜CCR5的HIV病毒株入侵靶细胞。"柏林病人"和"伦敦病人"正是利用这一原理,通过移植携带纯合子CCR5Δ32突变基因的异基因骨髓,实现了停用抗病毒药物后病毒无反弹的目标,故而被誉为HIV感染"治愈"案例。然而,这一成功是否存在偶然性?事实上,人群中携带CCR5Δ32纯合子基因突变概率极低、异基因骨髓配型十分困难、骨髓移植医疗费用昂贵、移植后HIV病毒株嗜性迁移等客观因素的存在,使得通过携带纯合子CCR5Δ32基因突变异基因骨髓移植法实现HIV感染者停用抗病毒药物且保持病毒不反弹的目标困难重重。因此,"柏林病人"和"伦敦病人"的成功经验为治疗HIV感染提供了新的方向和希望,但如认为HIV感染已被"治愈"为时尚早,需进一步研究证实。
Infection with the human immunodeficiency virus( HIV) requires the presence of CD4 receptors and chemokine receptors. Two of the most principal chemokine receptors are C-C chemokine receptor 5( CCR5) and/or the chemokine( C-X-C motif) receptor 4( CXCR4). Homozygosity of a 32-bp deletion in the CCR5 allele provides resistance against the cellular entry of CCR5-tropic HIV strains. The successful long-term control of HIV by allogeneic haematopoietic stem cell transplantations( allo-HSCT) from a donor who was homozygous for CCR5 delta32,had been documented as a "Berlin patient"and a "London patient". They both had remained without viral recrudescence after transplantation and discontinuation of antiretroviral therapy.However,a wide application of allo-HSCT from donors with homozygous CCR5 delta32 mutation for HIV remission is still quite challenging so far under the condition of a low percentage of homozygous CCR5 delta32 mutation,high risk of allo-HSCT,HIV tropism shift after HSCT,and huge expense. Although the "Berlin patient"and the "London patient"take a new hope to control HIV infection,it is still too early to conclude that the"cure"of HIV infection has been achieved.

关键词(KeyWords): 人类免疫缺陷病毒;柏林病人;伦敦病人;CCR5Δ32突变
human immunodeficiency virus;Berlin patient;London patient;CCR5 delta 32 mutation

Abstract:

Keywords:

基金项目(Foundation): 中国医学科学院医学与健康科技创新工程项目(2017-I2M-1-014);; 国家“十三五”重大科技专项(2017ZX10202101)

作者(Author): 秦岭;李太生;
QIN Ling;LI Tai-sheng;Department of Infectious Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Clinical Immunology Center,Chinese Academy of Medical Sciences;Center for AIDS Research,Chinese Academy of Medical Sciences;School of Medicine,Tsinghua University;

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