사람면역결핍바이러스 감염 및 후천면역결핍증후군의 예방 및 감염관리

진범식 대한의사협회 2024 대한의사협회지 Vol.67 No.3

Background: Although the global incidence of human immunodeficiency virus (HIV) has decreased significantly since modern antiretroviral therapy (ART), new HIV infections steadily occur, in the Republic of Korea. Based on the understanding of the risk factors for HIV infection, combined strategic behavioral and biomedical interventions should be implemented to reduce HIV infection. This paper reviews the strategies for the prevention of HIV infection. Current Concepts: While the consistent use of latex condoms is effective for the prevention of HIV transmission, consistent use of condoms is low among sexually active individuals. ART can be initiated, after exposure, to prevent HIV infection (post-exposure prophylaxis) after occupational or sexual exposure, injection drug use, and other nonoccupational exposures to HIV. There is a negligible risk of sexual transmission of HIV when the HIV-infected sexual partner has durably suppressed viral replication with ART. Antiretroviral agents have been shown to be highly effective when administered prophylactically to HIV-uninfected but at-risk individuals (preexposure prophylaxis). A high-risk group, such as men who have sex with men, is required to be included in health insurance care benefits for pre-exposure prophylaxis, in addition to the current partners of HIV-infected individuals, to ensure its efficacy. Discussion and Conclusion: HIV-related deaths are rapidly decreasing, but new HIV infections continue to occur. In an environment where a cure or the development of vaccines is unlikely, a multifaceted and proactive approach is required to minimize new HIV infections.

Travel Pattern and Prescription Analysis at a Single Travel Clinic Specialized for Yellow Fever Vaccination in South Korea

진범식,김재윤,Sara Gianella,이명희 대한감염학회 2016 Infection and Chemotherapy Vol.48 No.1

Background: Travel-related risks for infectious diseases vary depending on travel patterns such as purpose, destination, and duration. In this study, we describe the patterns of travel and prescription of vaccines as well as malaria prophylaxis medication (MPM) at a travel clinic in South Korea to identify the gaps to fill for the optimization of pre-travel consultation. Materials and Methods: A cohort of travel clinic visitors in 2011 was constructed and early one-third of the visitors of each month were reviewed. During the study period, 10,009 visited the travel clinic and a retrospective chart review was performed for 3,332 cases for analysis of travel patterns and prescriptions. Results: People receiving yellow fever vaccine (YFV) (n = 2,933) were traveling more frequently for business and tourism and less frequently for providing non-medical service or research/ education compared to the 399 people who did not receive the YFV. Overall, most people were traveling to Eastern Africa, South America, and Western Africa, while South-Eastern Asia was the most common destination for the non-YFV group. Besides YFV, the typhoid vaccine was the most commonly prescribed (54.2%), while hepatitis A presented the highest coverage (74.7%) considering the natural immunity, prior and current vaccination history. Additionally, 402 (82.5%) individuals received a prescription for MPM among the 487 individuals travelling to areas with high-risk of malaria infection. Age over 55 was independently associated with receiving MPM prescription, while purpose of providing service and travel duration over 10 days were associated with no MPM prescription, despite travelling to high-risk areas. Conclusion: Eastern Africa and South America were common travel destinations among the visitors to a travel clinic for YFV, and most of them were travelling for tourism and business. For the individuals who are traveling to areas with high-risk for malaria, more proactive approach might be required in case of younger age travelers, longer duration, and travel purpose of providing service to minimize the risk of malaria infection.

국내 HIV 감염 역학의 변화와 pre & post-exposure prophylaxis

진범식 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.2

Similar Durability of Two Single Tablet Regimens, Dolutegravir/Abacavir/Lamivudine and Elvitegravir/Cobicistat/Tenofovir/Emtricitabine: Single Center Experience

진범식,Jin-Hee Lee,Gayeon Kim 대한의학회 2020 Journal of Korean medical science Vol.35 No.29

Integrase inhibitor is uniquely available as single tablet regimen (STR) in Korea. In this study, the durability until 96 weeks was compared between dolutegravir/abacavir/lamivudine (D/A/L) and elvitegravir/cobicistat/tenofovir/emtricitabine (E/T/E) in treatment naïve human immunodeficiency virus 1 (HIV-1) infected individuals. From 2014 to 2017, 153 and 234 subjects started D/A/L and E/T/E, respectively. During 96 weeks, 73 discontinued initial STR and the reason of discontinuation was typable in 44. The frequency of drug adverse event related discontinuation (AEDC) was higher in D/A/L (13.1% vs. 6.4%, P = 0.023) while most non-AE related discontinuations occurred in E/T/E (8/9), such as drug-drug interaction, meal requirement and virologic failure. AEDC occurred usually within 24 weeks (20/35) and D/A/L to E/T/E AEDC incidence rate ratio was 3.71 (95% confidence interval, 1.36–10.10) in this period. Regarding the durability, D/A/L and E/T/E revealed no significant difference at week 96 (P = 0.138) while durability of D/A/L was worse in the aspect of AEDC (P = 0.013).

Antiretroviral Genotypic Resistance Mutations in HIV-1 Infected Korean Patients with Virologic Failure

진범식,최주연,최진영,김갑정,기미경,김준명,김성순 대한의학회 2009 Journal of Korean medical science Vol.24 No.6

Resistance assays are useful in guiding decisions for patients experiencing virologic failure (VF) during highly-active antiretroviral therapy (HAART). We investigated antiretroviral resistance mutations in 41 Korean human immunodeficiency virus type 1 (HIV-1) infected patients with VF and observed immunologic/virologic response 6 months after HAART regimen change. Mean HAART duration prior to resistance assay was 45.3±27.5 months and commonly prescribed HAART regimens were zidovudine/lamivudine/nelfinavir (22.0%) and zidovudine/lamivudine/efavirenz (19.5 %). Forty patients (97.6%) revealed intermediate to high-level resistance to equal or more than 2 antiretroviral drugs among prescribed HAART regimen. M184V/I mutation was observed in 36 patients (87.7%) followed by T215Y/F (41.5%) and M46I/L (34%). Six months after resistance assay and HAART regimen change, median CD4+ T cell count increased from 168 cells/μL (interquartile range [IQR], 62-253) to 276 cells/μL (IQR, 153-381) and log viral load decreased from 4.65 copies/mL (IQR, 4.18-5.00) to 1.91 copies/mL (IQR, 1.10-3.60) (P<0.001 for both values). The number of patients who accomplished viral load <400 copies/mL was 26 (63.4%) at 6 months follow-up. In conclusion, many Korean HIV-1 infected patients with VF are harboring strains with multiple resistance mutations and immunologic/virologic parameters are improved significantly after genotypic resistance assay and HAART regimen change.

Current trends of HIV/AIDS

진범식 ( Bum Sik Chin ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

HIV의 발견. 후천성면역결핍증(AIDS): 1981년 미국 대도시의 건강 성인에서 주폐포자충 폐렴(PCP)과 카포시 육종의 집단 발병을 계기로 명명. 병원체의 발견: 1984년 프랑스 Montagnier 박사가 인간면역결핍바이러스-1(HIV-1)을 분리. 진단법의 개발: 1985년 혈청검사법(ELISA)의 개발 . HIV의 유행현황. 전세계적으로 사하라사막 이남 아프리카에 가장 많은 환자가 존재하나 2000년대 초반 이후 폭발적인 환자 증가는 진정되는 추세. 예방사업 및 항레트로바이러스제 치료의 보급으로 신규진단 HIV감염자수 및 HIV관련 사망은 감소추세에 있으나 누적생존감염인수는 증가추세임.. 우리나라는 최근 신규진단 감염인수가 증가하여 2013년 이후 매년 1000명 이상의 새로운 HIV감염인이 진단되고 있음.. HIV의 자연사. 감염 후 약 2-4주의 잠복기 후 발열, 발진, 임파선비대, 인후통, 설사 등이 일정기간 지속되는 급성감염증상이 나타나지만 약 50%는 무증상임.. 이후 특별히 치료하지 않아도 무증상 잠복기로 이행되어 8-10년간 지속되지만 이 시기에도 면역기능은 점진적으로 감소하여 CD4 림프구수가 200 cells/ul 이하로 감소하면 기회감염이나 기회암이 발생하게 됨.. 에이즈 관련 증상·칸디다증 (구강, 식도, 기관지, 폐 등)·주폐포자충 폐렴·카포시 육종 (HHV-8 관련)·결핵 ( Mycobacterium tuberculosis)·거대세포바이러스 망막염. HIV 감염의 치료·항레트로바이러스제 투여·기회감염의 발생을 막기 위한 예방적 약제 투여·발생한 기회감염과 기회암을 치료하기 위한 약제 투여. 항레트로바이러스제 투여시점·현재 모든 HIV감염인에게 면역기능 저하와 관련 없이 치료를 권고·면역기능 저하가 명확하지 않더라도 치료를 일찍 시작할 경우 합병증 발생 감소·항레트로바이러스제 복용으로 바이러스 증식이 억제되면 타인으로의 전파력 감소. 권고되는 항레트로바이러스제의 종류·2NRTI (Nucleoside analogue Reverse Transcriptase Inhibitor) + PI (Protease Inhibitor)·2NRTI + NNRTI (Non-nucleoside Reverse Transcriptase Inhibitor)·2NRTI + INSTI (Integrase Strand Transfer Inhibitor) . 국내에서 사용 가능한 1차 치료제 조합약제 계열 약 종류 상품명 2NRTI+INSTI ABC/3TC/DTG 트리멕 TDF/ETC+DTG 트루바다+티비케이 TDF/ETC/EVG/c 스트리빌드 TDF/ETC+RAL 트루바다+이센트레스 2NRTI+PI/r TDF/ETC+DRV/r 트루바다+프레지스타/노비르 3TC, lamivudine; ABC, abacavir; COBI or c, cobicistat; DRV/r, darunavir/ritonavir; DTG, dolutegravir; TDF, tenofovir disoproxil fumarate; RAL, raltegravir; ETR , etravirine. INSTI계열 약제가 선호되는 이유 ·대부분의 환자에서 INSTI기반 치료는 효과가 우수하고 부작용이 적다. ·RAL 및 DTG 는 CYP 3A4-관련 약물 상호작용이 없다. . INSTI와 관련된 약물 상호작용 (http://www.hiv-druginteractions.org/) ·Rifampin, Al++, Mg++, Ca++등이 포함된 제산제나 변비약 등과의 병용은 피하는 것이 좋다. ·EVG/c의 경우 diazepam의 병용을 피하는 것이 좋고 triazolam이나 경구 midazolam사용은 금기이다. 또한 dexamethasone 전신투여 시 항레트로바이러스제의 효과가 저하될 수 있고 methylprednisolone, prednisolone, triamcinolone등은 쿠싱증후군을 유발할 수 있으므로 주의가 필요하다. ·DTG는 혈중 metformin의 농도를 증가시키므로 주의가 필요하다.

α-galactosidase A 유전자 분석으로 확인된 Fabry 병

진범식 ( Bum Sik Chin ),김지인 ( Jee In Kim ),이진성 ( Jin Sung Lee ),홍순원 ( Soon Won Hong ),정현주 ( Hyun Joo Chung ),김희만 ( Hee Man Kim ),김동기 ( Dong Ki Kim ),구영석 ( Young Suck Goo ),이호영 ( Ho Yung Lee ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

Fabry disease is a X-linked lysosomal storage disorder caused by deficiency of α-galactosidase A. This abnormality in enzyme results intracellular accumulation of globotriaosylceramide and leads to severe painful neuropathy with progressive renal cardiovascular, and cerebrovascular dysfunction and early death. We report a 35 year-old man who had been suffered from acroparesthesia aggravated by body temperature elevation and with asymptomatic renal function impairment, which were proven to be due to Fabry disease. We performed gene analysis by PCR direct sequencing and confirmed missense mutation of GLA gene. Recently enzyme replacement of α-galactosidase was introduced and we think that the importance of early diagnosis and treatment should be emphasized.

Integrase Strand Transfer Inhibitor Resistance Mutations in Antiretroviral Treatment-naïve Patients in Korea: a Prospective, Observational Study

김연재,진범식,김가연,신형식 대한의학회 2018 Journal of Korean medical science Vol.33 No.25

The present study investigated prevalence of integrase strand transfer inhibitors (INSTI) resistance mutations in HIV-1-infected antiretroviral therapy (ART)-naïve patients in Korea. From 106 plasma samples, amplification and sequencing of integrase genes was performed, and major or minor mutations were calculated by the Stanford HIV drug resistance mutation interpretation algorithm. No major INSTI resistance mutations were found, and 14 minor mutations were detected in 13 (12.3%) patients. The present data support the recommendation that routine testing for INSTI resistance mutations before starting ART is not necessary.

HIV감염 환자에서 bictegravir투약후 발생한 심한 황달을 동반한 간손상 1예

노현동,진범식,정재윤,김연재 대한내과학회 2022 대한내과학회 추계학술대회 Vol.2022 No.2

HIV 감염자에서 발생한 원인미상 간농양에 속발한 아메바성 장염 1예

진중혁,진범식,신형식,김연재,김가연,최종경,정은정,서자희 대한내과학회 2019 대한내과학회 추계학술대회 Vol.2019 No.1