人类免疫缺陷病毒合并梅毒感染者的临床特征和抗梅毒疗效

Clinical characteristics and anti-syphilis therapeutic effect of human immunodeficiency virus patients with syphilis infection

目的探讨人类免疫缺陷病毒(HIV)合并梅毒感染者的临床特征和抗梅毒疗效。方法对2019年1月1日至2020年10月1日就诊于解放军总医院第五医学中心的527例HIV感染者进行面对面问卷调查和实验室检查,包括年龄、性别、受教育程度、婚姻状况、感染途径、临床特征、CD4^(+)T细胞计数、HIV病毒载量和治疗策略。结果 HIV阳性者合并梅毒感染率为21.1%,与单纯HIV感染者相比,HIV合并梅毒感染者年龄轻、男性同性性接触感染为主、文化程度较低、CD4^(+)T细胞数量较低,差异有统计学意义(P<0.05)。抗梅毒治疗方面,注射用苄星青霉素治疗,每周1次,每次240万U,肌内注射,治疗3次为1个疗程,停药后3~6个月复查,总有效率为86.7%。抗梅毒疗效与患者年龄、HIV载量未发现明显相关性,差异无统计学意义(P>0.05)。CD4^(+)T细胞水平在200个/μL以上者,抗梅毒有效率为90.5%,高于CD4^(+)T细胞水平在200个/μL以下者(62.5%),差异有统计学意义(P<0.05)。结论 HIV感染者合并梅毒感染率较高,合并感染者CD4^(+)T细胞水平降低。

Objective To explore the clinical characteristics and onei-syphilis therapeutic effect of human immunodeficiency virus(HIV)positive patients co-infected with syphilis. Methods All 527 HIV positive patients were investigated by face-to-face questionnaire and laboratory examinations from January 1,2019 to October 1,2020. Information included age,sex,educational level,marital status,infection route,clinical features,CD4^(+)T cell count,HIV load and treatment strategies.Results The infection rate of syphilis in HIV positive patients was 21. 1%. Compared with the HIV infected patients without syphilis,the HIV positive patients co-infected with syphilis had significantly lower average age,higher male prevalence rate,higher homosexual transmission prevalence rate,and higher percentage of CD4^(+)T cells less than 200(P<0. 05). Anti-syphilis treatment efficacy was not related to the patient’s age,HIV load,there was no statistical difference(P>0. 05). The total effective rate was 86. 7% after 3 times of treatment with Benzyl-Penicillin for injection and 3-6 months after discontinuation. When the CD4^(+)T cell level was more than 200 cells/μL,the effective rate of treatment was 90. 5%,which was higher than that when the CD4^(+)T cell level was below 200 cells/μL(62. 5%). The difference was statistically significant(P<0. 05). Conclusion The prevalence rate of syphilis in HIV infected patients is high,and the count of CD4^(+)T cells in patients with combined infection is reduced.