Glucose metabolism continuous deteriorating in male patients with human immunodeficiency virus accepted antiretroviral therapy for 156 weeks

BACKGROUND The dynamic characteristics of glucose metabolism and its risk factors in patients living with human immunodeficiency virus(PLWH)who accepted primary treatment with the efavirenz(EFV)plus lamivudine(3TC)plus tenofovir(TDF)(EFV+3TC+TDF)regimen are unclear and warrant investigation.AIM To study the long-term dynamic characteristics of glucose metabolism and its contributing factors in male PLWH who accepted primary treatment with the EFV+3TC+TDF regimen for 156 wk.METHODS This study was designed using a follow-up design.Sixty-one male treatmentnaive PLWH,including 50 cases with normal glucose tolerance and 11 cases with prediabetes,were treated with the EFV+3TC+TDF regimen for 156 wk.The glucose metabolism dynamic characteristics,the main risk factors and the differences among the three CD4+count groups were analyzed.RESULTS In treatment-naive male PLWH,regardless of whether glucose metabolism disorder was present at baseline,who accepted treatment with the EFV+3TC+TDF regimen for 156 wk,a continuous increase in the fasting plasma glucose(FPG)level,the rate of impaired fasting glucose(IFG)and the glycosylated hemoglobin(HbA1c)level were found.These changes were not due to insulin resistance but rather to significantly reduced isletβcell function,according to the homeostasis model assessment ofβcell function(HOMA-β).Moreover,the lower the baseline CD4+T-cell count was,the higher the FPG level and the lower the HOMA-βvalue.Furthermore,the main risk factors for the FPG levels were the CD3+CD8+cell count and viral load(VL),and the factors contributing to the HOMA-βvalues were the alanine aminotransferase level,VL and CD3+CD8+cell count.CONCLUSION These findings provide guidance to clinicians who are monitoring FPG levels closely and are concerned about IFG and decreased isletβcell function during antiretroviral therapy with the EFV+3TC+TDF regimen for long-term application.

Evaluating patients' perception of service quality at hospitals in nine Chinese cities by use of the ServQual scale

Objective: To investigate patients' perception of service quality at hospitals in nine Chinese cities and propose some measures for improvement. Methods: The ServQ ual scale method was used in a survey involving patients at out-patient and in-patient facilities in Shanghai, Chongqing, Chengdu, Nanning, Guilin and Laibin of Guangxi, Honghezhou of Yunnan, Wulumuqi of Xinjiang and Zhongshan of Guangdong. The data collected were entered and analyzed using SPSS 20.0. Statistical analyses included descriptive statistics, factor analyses, reliability analyses, product-moment correlations, independent-sample t-tests, One-way ANOVA and regression analyses. Results: The Kaiser-Meyer-Olkin value for the factor analysis of the scale was 0.979. The Cronbach's α for the reliability analysis was 0.978. All the Pearson correlation coei cients were positive and statistically signii cant. Visitors to out-patient facilities reported more positive perception tacilities on tangibles(t = 4.168, P(t = 1.979, P <han visitors to in-patient f 0.05). Patients of 60 years of age and above reported mor< 0.001) and reliability e positive perception th<an those between 40 and 49 on reliability(F = 3.311, P = 0.010), assurances(F = 2.751, P 0.05) and empathy(F = 4.009, P = 0.003). For the i ve dimensions of the scale, patients in Laibin, Guangxi reported the most positive perceived service quality, followed by patients in Shanghai. On the other hand, patients in Chongqing and Nanning and Guilin of Guangxi reported relatively poor perceptions of service quality. Standardized regression coei cients showed statistically significant(P < 0.001) positive values for all Serv Qual dimensions. Empathy(β = 0.267) and reliability(β uality. = 0.239) most strongly predicted perception of service qConclusions: Chinese patients perceived service quality as satisfactory. Hospitals in various regions of China should enhance their awareness and ability to serve their patients.

Very high baseline HIV viremia impairs efficacy of non-nucleoside reverse transcriptase inhibitor-based ART:a longterm observation in treatment-naïve patients

Background:It is not completely clear whether a very high pre-therapy viral load(≥500000 copies/ml)can impair the virological response.The aim of this study was to examine the influence of very high baseline HIV-RNA levels on long-term virological responses under one type of regimen.Methods:A retrospective study was performed based on data from two multicenter cohorts in China from January to November 2009,and from May 2013 to December 2015.Untreated HIV infected adults between 18 and 65 years old were recruited before receiving non-nucleoside reverse transcriptase inhibitor-based regimen.All patients had baseline HIV-RNA levels over 500 copies/ml,good adherence,and were followed for at least 24 weeks.Virological suppression was defined as the first HIV-RNA<50 copies/ml.Virological failure was defined as any of incomplete viral suppression(HIV-RNA≥200 copies/ml without virological suppression within 24 weeks of treatment)and viral rebound(confirmed HIV-RNA level≥50 copies/ml after virological suppression).Chi-square test,Kaplan–Meier analysis,Cox proportional hazards model and Logistic regression were used to compare virological response between each pretreated viral load stratum.Results:A total of 758 treatment-naïve HIV patients in China were enlisted.Median follow-up time(IQR)was 144(108–276)weeks.By week 48,rates of virological suppression in three groups(<100000,100000–500000 and≥500000 copies/ml)were 94.1,85.0,and 63.8%,respectively(P<0.001).Very high baseline HIV viremia over 500000 copies/ml were found to be associated with delayed virological suppression(≥500000 vs<100000,adjusted relative hazard=0.455,95%CI:0.32–0.65;P<0.001)as well as incomplete viral suppression(≥500000 vs<100000,adjusted odds ratio[aOR]=6.084,95%CI:2.761–13.407;P<0.001)and viral rebound(≥50000 vs<100000,aOR=3.671,95%CI:1.009–13.355,P=0.048).Conclusions:Very high levels of pre-treatment HIV-RNA were related with delayed efficacy of NNRTI-based ART and increased risk of treatment failure.More potent initial regimens should be considered for those with this clinical character.