Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome

AIM：To compare the clinical manifestation of cytomegalovirus（CMV）retinitis and microvascular retinopathy（MVR）in patients with acquired immunodeficiency syndrome（AIDS）in China.METHODS：A total of 93 consecutive patients with AIDS,including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed.Highly active antiretroviral therapy（HAART）status was recorded.HIV and CMV immunoassay were also tested.CD4＋T-lymphocyte count and blood CMV-DNA test were performed in all patients.Aqueous humor CMV-DNA test was completed in 39patients.Ophthalmological examinations including best corrected visual acuity（BCVA,by International Standard Vision Chart）,intraocular pressure（IOP）,slit-lamp biomicroscopy,indirect ophthalmoscopy were performed.RESULTS：In MVR group,the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13.Blood CMV-DNA was 0（0,269 000）and 42 patients（80.77%）did not receive HAART.In CMV retinitis group,13 patients（31.71%）had anterior segment abnormality.The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470（0,1 450 000）.Nineteen patients（46.34%）had not received HAART.MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%,respectively.Two patients with MVR progressed to CMV retinitis during the follow-up period.CONCLUSION：In comparison of CMV,patients with MVR have relatively mild visual function impairment.Careful ophthalmological examination and close follow-up are mandatory,especially for patients who have systemic complications,positive CMV-DNA test and without received HAART.

Salivary gland disease in human immunodeficiency virus/acquired immunodeficiency syndrome: A review

The effect of human immunodeficiency virus(HIV) infection on salivary glands has diagnostic and prognostic significance. HIV-salivary gland disease(HIV-SGD) is comprehensively ascertained amongst the major critical acquired immunodeficiency syndrome(AIDS)-relatedoral manifestation and causes substantial morbidity. Parotid gland swelling due to sicca syndrome, parotid lipomatosis, sialadenitis, diffuse infiltrative lymphocytosis syndrome, benign lymphoepithelial lesions, neoplasms(benign or malignant) of salivary gland, parotid gland inflammation, diminished flow rates of saliva and xerostomia have been documented that also affects the health- associated characteristics of life in subjects infected with HIV. There is a necessity for health care researchers to diagnose it, particularly as it might worsen if left undiagnosed. The precise characteristic of alterations in dynamics of salivary gland structure and functionality with long-standing usage of highly active anti-retroviral therapy still remains unknown. HIV positive children also present with bilateral parotid enlargement and the syndrome state with classical clinical and cytological features of predominated lymphoid hyperplasia. Though various case reports and studies have been extensively published on different aspects of HIV-SGD, it has not been described solely, thus leading to occasional confusion of nomenclature and clinical presentation of HIV-SGD. This article reviews the pathogenesis of HIV-related SGD and its components and various other miscellaneous disorders affecting the salivary glands in HIV/AIDS.

The default mode network is affected in the early stage of simian immunodeficiency virus infection:a longitudinal study

Acquired immune deficiency syndrome infection can lead to cognitive dysfunction represented by changes in the default mode network.Most recent studies have been cross-sectional and thus have not revealed dynamic changes in the default mode network following acquired immune deficiency syndrome infection and antiretroviral therapy.Specifically,when brain imaging data at only one time point are analyzed,determining the duration at which the default mode network is the most effective following antiretroviral therapy after the occurrence of acquired immune deficiency syndrome.However,because infection times and other factors are often uncertain,longitudinal studies cannot be conducted directly in the clinic.Therefore,in this study,we performed a longitudinal study on the dynamic changes in the default mode network over time in a rhesus monkey model of simian immunodeficiency virus infection.We found marked changes in default mode network connectivity in 11 pairs of regions of interest at baseline and 10 days and 4 weeks after virus inoculation.Significant interactions between treatment and time were observed in the default mode network connectivity of regions of interest pairs area 31/V6.R and area 8/frontal eye field(FEF).L,area 8/FEF.L and caudal temporal parietal occipital area(TPOC).R,and area 31/V6.R and TPOC.L.ART administered 4 weeks after infection not only interrupted the progress of simian immunodeficiency virus infection but also preserved brain function to a large extent.These findings suggest that the default mode network is affected in the early stage of simian immunodeficiency virus infection and that it may serve as a potential biomarker for early changes in brain function and an objective indicator for making early clinical intervention decisions.

Elevated homocysteine levels in human immunodeficiency virus-infected patients under antiretroviral therapy: A meta-analysis

AIM: To evaluate the association between the levels of homocysteine(Hcy), folate, vitamin B12 in human immunodeficiency virus(HIV)-infected patients who were treated with antiretroviral therapy(ART) or not treated with ART.METHODS: The Pub Med and Scielo databases were searched. Eligible studies regarding plasma Hcy level in HIV-infected patients were firstly identified. After careful analysis by two independent researches, the identified articles were included in the review according to two outcomes(1) Hcy, folate and vitamin B12 blood concentration in HIV-infected subjects vs health controls and;(2) Hcy blood concentration in HIV-infected subjects under ART vs not treated with ART. RevM an(version 5.2) was employed for data synthesis.RESULTS: A total of 12 studies were included in outcome 1(1649 participants, 932 cases and 717 controls). Outcome 1 meta-analysis demonstrated higher plasma Hcy(2.05 μmol/L; 95% CI: 0.10 to 4.00, P < 0.01) and decreased plasma folate concentrations(-2.74 ng/m L; 95%CI:-5.18 to-0.29, P < 0.01) in HIV-infected patients compared to healthy controls. No changes in vitamin B12 plasma concentration were observed between groups. All studies included in the outcome 2 meta-analysis(1167 participants; 404 HIVinfected exposed to ART and 757 HIV-infected non-ART patients) demonstrated higher mean Hcy concentration in subjects HIV-infected under ART compared to nonART HIV subjects(4.13 μmol/L; 95%CI: 1.34 to 6.92, P < 0.01).CONCLUSION: This meta-analysis demonstrated that the levels of Hcy and folate, but not vitamin B12, were associated with HIV infection. In addition, Hcy levels were higher in HIV-infected patients who were under ART compared to HIV-infected patients who were not exposed to ART. Our results suggest that hyperhomocysteinemia should be included among the several important metabolic disturbances that are associated with ART in patients with HIV infection.

Factors Associated with Antiretroviral Therapy Defaulting among Adult Patients Receiving Care at Chikankata Mission Hospital, Chikankata District, Zambia

Background: Defaulting on antiretroviral therapy has been identified as the most important factor contributing to the antiretroviral therapy failure rate. This study aimed to investigate factors associated with defaulting on antiretroviral therapy among adult patients receiving care at Chikankata Mission Hospital antiretroviral therapy clinic. Method: Cross-sectional analytical study on 385 participants selected by a computer generated random numbers technique of simple random sampling from among the patients receiving antiretroviral therapy at Chikankata Mission Hospital. Data collected were processed and analysed using Statistical Package for Social Science version 27. Univariate and backward multivariable logistic regression analysis was performed to identify factors associated with antiretroviral therapy defaulting. The level of significance was set at 5% with a confidence level of 95%. Results: Over half (58.4%) of the study participants defaulted on antiretroviral therapy. About 65.8% of study participants indicated improved health as the reason they defaulted on antiretroviral therapy. Most participants indicated that it was important to always go for antiretroviral therapy services (Adjusted Odds Ratio 1.95;95% Confidence Interval: [1.14 - 3.33], p = 0.015). Very few participants indicated poor family support for antiretroviral therapy services (Adjusted Odds Ratio 4.08;95% Confidence Interval: [2.02 - 8.23], p Conclusion: Defaulting on antiretroviral therapy continues to be a significant problem and needs to be addressed as a matter of priority. More counselling and awareness-raising programmes are required to improve knowledge and understanding on the importance of attending scheduled antiretroviral therapy clinics and services as well as the consequences of defaulting on antiretroviral therapy.

Effect of treatment course of comprehensive intervention with Traditional Chinese Medicine on mortality of acquired immunodeficiency syndrome patients treated with combined antiretroviral therapy

OBJECTIVE:To investigate the effect of a treatment course of comprehensive intervention with Traditional Chinese Medicine(TCM) on the mortality of patients with acquired immunodeficiency syndrome(AIDS) treated with combined antiretroviral therapy(c ART).METHODS:AIDS patients who had taken c ART in a national TCM human immunodeficiency virus treatment trial program(NTCMTP) before 2009 were enrolled in this study and followed for 36 months from November 2009.Patients enrolled in the NTCMTP in 2004 were taken as the first group,those enrolled in 2006 as the second group,and those enrolled in 2009 as the third group.Cumulative survival rates were calculated by the life table method.Survival curves for subgroups were compared by the log-rank test.Hazard ratios were calculated with a Cox proportional hazards model.RESULTS:A total of 1443 AIDS patients were followed for 3 years(4198 person-years).During this period,91(6.3%) patients died and 13(0.9%) were lost to follow-up.The total mortality rate was 2.17/100 person-years.The mortality rate of patients enrolled in the NTCMTP in 2004 was 1.49/100 person-years,which was lower than that of patients enrolled in 2006(2.23/100 person-years) and 2009(3.48/100 person-years).After adjusting for other factors,a shorter time of treatment with TCM,male sex,older age,lower CD4 + T-cell counts,and long-term treatment with c ART were risk factors of mortality.CONCLUSION:Long-term treatment with TCM decreased the mortality risk of AIDS patients.Factors such as being male,older age,CD4+ T-cell counts,and time of treatment with TCM and c ART were correlated with mortality.

Prevalence of liver injury among patients with acquired immunodeficiency syndrome treated with highly active antiretroviral therapy in China

OBJECTIVE: To estimate the prevalence of liver injury among patients with acquired immunodeficiency syndrome(AIDS) who received highly active antiretroviral therapy(HAART) in rural Henan Province in China, and to explore whether Traditional Chinese Medicine(TCM) treatment based on HAART would increase this risk.METHODS: This was a retrospective cross-sectional study. We collected medical information on patients with AIDS from two treatment databases in2014. Criteria established by the AIDS Clinical Trials Group in 1996 were used for grading liver injury,classified based on the limit of normal(ULN) for alanine transaminase and aspartate aminotransferase:grade 1(1.25-2.5 × ULN); grade 2(2.6-5 × ULN);grade 3(5.1-10 × ULN); and grade 4(> 10 × ULN).Factors associated with liver injury were evaluated using a logistic regression model.RESULTS: A total 6953 patients with AIDS(3324 male and 3629 female patients) were enrolled into this study. The prevalence of liver injury was 22.0%(18.0% grade 1, 3.1% grade 2, 0.9% grade 3). In multivariate analysis, patients aged 34-45 years were more likely to have liver injury than patients in other age groups [adjusted odds ratio(AOR), 1.39; 95%CI, 1.01-1.91)]. Other factors associated with liver injury included male sex(AOR, 1.64; 95% CI,1.46-1.85), HIV infection via blood(AOR, 1.47; 95%CI, 1.19-1.82), hepatitis B virus antibody positive(AOR, 1.07; 95% CI, 0.85-1.36), and hepatitis C virus(HCV) antibody positive(AOR, 2.76; 95% CI,2.28-3.34).CONCLUSION: The prevalence of liver injury was relatively high among HAART-experienced patients. Several factors associated with liver injury included male sex, age 35-45 years old, HIV infection through blood, and concurrent HCV infection. TCM had no relationship with liver injury in patients receiving HAART.

Comment on the intervention of Traditional Chinese Medicine on survival rates of patients living with human immunodeficiency virus and acquired immune deficiency syndrome

Despite many differences between Traditional Chinese Medicine(TCM) and conventional medicine,the use of TCM in the treatment of human immunodeficiency virus and acquired immune deficiency syndrome(HIV/AIDS) is increasingly recognized and accepted by patients. Recent research findings on the benefits of Chinese herbal medicine on long-term survival in patients with HIV/AIDS are encouraging and hopeful, but inconclusive. More research is needed.

Wenshen Jianpi recipe(温肾健脾方) induced immune reconstruction and redistribution of natural killer cell subsets in immunological non-responders of human immunodeficiency virus/acquired immune deficiency syndrome:a randomized controlled trial

OBJECTIVE:To evaluate the effects of the Wenshen Jianpi recipe(温肾健脾方,WJR)on immune reconstruction and natural killer(NK)cells in immunological non-responders(INRs)of people living with human immunodeficiency virus(HIV)(PLWH)and propose new therapeutic strategies for HIV.METHODS:Based on Traditional Chinese Medicine treatment principle“invigorating Qi and warming Yang in the spleen and kidneys”,WJR combined with antiretroviral therapy(ART)therapy was performed in a randomized,double-blind,placebo-controlled study of 60 patients with non-responders.The randomized process was executed by the Clinical Evaluation Center of China Academy of Chinese Medical Sciences.Sixty patients who met the inclusion criteria obtained random numbers(that is the drug number)was randomly divided into a treatment group and a placebo control group according to a 1∶1 ratio.CD4+T cell counts and natural killer(NK)cells counts were evaluated at baseline and 12-week,24-week follow-ups.RESULTS:Four participants received random numbers and did not enter the group due to the patient’s own reasons.A total of 56 patients were enrolled,including 28 in the treatment group and 28 in the control group.CD4+T cell counts in the treatment group were significantly increased at week 24(P=0.01<0.05),which were significantly higher than those in the control group(P=0.01<0.05).Although no significant differences were observed between two groups,the CD56bri CD16-NK cell counts in the treatment group were significantly increased after duration.and CD56dim CD16+NK cell counts in the treatment group were significantly higher than those in the control group after 24 weeks of treatment(P=0.025<0.05).As compared with the control group,the treatment group had significantly lower CD56neg CD16+NK cell counts after 24 weeks of treatment(P=0.023<0.05).CONCLUSIONS:WJR promotes the immune reconstruction of INRs and redistribution of NK cell subsets,notably decreasing CD56neg CD16+NK cell counts in INRs.However,the redistribution of NK cell subsets is not beneficial for immune reconstruction in INRs.Further large-scale RCTs are required to evaluate the effect of WJR on immune recovery in INRs and decipher the underlying mechanism.

基于IAMEF模式的药学服务对获得性免疫缺陷综合征抗逆转录病毒治疗干预效果

目的探讨基于IAMEF模式的药学服务对获得性免疫缺陷综合征(AIDS)患者抗逆转录病毒治疗(ART)的干预效果。方法选取医院感染免疫门诊2020年1月至2022年1月收治的接受ART的AIDS患者170例,按随机数字表法分为观察组和对照组,各85例。两组患者均予基本的药品保障供应及常规药学咨询服务,观察组患者加予基于信息收集-分析评估-制订计划-执行计划-跟踪随访(IAMEF)模式的药学服务,两组均干预10个月。比较干预前后患者的T淋巴细胞亚群水平、病毒载量、服药依从性及不良反应发生率。结果与对照组比较,观察组患者干预后的CD_(3)^(+)和CD_(4)^(+)水平及CD_(4)^(+)/CD_(8)^(+)均显著升高,病毒载量显著降低(P<0.05)。干预后,观察组患者服药依从性好的占比及Morisky用药依从性量表-8评分均显著高于对照组,且漏服药物、定时服药及遵医嘱剂量用药占比均显著优于对照组(P<0.05)。观察组患者不良反应发生率为17.65%,显著低于对照组的47.06%(P<0.05)。结论基于IAMEF模式的药学服务可改善AIDS患者的T淋巴细胞水平,降低病毒载量,提高服药依从性,降低不良反应发生率。

金匮肾气丸联用cART对HIV-1感染者的疗效及不良反应分析

获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)的主要治疗方法为联合抗逆转录病毒治疗(combined antiretroviral therapy,cART),但部分患者由于免疫功能重建不全和不良反应,可能出现药物性肝损伤、消化功能下降、神经系统毒性和代谢紊乱等,严重影响了抗病毒疗效和患者生存质量,已成为AIDS治疗领域的瓶颈[1]。部分国家资助的中医药防治AIDS科研课题提出正虚(主要为肾虚)是AIDS发生发展的内在病理基础,以肾气与肾阴肾阳的功能下降为主要特征[2-3]。补肾制剂可能是缓解人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染患者病情和不良反应的可靠方式。金匮肾气丸是由地黄、山药、茯苓、牡丹皮、山茱萸、牛膝、泽泻等多味中药制成的综合制剂[4],具有温补肾阳、化气行水的作用。本研究首次采用金匮肾气丸与cART联用治疗HIV-1感染者,比较了金匮肾气丸与cART联用、单用cART对HIV-1感染者抗病毒疗效和不良反应的差异,试图为探索HIV-1感染者治疗的新途径提供参考。

经抗病毒治疗的成年HIV感染/AIDS患者并发结核病预测模型的建立与验证

目的探讨经抗病毒治疗(ART)的成年人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)患者并发结核病(TB)的影响因素,构建列线图模型预测HIV感染/AIDS患者并发TB风险。方法对2017年2月至2021年2月于重庆市公共卫生医疗救治中心接受ART的1486例HIV感染/AIDS患者进行回顾性研究。采用单因素、多因素Logistic回归分析HIV感染/AIDS患者并发TB的独立危险因素并构建列线图预测模型。绘制受试者工作特征曲线、校准曲线和决策曲线进行内、外部验证,评价模型预测效能和临床实用性。结果男性、开始ART年龄为18~<45岁、世界卫生组织临床分期为Ⅲ期或Ⅳ期、基线CD4+T淋巴细胞计数为200~<350个/μL或<200个/μL、基线病毒载量为10000~100000 copy/mL或>100000 copy/mL和贫血是HIV感染/AIDS患者并发TB的独立危险因素(P<0.05)。训练集及测试集列线图预测模型内外部验证的曲线下面积分别为0.727(95%CI:0.696~0.758)、0.780(95%CI:0.722~0.838)。校准曲线拟合效果良好,决策曲线分析结果显示该模型具有良好的临床收益。结论基于上述独立危险因素建立的HIV感染/AIDS患者并发TB风险的列线图预测模型具有较强的预测效能,能够为早期降低TB发病风险提供科学依据。

基线CD4^(+)T淋巴细胞计数水平与HIV/AIDS患者抗病毒治疗后免疫重建结局的关系研究

目的探讨基线CD4^(+)T淋巴细胞计数水平与人类免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)患者抗病毒治疗后免疫重建结局的关系。方法回顾性选取2021年9月至2022年3月中国科学技术大学附属第一医院(安徽省立医院)感染科收治的新确诊HIV/AIDS的患者110例,所有患者均接受高效抗逆转录病毒治疗(HAART),对患者进行1年随访,按照末次随访CD4^(+)T淋巴细胞计数<200个/μL或增长未超过基线的20%作为判定免疫重建不良的标准,对患者免疫重建结局进行分组,其中78例患者纳入免疫重建良好组,32例患者纳入免疫重建不良组,对患者治疗前后不同时间的CD4^(+)、CD8^(+)T淋巴细胞计数水平进行监测,并探究影响患者免疫重建结局的影响因素。结果治疗后3、6、9、12个月时,免疫重建不良组患者的病毒载量分别为26983(456,52239)、9126(316,14012)、1622(215,4501)、212(98,325)拷贝/mL,均高于免疫重建良好组[21598(412,48236)、6533(264,9154)、1231(152,2105)、135(52,287)拷贝/mL],差异均有统计学意义(P<0.05)。两组患者治疗前后各时间段的CD8^(+)T淋巴细胞计数水平组间比较,差异均无统计学意义(P>0.05)。单因素分析结果显示,感染途径、性别、学历水平、婚姻状态对其免疫重建效果无影响(P>0.05),年龄偏大、确诊至治疗时间在1年以上、基线CD4^(+)T淋巴细胞水平低、基线病毒载量高均会对患者的免疫重建效果产生负面影响(P<0.05)。多因素Logistic回归分析结果显示,年龄偏大、确诊至治疗时间在1年以上、基线CD4^(+)T淋巴细胞水平低、基线病毒载量高均会影响患者的免疫重建效果(OR=2.567,95%CI:1.075~6.127;OR=4.067,95%CI:1.690~9.785;OR=2.550,95%CI:1.096~5.934;OR=2.816,95%CI:1.203~6.591)。结论较高的基线CD4^(+)T淋巴细胞计数水平、较低的病毒载量有利于HIV/AIDS患者抗病毒治疗后的免疫重建,而基线CD4^(+)T淋巴细胞计数水平的低下可能是免疫重建不良的重要危险因素。

PBMCs中miR-21、miR-223表达与HIV/AIDS患者抗逆转录病毒治疗效果的相关性

目的探讨人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者抗逆转录病毒治疗效果与外周血单个核细胞(PBMCs)中微小RNA(miR)-21、miR-223表达水平的关系。方法选取2020年3月至2022年3月期间南通市第三人民医院门诊就诊行抗逆转录病毒治疗的142例HIV/AIDS患者为观察组,根据其治疗效果分为有效组(n=110)和无效组(n=32);选取同期体检健康者139例为对照组。采用实时荧光定量聚合酶链反应法检测PBMCs中miR-21、miR-223表达水平;采用多因素Logistic回归分析HIV/AIDS患者抗逆转录病毒治疗无效的影响因素。结果观察组PBMCs中miR-21、miR-223表达水平高于对照组(P<0.05)。无效组治疗后3个月、治疗后6个月、治疗后12个月的PBMCs中miR-21、miR-223表达水平均高于有效组(P<0.05)。有效组随治疗时间延长,PBMCs中miR-21、miR-223表达水平逐渐降低(P<0.05)。无效组治疗前世界卫生组织(WHO)分期3期患者比例高于有效组(P<0.05)。miR-21、miR-223、治疗前WHO分期3期是影响HIV/AIDS患者抗逆转录病毒治疗无效的独立危险因素(P<0.05)。结论miR-21、miR-223在一定程度上可反映HIV/AIDS患者抗逆转录病毒治疗效果,治疗无效患者PBMCs中miR-21、miR-223表达水平相对较高。

抗逆转录病毒疗法对艾滋病病人肠道菌群影响的研究进展

艾滋病是一种人类免疫缺陷病毒(human immunodeficiency virus,HIV)引起的免疫缺陷疾病,目前普遍通过高效的抗逆转录病毒疗法(antiretroviral treatment,ART)来降低病人病毒载量,延缓艾滋病进程。但由胃肠道菌群引起的消化道疾病、肿瘤等艾滋相关并发症仍然威胁着HIV感染者的生活和健康,同时ART的使用也会导致肠上皮黏膜屏障损伤及肠道免疫异常并肠道菌群平衡的破坏。该研究通过总结分析ART治疗后的艾滋病病人肠道菌群和免疫变化相关的研究,深入了解ART对肠道菌群的影响,为减轻抗逆转录药物对消化道的影响提供新的思路。

云南省艾滋病抗病毒治疗医护人员的职业倦怠及影响因素分析

目的 了解云南省艾滋病抗病毒治疗医护人员的职业倦怠现状及影响因素。方法 采用整群抽样的方法,对2022年1月发布于云南省艾滋病抗病毒治疗信息管理系统的自制一般信息调查表、中文版Maslach职业倦怠量表(Chinese version of Maslach burnout inventory,CMBI)进行调查。结果 共收到有效问卷442份,抗病毒治疗医护人员的职业倦怠检出率为53.39%,情感耗竭检出率为15.61%,人格解体检出率为21.04%,成就感降低检出率为38.01%。二元Logistic回归分析结果显示,加班频率高(OR=2.793,95%CI:1.844~4.213)、报酬公平性低(OR=0.676,95%CI:0.496~0.921)的医护人员更易发生情感耗竭;报酬公平性低(OR=0.705,95%CI:0.547~0.908)的医护人员更易出现人格解体;加班频率低(OR=0.749,95%CI:0.572~0.981)、工作在乡镇治疗点(省、州市级OR=0.377,95%CI:0.161~0.883;县级OR=0.438,95%CI:0.242~0.794)更易出现成就感降低。结论 云南省抗病毒治疗医护人员的职业倦怠呈现中等水平,个人成就感降低较严重。建议优化抗病毒治疗工作流程,合理规划奖励机制,重视乡镇一级医护人员的身心健康,从而缓解医护人员的职业倦怠状况。

云南省2004~2022年经母婴传播HIV感染儿童抗病毒治疗效果评价及影响因素分析

目的 探讨云南省2004~2022年经母婴传播人类免疫缺陷病毒(HIV)感染儿童抗病毒治疗效果及影响因素,为提高疗效提供参考。方法 收集云南省经母婴传播HIV感染儿童抗病毒治疗资料,采用描述性流行病学方法 ,分析抗逆转录病毒疗法(ART)治疗HIV感染患儿的基本特征、不同年份启动ART治疗儿童数量和年龄分布情况;用多元Logistics回归分析ART疗效的影响因素。结果 新入组接受ART治疗的患儿数量自2004年起随年份的增长呈上升趋势, 2013年后逐年下降。截止2022年8月全省1451例在治患儿中,男性占48.45%;目前年龄16.4(12.8, 18.7)岁;开始ART年龄7.0(4.2, 9.8)岁;已接受ART治疗时间8.6(5.5, 10.8)年;确诊HIV/艾滋病(AIDS)到启动ART间隔时间5.1(0.7, 29.5)个月;病毒完全抑制率为68.16%(989/1451), ART治疗失败率为20.68%(300/1451)。单因素分析显示:ART疗效的影响因素有开始ART年龄、已接受ART治疗时间、确诊HIV/AIDS到启动ART间隔时间、目前ART方案、是否更换过ART方案(P<0.05)。以单因素分析中差异有统计学意义的因素作为自变量,进行多因素Logistic回归分析,结果显示:ART疗效的影响因素为已接受ART治疗时间、确诊HIV/AIDS到启动ART间隔时间、目前ART方案、是否更换过ART方案(P<0.05)。结论 应以早发现、早治疗、规范治疗和提高儿童患儿依从性为重点,特别关注学龄期儿童以及更换过治疗方案的患儿,是进一步提高患儿ART疗效的关键。

快速启动高效抗反转录病毒治疗对较高CD4^(+)T淋巴细胞的人类免疫缺陷病毒感染-艾滋病患者治疗依从性及预后的影响

目的探讨快速启动高效抗反转录病毒治疗(HAART)对较高CD4^(+)T淋巴细胞的人类免疫缺陷病毒感染-艾滋病(HIVAIDS)患者治疗依从性及预后的影响。方法选取2021年7月至12月在新余市人民医院感染科住院和艾滋病门诊就诊的HIVAIDS患者61例,将确诊7d以内及时就诊且知情同意下启动抗病毒治疗的32例患者设为快速启动组,将确诊后未及时转至艾滋病门诊或转来后未接受快速启动HAART的患者29例设为未接受快速启动组。记录两组患者的基线病毒载量(HIV-RNA)及CD4^(+)T淋巴细胞计数以及抗病毒治疗6、12个月病毒载量及CD4T淋巴细胞计数,并记录入组患者治疗依从性、病毒抑制率、失访率。结果快速启动组治疗6、12个月的CD4^(+)T淋巴细胞计数高于未接受快速启动组,差异有统计学意义(P<0.05);快速启动组治疗6、12个月的HIV-RNA低于未接受快速启动组,差异有统计学意义(P<0.05);快速启动组的治疗依从性和病毒抑制率高于未接受快速启动组,失访率低于未接受快速启动组,差异有统计学意义(P<0.05)。结论快速启动(确诊7d以内)HAART能最大程度提高较高CD4^(+)T淋巴细胞的HIV/AIDS患者抗病毒治疗依从性,提高病毒抑制率、CD4^(+)T淋巴细胞计数水平,并能减少失访率,值得临床推广。

共情护理在艾滋病患者抗病毒治疗中的应用效果

目的:探讨共情护理在艾滋病患者抗病毒治疗中的应用效果。方法:选取2022年1—12月于鄂州市第三医院行抗病毒治疗的60例艾滋病患者作为研究对象,根据随机数字表法分为对照组与观察组,各30例。对照组给予常规护理,观察组在对照组基础上给予共情护理。比较两组心理状态、认知水平及治疗依从性。结果:护理前,两组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分比较,差异无统计学意义(P>0.05);护理后,两组SAS、SDS评分低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05)。护理前,两组艾滋病疾病知识、抗病毒治疗知识评分比较,差异无统计学意义(P>0.05);护理后,两组艾滋病疾病知识、抗病毒治疗知识评分高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组治疗总依从率高于对照组,差异有统计学意义(P=0.030)。结论:共情护理在艾滋病患者抗病毒治疗中的应用效果显著,可缓解患者焦虑、抑郁情绪,提高疾病认知水平与治疗依从性。

Differences in acquired immune deficiency syndrome treatment and evaluation strategies between Chinese and Western Medicine

Complementary and alternative medicine, including Chinese medicine(CM), has been used to treat acquired immune deficiency syndrome(AIDS) for almost 30 years. We aimed to compare the main differences between AIDS treatment and evaluation strategies between CM and Western Medicine(WM), and analyze advantages and disadvantages.The characteristics of integrative medicine(IM),based on CM and WM, include a patient-centered mode of medicine based on evidence. IM focuses on complex intervention and management with systemic and individual treatment. The evaluation indexes of IM might consist of objective indicators and subjective indexes. IM might be a more valuable method for treating AIDS in the future instead of WM or CM alone.