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.

Human immunodeficiency virus/acquired immune deficiency syndrome: Using drug from mathematical perceptive

Entry of acquired immune deficiency syndrome virus into the host immune cell involves the participation of various components of host and viral cell unit. These components may be categorized as attachment of the viral surface envelope protein subunit, gp120, to the CD4+ receptor and chemokine coreceptors, CCR5 and CXCR4, present on T cell surface. The viral fusion protein, gp41, the second cleaved subunit of Env undergoes reconfiguration and the membrane fusion reaction itself. Since the CD4+ T cell population is actively involved; the ultimate outcome of human immunodeficiency virus infection is total collapse of the host immune system. Mathematical modeling of the stages in viral membrane protein-host cell receptor-coreceptor interaction and the effect of antibody vaccine on the viral entry into the susceptible host cell has been carried out using as impulsive differential equations. We have studied the effect of antibody vaccination and determined analytically the threshold value of drug dosage and dosing interval for optimum levels of infection. We have also investigated the effect of perfect adherence of drug dose on the immune cell count in extreme cases and observed that systematic drug dosage of the immune cells leads to longer and improved lives.

Drug-induced erythroderma in patients with acquired immunodeficiency syndrome

BACKGROUND: To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome(AIDS) complicated with drug-induced erythroderma.METHODS: The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis(SCORTEN) scores, and disease outcome spectrums were analyzed.RESULTS: Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin(IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%.CONCLUSIONS: The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.

Differential Diagnosis and Association of Acquired Immunodeficiency Syndrome and Systemic Erythematous Lupus: A Brief Review

Acquired immunodeficiency syndrome and lupus erythematosus are multisystem diseases that can affect several organs and systems at different stages of disease evolution. Both diseases share common clinical manifestations, which may lead to diagnostic difficulties, especially at the onset of the disease. Another additional challenge is when there is an association of the two pathologies. The objective of this brief review is to describe the clinical manifestations of the diseases and to make considerations regarding the moment of onset of symptoms. Knowledge of these common manifestations and their peculiarities may alert clinicians to possible diagnoses and avoid errors in the evaluation and conduction of these patients.

Improvement in human immunodeficiency virus-1/acquired immune deficiency syndrome patients' well-being following administration of “Phyto V7”

AIM:To corroborate the capacity of Phyto V7,a complex of phytochemicals,to improve the physical well-being of human immunodeficiency virus-1(HIV-1) infected and acquired immune deficiency syndrome(AIDS) patients not undergoing antiretroviral treatment.METHODS:Two hundred and thirty nine HIV-1 seropositive male and female voluntary inmates were recruited through the Uruguay National Program of AIDS.The study participants received for 90 consecutive days every eight hours two tablets(760 mg/each) of Phyto V7,containing a mix of the following phytochemicals:flavonols(Kaempferol,Quercetin),flavones(Apigenin,Luteolin),hydroxycinnamic acids(ferrulic acid),carotenoids(Lutein,Lycopene,Beta carotene) and organosulfur compounds,all from vegetal origin.The participants did not receive any antiretroviral treatment during the study.At days 0,30,60 and 90(± 2 d) the participants were evaluated for body mass index(BMI),tolerance to Phyto V7 and Index of Quality of Life based on the Karfnosky scale.ANOVA,Tukey Post-test,χ2 test and Wilcoxon Signed Rank test were used to analyze the effect of treatment.RESULTS:One hundred and nighty nine study participants finished the study.Already after 30 d of Phyto V7 consumption,the weight,BMI and Karnofsky score statistically significantly improved(P < 0.001),and continued to improve until the end of the study.The mean weight gain per participant during the 90 d wasof 1.21 kg(approximately 2% of body weight).The overall increase in the mean Karnofsky score after 90 d was 14.08%.The lower the BMI and Karnofsky score of the participants were at the beginning of the study,the more notorious was the improvement over time.For example,the mean increment of Index of Quality of Life,among the participants with an initial Karnofsky score of 5 or below(n = 33) from day 0 to day 90,was of 35.67%(0.476 ± 0.044 vs 0.645 ± 0.09; P < 0.001).The tolerability to Phyto V7 was very good and no adverse reactions were recorded or reported.CONCLUSION:Administration of the Phyto V7 can be an important tool to improve the well-being of HIV-1 seropositive individuals and AIDS patients,not undergoing antiretroviral treatment.

Investigation of perceived stigma among people living with human immunodeficiency virus/ acquired immune deficiency syndrome in Henan Province, China

Purpose:To investigate the level of and factors influencing perceived stigma and discrimination among people living with human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(PLWHA)in Henan Province.Methods:In total,161 PLWHA from Zhengzhou and Zhenping were investigated using the Berger HIV stigma scale.Results:The mean Berger stigma scale score was 105.70±15.20,indicating a middle stigma level.Among the four subscales of the Berger stigma scale,the disclosure concerns score was highest,while the negative self-image score was lowest.Multivariate analyses showed that factors influencing perceived HIV stigma included the level of education and route of infection.Conclusion:The level of perceived HIV stigma and discrimination among PLWHA in Henan Province is moderate and was affected by the level of education and route of infection.Special intervention should be established to address this problem.

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.

Epidemiological characterization and geographic distribution of human immunodeficiency virus/acquired immunodeficiency syndrome infection in North African countries

BACKGROUND Human immunodeficiency virus(HIV)infection is a major global public health concern.North African countries carry a disproportionate burden of HIV representing one of the highest rates in Africa.AIM To characterize the epidemiological and spatial trends of HIV infection in this region.METHODS A systematic review was carried out on all the published data regarding HIV/acquired immunodeficiency syndrome in North African countries over ten years(2008-2017)following the PRISMA guidelines.We performed a comprehensive literature search using Medline PubMed,Embase,regional and international databases,and country-level reports with no language restriction.The quality,quantity,and geographic coverage of the data were assessed at both the national and regional levels.We used random-effects methods,spatial variables,and stratified results by demographic factors.Only original data on the prevalence of HIV infection were included and independently evaluated by professional epidemiologists.RESULTS A total of 721 records were identified but only 41 that met the criteria were included in the meta-analysis.There was considerable variability in the prevalence estimates of HIV within the countries of the region.The overall prevalence of HIV ranged from 0.9%[95%confidence interval(CI)0.8-1.27]to 3.8%(95%CI 1.17-6.53).The highest prevalence was associated with vulnerable groups and particularly drug abusers and sexually promiscuous individuals.The dense HIV clustering noted varied from one country to another.At least 13 HIV subtypes and recombinant forms were prevalent in the region.Subtype B was the most common variant,followed by CRF02_AG.CONCLUSION This comprehensive review indicates that HIV infection in North African countries is an increasing threat.Effective national and regional strategies are needed to improve monitoring and control of HIV transmission,with particular emphasis on geographic variability and HIV clustering.

^(99m)Tc-ECD brain SPECT imaging in patients with acquired immunodeficiency syndromes

In order to investigate the changes of regional cerebral blood flow(rCBF) in patients with acquired immunodeficiency syndromes (AIDS), 99mTc-ECDbrain SPECT imaging was performed in 5 patients with AIDS and 16 sex and agematched normal controls, and the rCBF percentages compared to the cerebellum werecalculated using a semi-quantitative processing software. Hypoperfusions in the rightand left frontal, temporal, porietal lobe, basal ganglia and left thalamus were seen in1 patient with dementia. Hypoperfusions in the right and left frontal and temporallobe were seen in 4 asymptomatic patients. The rCBF in the right and left frontal.temporal, porietal lobe, basal ganglia and thalamus, front and pons were decreasedsignificantly in patients with AIDS than those of the control subjects (p ＜0.005). Itis concluded that there exists reduced cortico-subcortical rCBF in AIDS patients.

“零转介”AIDS诊疗管理模式的临床验证

目的探讨“零转介”诊疗管理模式对人类免疫缺陷病毒(HIV)感染患者治疗疗效和满意度的效果。方法选取石家庄市第五医院2022年7月至12月新增HIV感染者100例,随机分为对照组和研究组,每组50例。对照组给予常规认知干预和健康指导、心理干预,研究组在确诊前较对照组提前7~10 d即给予认知干预、生活指导和心理干预。比较对照组和研究组患者的HIV感染患者睡眠[匹兹堡睡眠质量指数表(PSQI)]、服药依从性、焦虑抑郁量表分值。结果对照组患者的PSQⅠ评分高于研究组患者(P<0.01);研究组患者的焦虑抑郁的心理状况要优于对照组(P<0.05);对照组患者服药依从性良好者比例低于研究组患者(P<0.01);研究组患者对疾病的接受度和认知评定量表均好于对照组患者(P<0.01)。结论“零转介”模式,提前给予认知干预、生活指导和心理干预,可提高HIV感染患者满意度,对社会层面的AIDS预防具有积极意义。

空间滞后模型在新疆地区HIV/AIDS报告率影响因素生态学研究中的应用

目的应用空间滞后模型分析影响新疆地区人类免疫缺陷病毒(HIV)/艾滋病(AIDS)报告率的社会人口学因素,探讨该模型在AIDS流行病学中的应用价值。方法利用Geoda软件对新疆85个区县2007年—2015年HIV/AIDS报告率与社会人口学因素进行空间回归模型分析。结果多重线性回归(OLS)模型显示回归残差存在空间自相关性(Moran′s I=0.2867,P<0.001),参照拉格朗日乘数(LM)检验,最后选用空间滞后模型(SLM)进行数据分析。SLM中空间滞后项差异具有统计学意义(P<0.001),即HIV/AIDS报告率存在正的空间自相关性。HIV/AIDS报告率与人口数呈正相关,与农业人口比例呈负相关。与传统OLS模型相比,SLM的调整R^(2)上升,对数似然比的绝对值和赤池信息量准则(AIC)值下降,提示拟合效果更好。结论人口多和城镇化比例高的地区HIV/AIDS报告率较高。SLM在AIDS影响因素的生态学研究中有推广价值。

艾博韦泰联合多替拉韦治疗HIV感染/AIDS多重耐药1例报道

随着抗反转录病毒治疗(antiretroviral therapy,ART)的快速启动和推广,HIV感染已成为一种可以治疗的慢性传染病,然而治疗期间若ART不规范或患者依从性差可引起耐药变异。本研究报道1例30岁多重耐药HIV感染者使用艾博韦泰(albuvirtide,ABT)联合多替拉韦(dolutegravir,DTG)的治疗经过。患者治疗失败后行HIV耐药检测,结果显示患者对核苷类逆转录酶抑制剂、非核苷类逆转录酶抑制剂及蛋白酶抑制剂中的多种药物存在不同程度耐药,在既往药物中仅对整合酶抑制剂类药物敏感。结合患者HIV耐药检测结果,治疗方案更换为“ABT+DTG”,患者病毒复制被成功抑制,且患者在8个月治疗过程中免疫功能逐步提升。而后因个人原因,患者短暂停用“ABT+DTG”治疗1个月,免疫水平下降,病毒载量出现反跳。后行“ABT+DTG”方案治疗至2023年3月,CD4^(+)T淋巴细胞计数平稳升高至291×10^(6)个/L,病毒载量持续降低至小于40×10^(3)copies/L,治疗期间患者耐受性及安全性较好。提示ABT联合DTG方案是HIV多重耐药患者一种新的治疗选择。

深圳市龙岗区新发现≥50岁患者HIV感染/AIDS流行趋势特征和定量预测

目的掌握≥50岁患者的HIV感染/AIDS流行趋势特征,并进行定量预测,为指导疫情防控和风险评估提供科学依据。方法用描述流行病学方法分析深圳市龙岗区2018-2023年新发现≥50岁患者HIV感染/AIDS的趋势特征,用缓冲算子序列建立灰色均值GM(1,1)模型进行趋势判定和定量预测。结果2018-2023年深圳市龙岗区新发现≥50岁HIV感染/ADIS患者271例,年均(45±11)例;男/女性别比3.44∶1,50~59岁占62.37%,职业分布较广,以家务及待业(37.27%)和商业服务(15.87%)较多,已婚或有配偶占53.51%,初中以下文化占62.36%,外市户籍占81.18%;感染途径以异性传播(71.22%)为主,非婚异性性接触史高(63.10%);发现途径以医疗机构检测发现(76.38%)为主。各年≥50岁HIV感染/ADIS患者在人群特征、感染途径和检测样本来源等分布上未呈现趋势变化(P>0.05);在当年新发现HIV感染/ADIS患者构成比呈现出增长趋势(P<0.05)。建立的弱化算子GM(1,1)灰色模型优秀,平均相对误差<2.0%,精度>98.0%,发展系数为0.05,患者数呈增长趋势,预测2024-2028年≥50岁患者年发现数将可能从62例增长至75例。结论深圳市龙岗区≥50岁HIV感染/ADIS患者在构成占比和患者数上均呈增长趋势,应重点关注≥50岁HIV感染/ADIS患者,针对老年人群加强宣传教育、制定和完善AIDS综合干预和防治体系。灰色GM(1,1)预测模型可用于≥50岁人群中HIV感染/AIDS流行趋势判定和定量预测,对风险定量评估和疫情防控具有较好的指导意义。

新发HIV/AIDS患者抑郁心理干预效果及其与CD_(4)^(+)T细胞计数的关系研究

背景HIV/AIDS与抑郁症相关,抑郁症加大HIV相关认知紊乱(HAND)风险,并降低患者抗逆转录病毒治疗(ART)依从性,加剧HIV传播风险。国内研究较少报道新发HIV/AIDS患者(PLWHA)抑郁心理干预效果及与CD_(4)^(+)T细胞计数相关性。目的探究新发PLWHA抑郁心理干预效果及与CD_(4)^(+)T细胞计数相关性,为AIDS临床诊疗提供参考。方法2020年4月—2022年6月采用方便取样方法在江西省ART定点医院抽取新发PLWHA抑郁患者,患者确诊后立即启动ART及心理干预,干预总周期为12周。在干预前后采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)进行评估,并检测CD_(4)^(+)T细胞计数进行分析。结果共纳入新发PLWHA抑郁患者200例,有效随访178例,有效率为89.0%。178例PLWHA抑郁患者轻中度88例(49.4%)、重度90例(50.6%),伴焦虑者173例(97.2%)。患者CD_(4)^(+)T细胞计数均值在干预前为(346.39±156.87)个/μL,干预后为(421.93±149.61)个/μL。干预后,新发PLWHA抑郁患者CD_(4)^(+)T细胞计数高于干预前(t_(配对)=10.971,P<0.05),HAMD、HAMA总分及各因子评分均低于干预前(P<0.05)。干预前,HAMD总分与CD_(4)^(+)T细胞计数分级(以500个/μL为分界值)呈负相关(r_(s)=-0.157,P=0.036)、与HAMA总分呈正相关(r_(s)=0.764,P<0.001)。干预后,HAMD总分与干预后CD_(4)^(+)T细胞计数呈负相关(r_(s)=-0.150,P=0.046)、与HAMA总分呈强正相关(r_(s)=0.939,P<0.001)。干预前,新发PLWHA抑郁患者CD_(4)^(+)T细胞计数<500个/μL者HAMD、HAMA总分高于CD_(4)^(+)T细胞计数≥500个/μL者(P<0.05)。结论新发PLWHA抑郁严重程度与CD_(4)^(+)T细胞计数相关,经专业心理干预能显著改善。

HIV感染者/AIDS患者疾病接受度现状及相关因素研究

目的了解人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者疾病接受度现状及其相关因素,以指导临床制定干预措施,并为改善其临床结局提供实证依据。方法采用便利抽样法选取在某医院AIDS定点治疗门诊接受治疗的555例HIV感染者/AIDS患者,收集研究对象的一般资料、疾病接受度、疾病自我管理效能和临床结局(即生活质量、CD4+T淋巴细胞计数、HIV病毒载量)。结果HIV感染者/AIDS患者疾病接受度平均为(26.08±5.34)分。多元线性回归分析结果显示,宗教信仰、疾病自我管理效能是影响患者疾病接受度的相关因素(均P<0.05),可解释HIV感染者/AIDS患者疾病接受度30.4%的变异,且患者的疾病接受度与其生活质量紧密相关(P<0.001)。结论HIV感染者/AIDS患者的疾病接受度处于中等水平。在临床工作中医务人员应充分考虑患者的宗教信仰情况和疾病自我管理效能水平,以制定针对性的干预措施,提高患者疾病接受度,从而进一步促进患者获得更高的生活质量。

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。

HIV/AIDS患者发生重症肺炎的影响因素分析

目的探讨人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者发生重症肺炎的影响因素。方法回顾性分析2017年1月至2023年8月宁夏医科大学总医院感染性疾病科收治的139例HIV/AIDS合并肺部感染患者的临床资料,其中重症肺炎组48例,非重症肺炎组91例,采用logistic回归分析HIV/AIDS患者发生重症肺炎的影响因素,绘制受试者工作特征(ROC)曲线分析各指标对重症肺炎的预测价值。结果139例HIV/AIDS合并肺部感染患者中,重症肺炎发生率为34.5%(48/139)。单因素分析结果显示:咳嗽、气短、中性粒细胞百分比、淋巴细胞百分比、淋巴细胞绝对值、凝血酶原活动度(PTA)、CD4^(+)T及CD8^(+)T淋巴细胞计数、中性粒细胞/淋巴细胞比值(NLR)、清蛋白、病原体种数大于或等于2种、持续强效抗反转录病毒疗法(ART)治疗(>3个月)与HIV/AIDS患者发生重症肺炎显著相关(P<0.05),logistic逐步回归分析发现,既往患肺孢子菌肺炎(PCP)、病原体种数大于或等于2种、NLR升高、PTA升高、气短是HIV/AIDS患者发生重症肺炎的独立危险因素(P<0.05),持续ART治疗(>3个月)、CD8^(+)T淋巴细胞计数是其独立保护因素(P<0.05)。多因素联合预测的曲线下面积(AUC)最大(AUC=0.917,95%可信区间0.873~0.961,P<0.01)。结论HIV/AIDS患者发生重症肺炎与既往患PCP、病原体种数大于或等于2种、高NLR、高PTA、气短、是否持续ART治疗(>3个月)、CD8^(+)T淋巴细胞计数密切相关。多因素联合预测具有较好的预测价值。

AIDS病人/HIV感染者孤独感研究进展

对艾滋病(AIDS)病人/人类免疫缺陷病毒(HIV)感染者孤独感的概念、机制、现状、评估工具、影响因素以及干预措施进行综述,旨在为今后对AIDS病人/HIV感染者进行心理干预,促进其身心健康提供参考。

完全植入式静脉输液港在HIV/AIDS患者中的应用效果

目的探讨完全植入式静脉输液港(TIVAP)在人类免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)患者中的应用效果。方法回顾性分析2019年6月至2022年9月苏州大学附属传染病医院在数字剪影血管造影机X线透视引导下经胸壁放置TIVAP的10例HIV/AIDS患者的临床资料及随访结果,观察围手术期并发症、术后导管通畅性等情况。结果10例HIV/AIDS患者均成功置入TIVAP,手术成功率100%。术后有2例TIVAP发生局部感染,并取出,余8例TIVAP正常使用。随访期内未见感染,无气胸、血肿、导管夹闭综合征、TIVAP导管处静脉血栓及导管锁脱落等并发症发生。结论HIV/AIDS患者放置TIVAP具有成功率高、方便、微创等特点,值得临床进一步推广应用,但术后感染率较普通人群高,应加强围手术期管理,积极处理术后感染,以显著改善患者预后。

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。