【摘要】 目的 評價高效抗逆轉錄病毒療法（highly active antiretroviral therapy，HAART）對艾滋病患者的療效，并觀察其耐藥情況。 方法 2008年11月，對23例接受免費HAART治療1~3年的艾滋病患者的HIV-RNA病毒載量、HIV-1耐藥、CD4+T淋巴細胞絕對計數、常規生化檢測結果進行分析。 結果 23例艾滋病患者在HAART治療1~3年后有6例（26.1%）患者HIV-RNA載量在水平線以下，17例（73.9%）HIV-RNA載量未達到檢測線以下。5例患者（21.7%）的HIV-1發生了耐藥，服藥依從性良好的患者僅9例（39.1%）。 結論 HAART對艾滋病患者的療效較差、耐藥率高、服藥依從性差。【Abstract】 Objective To evaluate the efficacy of highly active antiretroviral therapy (HAART) in treating HIV, and observe the resistance of HAART in AIDS patients. Methods Twenty-three HIV patients receiving free HAART for one to three years were investigated. The plasma viral load, drug resistance to HIV-1, CD4+ T cell count were tested and routine laboratory examinations were performed in our study. Results After one to fhnee-year HAART treatment, HIV viral load of six patients (26.1%) declined to the undetectable level, while the viral load of 17 patients (73.9%) kept at a high level. Resistance to HIV-1 occurred in five cases (21.7%). Only nine patients (39.1%) had good treatment compliance. Conclusion HAART has a poor therapeutic effect on patients with HIV/AIDS with a high rate of drug resistance and poor treatment compliance.
Objective To study the distribution of HIV/AIDS high-risk population, HIV infection and the main risk factors for developing HIV/AIDS’ controllable measures and exploring appropriate health education and behavior intervention models. Methods A total of 360 commercial sex workers (CSW) joined together through convenience sampling and 360 drug users (DU) joined together through convenience sampling or snow-balling sampling whose relevant behavior factors were investigated by questionnaires. Results The general rate of knowing knowledge about AIDS was 75.2% among 360 CSW, 67.8% CSW used condom in commercial sex activities; none of 149 CSW blood samples was detected HIV or syphilis antibody positive. The general rate of knowing knowledge about AIDS was 83.7% among 360 DU who injected drugs last month, the rate of sharing needles was 47.6% and the low rate of condom used; 1 HIV antibody and 5 syphilis antibodies positive were found among 198 DU blood samples, so HIV and syphilis infection rate were 0.51%and 2.53%, respectively. Conclusion The rate of HIV infection is a very low level and there are many risk factors among CSW and DU. A good job should be done to integrate AIDS health education with behavioral intervention and the monitoring system for the AIDS/HIV high-risk population should be improved.
Zhaojue is a deeply impoverished county located in Liangshan Autonomous Prefecture with high prevalence of human immunodeficiency virus infection. Based on local conditions, West China Hospital of Sichuan University has established a targeted supporting mode called “three-level organization and five-in-one”. This mode integrates administrative support teams, multiple disciplinary technical support teams and on-site expert teams to achieve five goals, including building effective teams, promoting clinical practice, enhancing skill training, focusing on academics and building a systematic platform. This model has improved the ability of treatment on human immunodeficiency virus infection and overall health services in Zhaojue County. It also reflects the responsibility of West China Hospital of Sichuan University in poverty alleviation and public welfare.
ObjectivesTo evaluate the effects of short message service (SMS) intervention for improving antiretroviral treatment adherence in HIV patients by meta-analysis.MethodsDatabases including PubMed, EMbase, CINAHL, Web of Science, ScienceDirect, The Cochrane Library, CNKI, WanFang Data, VIP and CBM were searched electronically from January 2000 to December 2018 to collect randomized controlled trials (RCTs) on the efficacy of SMS intervention on HIV patients. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 10 RCTs with 2 411 patients were included. The meta-analysis showed that SMS intervention could improve significantly treatment adherence of HIV patients (RR=1.11, 95%CI 1.03 to 1.20, P<0.01). The subgroup analysis showed that weekly texting had an effect on treatment adherence (RR=1.15, 95%CI 1.00 to 1.33, P<0.05); personal sending (RR=1.17, 95%CI 0.99 to 1.38, P=0.06) and daily sending (RR=1.02, 95%CI 0.83 to 1.26, P=0.84) of SMS had no statistical significance on treatment adherence; the intervention duration of 6 months (RR=1.11, 95%CI 1.00 to 1.23, P=0.05) could improve the treatment adherence, while the intervention duration of 12 months (RR=1.07, 95%CI 0.98 to 1.17, P=0.13) had no statistical difference on treatment adherence; there was no statistical difference in CD4+ cell count before and after treatment (WMD=4.18, 95%CI ?39.33 to 47.69, P=0.85).ConclusionsBy comparing SMS intervention with routine nursing, sending SMS weekly for 6 months to remind HIV patients to take medicine can improve treatment adherence. Due to the limitation of quantity and quality of the included studies, the above conclusions are required to be assessed by more high-quality studies.
ObjectiveTo systematically evaluate the effects of cognitive behavioural therapy (CBT) on improving depression, medication adherence and quality of life in people living with HIV/AIDS (PLHIV). MethodsWe searched The Cochrane Library (Issue 4, 2013), Ovid-JBI, PubMed, EMbase, PsycARTICLES, CBM and CNKI to collect randomized controlled trials (RCTs) on improving depression, medication adherence and quality of life in PLHIV from the establishment dates to April 30th 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Meta-analysis was conducted using RevMan 5.2. ResultsA total of 17 RCTs were included, involving 2 163 patients. The results of meta-analysis showed that CBT significantly improved PLHIV's depression (SMD=-0.26, 95%CI-0.41 to-0.10, P=0.001), and quality of life (SMD=-0.57, 95%CI-1.04 to-0.11, P=0.02) in 6 months. Meanwhile, CBT significantly improved PLHIV's medication adherence (WMD=3.98, 95%CI 1.67 to 6.30, P=0.000 8) in the long term. ConclusionCBT is efficacious in improving PLHIV's depression and quality of life in the short term, and improving medication adherence in the long term, compared to standard care.
ObjectiveTo summarize the clinical, radiological and pathological characteristics of acquired immune deficiency syndrome (AIDS) combined with Pneumocystis carinii pneumonia (PCP), so as to improve the clinicians' understanding of the disease. MethodsThe clinical data of 50 AIDS patients combined with PCP admitted between February 2006 and May 2015 were retrospectively analyzed, including medical history, physical signs, laboratory examination, chest high resolution CT (HRCT), pathological characteristics, treatment and prognosis, etc. ResultsThe clinical features of AIDS patients combined with PCP included cough, dyspnea and fever, without obvious positive signs in the lung.The patients were divided as a mild group, a moderate group and a severe group according to the levels of PaO2.There was significant difference among three groups in serum albumin level [(23±3) g/L vs. (30±5) g/L and (28±6) g/L, P < 0.01].There were no significant differences among three groups in CD4+ T lymphocyte and lactate dehydrogenase (LDH) (P > 0.05).The typical chest radiograph feature of HRCT was ground-glass shadows in both lungs, and may be associated with reticular shadows or "gravel sign" and cyst.Of 50 patients, 16 patients were diagnosed via pathology of transbronchial lung biopsy(TBLB) and only 5 patients were diagnosed via silver staining of the bronchoalveolar lavage fluid (BALF).The other patients were clinically diagnosed.100% of the patients were treated with sulfamethoxazole (SMZco), 64%with caspofungin, and 72% with glucocorticoid.All the patients relieved with no death in hospital. ConclusionWhen a patient got cough, dyspnea and fever, especially ground glass on HRCT in both lungs, AIDS combined with PCP should be highly considered, and diagnostic treatment with SMZco and CD4+ T lymphocyte measurement should be conducted as soon as possible, so as to reduce misdiagnosis and mortality.
【摘要】 目的 探討艾滋病患者合并機會性感染的臨床特征并評價其治療效果。 方法 回顧分析2003年-2009年53例確診為艾滋病患者的臨床資料，對患者合并機會性感染的臨床特征，包括發生機會性感染的時間、發生機會性感染時CD4+T細胞計數、起病急緩、嚴重程度等，進行觀察和分析，并給予國家推薦的標準治療方案進行治療，通過臨床癥狀、病毒載量、CD4+T細胞計數、影像學監測進行療效分析，隨訪時間為初治至出院后6年。 結果 53例艾滋病患者均為重癥感染，41例為混合感染，其中2個以上部位感染者為36例（67.9%），2種以上病原體感染者為28例（52.8%），3種以上病原體感染者13例（24.5%）。最常見的機會性感染為結核35.8%（19/53）；其次為卡氏肺孢子菌肺炎30.2%（16/53）；敗血癥20.8%（11/53），此外，尚有隱球菌感染15.1%（8/53）、弓形蟲感染3.8%（2/53）、帶狀皰疹病毒感染7.5%（4/53）、念珠菌感染17.0%（9/53）、巨細胞病毒感染7.5%（4/53）、合并乙肝11.3%（6/53）、丙肝3.8%（2/53）。機會性感染治療有效率為77.4%（41/53），病死率為22.6%（12/53），其中隱球菌腦膜炎或混合感染者病死率最高。 結論 艾滋病患者在CD4+T細胞計數lt;350/mm3時各種機會感染明顯升高，且隨著CD4+T細胞計數的下降呈增高趨勢，艾滋病合并機會性感染最常見的是結核，其次卡氏肺孢子菌肺炎；合并結核的治療效果較好，合并隱球菌腦病的病死率最高。早期啟動高效抗逆轉錄病毒治療效果好。【Abstract】 Objective To investigate the clinical characteristics of acquired immune deficiency syndrome (AIDS) combined with opportunistic infections and its treatment. Methods We retrospectively analyzed the clinical data of 53 patients diagnosed to have AIDS in our hospital between 2003 and 2009. The clinical features (such as time of the onset of opportunistic infections, CD4+ T cells value at the onset, severity of the infection, etc.) of the opportunistic infections (such as tuberculosis, Pneumocystis carinii pneumonia, toxoplasmosis, etc.) were also observed and analyzed. The patients were treated according to the national standards. The clinical outcome was analyzed based on such indicators as clinical symptoms, viral load, CD4+ T cells value at the onset, and the results of various imaging. Follow-up was done for six years. Results All 53 patients had severe AIDS infection. Forty-one of them had combined infections, among whom 36 (67.9%) had infections in two or more parts of the body, 28 (52.8%) were infected by two or more pathogens, and 13 (24.5%) were infected by three or more pathogens. The most common opportunistic infection was tuberculosis (35.8%,19/53) followed by pneumocystis carinii pneumonia (30.2%,16/53) and septicemia (20.8%,11/53). Other infections included cryptococcal infection (15.1%, 8/53), toxoplasma gondii infection (3.8%, 2/53), herpes zoster virus infection (7.5%, 4/53), candidiasis (17.0%, 9/53), cytomegalovirus infection (7.5%, 4/53), combined hepatitis B (11.3%, 6/53), and hepatitis C (3.8%, 2/53). Effective treatment rate for opportunistic infections was 77.4% (41/53) with a mortality of 22.6% (12/53). The highest fatality rate occurred to those patients with cryptococcal meningitis or mixed infections. Conclusions The occurrence of opportunistic infections rises obviously when CD4+ T cells is lower than 350/mm3, and it increases more significantly as the value of CD4+ T cells goes down. The most common opportunistic infection is tuberculosis followed by pneumocystis carinii pneumonia. The clinical outcome for the combined cases of tuberculosis is good, while combined cryptococcal encephalopathy has the highest mortality rate. High active anti-retroviral therapy should be initiated as early as possible.