几种检测感染人类免疫缺陷病毒水平的方法

在人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者中，定量检测病毒含量对于诊断急性HIV感染、监测慢性感染的疾病进程和评价治疗效果十分关键。从确认HIV是艾滋病的病原体以来，人们研究了很多方法检测感染者体内HIV水平，下面对几种主要方法进行综述。     

老年HIV感染者和AIDS病人服药依从性影响因素及干预的研究进展

综述老年人类免疫缺陷病毒(HIV)感染者和获得性免疫缺陷综合征(AIDS)病人(people living with HIV/AIDS,PLWHA)服药依从性影响因素及干预措施的研究进展。指出影响老年PLWHA服药依从性的主要因素包括抗病毒药物、病人自身、家庭、社会4个方面。对老年PLWHA服药依从性的干预对策包括简化抗病毒治疗、利用心理咨询技能、护士主导的管理、陪伴者的压力管理、国家政策落实5个方面,综合分析干预对策的效果和局限性,为进一步制订AIDS管理实践指南提供参考。     

HIV感染者合并慢性非传染性疾病多药依从性管理的研究进展

由于艾滋病抗病毒药物的广泛使用,HIV感染者寿命得以延长,老年HIV感染者的人数不断增多,最终导致HIV合并慢性非传染性疾病（chronic non-communicable diseases,NCDs）的人群逐年递增。NCDs包括心血管疾病、糖尿病、癌症和慢性呼吸道疾病等,需要长期服用多种药物,加之复杂的HIV抗病毒药物方案,会导致HIV感染者服药依从性降低,出现错服、漏服等现象。HIV感染者多药依从性问题逐渐引起重视。该文系统回顾了HIV感染者合并NCDs多药依从性管理的相关研究,对HIV感染者合并NCDs多药依从性的定义和影响因素进行阐述,并提出提高合并NCDs的HIV感染者多药依从性的干预措施,以期为HIV感染者多药依从性管理的研究和护理实践提供参考。     

HIV/HCV重叠感染20例ART治疗的临床观察

目的:研究HIV/HCV重叠感染者用抗反转录病毒治疗(ART)的疗效和药物的副作用以及HIV和HCV的相互影响。方法:治疗前后定期采集20例HIV/HCV重叠感染者外周血,分离血浆检测HIV-RNA含量、CD4、CD8、CD3计数以及HCV-RNA和肝功能、肝纤维化指标。结果:ART6月后HIV-RNA全部<100cop/mL,CD4不同程度增多,肝纤维化好转。结论:依非韦伦、拉米夫定和司它夫定联合治疗HIV/HCV重叠感染者可有效抑制HIV-RNA的复制,并提高机体免疫功能。     

丙型肝炎病毒与人类免疫缺陷病毒共感染对人类免疫缺陷病毒病毒载量影响

目的 分析未经抗逆转录病毒(anti-retrovirus,ARVs)治疗的患者中人类免疫缺陷病毒(human immunodeficiency virus,HIV)和丙型肝炎病毒(hepatitis C virus,HCV)共感染对HIV病毒载量的影响.方法 64例未经治疗的HIV患者根据HCV IgG、HCV IgM检测的结果,分为HCV IgG阴性和阳性及HCV IgM阴性和阳性组,对阴性和阳性组HIV病毒载量的对数值进行统计学分析和比较.结果 以HCV IgG分组,两组患者病毒载量(VL)对数值(LogVL)之间的差异有统计学意义(4.01±0.97 vs 4.81±0.54,P＜0.05).若以HCV IgM进行分组,则两组LogVL之间的差异无统计学意义(4.12±0.98 vs 4.10±0.97,P＞0.05).结论 未使用过抗逆转录病毒治疗情况下,HIV/HCV共感染者的HIV病毒载量低于HIV单独感染者,但有无活动性HCV感染对HIV病毒载量不构成影响.     

2006年北京市人类免疫缺陷病毒感染者/艾滋病患者免疫状况分析

目的 了解北京市不同临床阶段人类免疫缺陷病毒(HIV)感染者机体免疫状况及其变化规律,探讨HIV-1感染者治疗时机的选择.方法 应用流式细胞仪对180例在北京市疾病预防控制中心(CDC)性病艾滋病预防控制所进行咨询检测HIV感染者的267份血样进行CD4淋巴细胞的绝对数和百分数检测.结果 180例HIV感染者CD4淋巴细胞的平均值为313.5个/l,46例HIV感染者进入艾滋病期,134个病例处于无症状期;CD4淋巴细胞数有随着感染时间增长进行性减少的趋势.建议进入艾滋病期的46个病例进行抗病毒治疗.结论 北京市HIV感染者CD4淋巴细胞数处于较低的水平,处在艾滋病期或正从无症状期向艾滋病期转变,应该加强HIV感染者的免疫状况监测工作.     

广东省2298例HIV感染或AIDS初诊患者T细胞亚群的检测分析

目的:了解广东省人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者的细胞免疫情况,为开展抗病毒治疗提供依据.方法:采用FACS Calibur流式细胞仪,检测2 298例初次诊断HIV感染者或获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)初诊患者的外周血中CD4 、CD8 T细胞绝对值及计算CD4 /CD8 ,比较HIV感染者及AIDS患者、不同年龄段HIV感染者及AIDS患者的上述指标的差异.结果:2 298例中,CD4 T细胞绝对值为0.001×109/L～1.812×109/L,中位数0.351×109/L.CD4 T细胞小于0.200×109/L有460例,占20.0%;0.200～0.350×109/L有676例,占29.4%;超过0.350×109/L的有1 162例,占50.6%.AIDS患者CD4 、CD8 、CD4 /CD8 均低于HIV感染者(P＜0.01).与其他年龄段比较,50岁以上HIV感染者及AIDS患者CD4 及CD4 /CD8 较低(P＜0.05～0.01),50岁以上AIDS患者的CD8 T细胞计数较低(P＜0.05).结论:广东省HIV感染者、AIDS患者CD4 T细胞总体水平较低,对50岁以上的HIV感染者及AIDS患者要严密监测病情的进展,及时予合适的治疗,提高患者的生存质量.     

HIV感染者和艾滋病患者伴结核病或丙肝的治疗策略之我见

1引言 目前人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者和艾滋病患者在接受抗逆转录病毒治疗(antiretroviral therapy,ART)后,生存期明显延长.所以,HIV感染者和艾滋病患者合并丙型病毒性肝炎(丙肝)和(或)结核病的机会大大增加.然而,当HIV感染者和艾滋病患者合并丙肝和(或)结核病后,临床表现会有所不同,对药物的反应也不尽相同,并给治疗带来一定的难度.目前,对该类患者的治疗时机及用药方案选择方面也存在着一定的争议,本文扼要分析这些争议,并探讨其治疗策略,以供同行参考.     

1例艾滋病合并直肠癌术后肠吻合口瘘病人的护理

正人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者携带HIV带有传染性,主要存在于感染者和病人的体液(如血液、精液、阴道分泌物、乳汁等)及多种器官中,可通过含HIV的体液交换或器官移植而传播~([1])。直肠癌是消化道常见的恶性肿瘤,居消化道癌的第2位,目前手术仍是治疗直肠癌的主要     

心理干预在HIV、HCV合并感染患者中的应用

目的:探讨心理干预在人类免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)合并感染患者中的应用及效果.方法:对 63例HIV、HCV合并感染患者给予个性化心理干预.结果:本组患者治疗依从性良好,均能遵医嘱服药、按时复查.结论:心理干预对提高HIV、HCV合并感染患者的治疗依从性有重要意义.     

血药浓度监测在儿童艾滋病患者抗病毒治疗依从性评价中的应用

目的 探讨血药浓度监测在儿童艾滋病患者抗病毒治疗依从性评价中的应用价值.方法 收集2009年3-10月河南省上蔡县CDC诊治的87例患儿连续3次随访的治疗相关信息及261份血浆标本,建立高效液相色谱-质谱联用的方法,测定血浆中抗病毒药物浓度.对治疗方案、患儿年龄、性别、父母情况、治疗经历和治疗时间等可能影响依从性的相关因素采用单因素Logistic回归分析.结果 以血药浓度是否低于LLTR 1000 ng/ml为标准判断患者是否漏服药物,发现28份标本血药浓度

Abstract：

Objective To evaluate the application of plasma drug monitoring in pediatric HIV/AIDS patient antiretroviral therapy adherence monitoring.Methods Totally 261 plasma samples and related information were collected from three consecutive follow-up visits of 87 HIV-infected children treated in Shangcai county CDC of Henan province from March to October 2009.The plasma concentrations of antiretroviral drugs were measured by a developed high performance liquid chromatography-mass spectrometry method.Potential adherence influencing factors, such as regimen, age, gender, parent conditions, previous ART exposure and therapy duration, were analyzed by univariate logistic regression.Results Plasma concentration of antiretroviral drugs lower than LLTR (1 000 ng/ml) was the criteria to identify missed dose.The concentrations of 28 plasma samples were lower than LLTR, which meant missing dose.There were 17 patients (19.5%) with their concentrations lower than LLTR at least once in three follow-up visits.Logistic regression analysis of adherence related factors showed that compared with the children whose parents were both alive, the children whose mother and (or) father died were more likely to miss dose.The odds ratio was 4.13(95% credibility interval:1.37-12.46, P values was 0.012).Conclusions HIV-infected children have adherence problems when receiving antiretroviral therapy.Plasma therapeutic drug monitoring can be one of the effective methods to monitor the adherence.     

The effect of patient-centered education in adherence to the treatment regimen in patients with coronary artery disease

This study aimed to determine the effect of patient-centered education on adherence to the treatment regimen in patients with coronary artery disease. It was a parallel randomized controlled study with a 1:1 allocation ratio. 104 patients who met the inclusion criteria were chosen through non-probability consecutive sampling and divided into intervention and control groups. For the intervention group, along with the usual education, two sessions of 45-60 minute patient-centered education were performed. The control group received only the usual education. The primary outcome was adherence to the treatment regimen which was measured before and after the intervention. The findings indicated that there was a statistically significant difference between the mean scores of adherence to the treatment regimen in three dimensions of diet, physical activity, and medication at the beginning and end of the research in intervention and control groups. Patient-centered education is effective in improving adherence to the treatment regimen in patients with coronary artery disease. Consequently, patient-centered education applied in the current study can be recommended as a simple, low-cost, and efficient technique in increasing adherence to the treatment regimen in patients with coronary artery disease.     

Orthopedic complications. Compartment syndrome, fat embolism syndrome, and venous thromboembolism

Specialized education in the care of orthopedic patients includes an understanding of the common complications for which patients require monitoring. With a socioeconomic backdrop of decreasing hospital stays and prospective payment, patient care must be managed proactively. For all three complications presented, there are unique sets of risk factors that, when present, contribute to a high index of suspicion for morbidity. Clusters of symptoms have also been discussed representing the expected normal patterns. With this knowledge as a foundation, clinical application is essential to incorporate other salient aspects of individual situations. Nurses diagnose and treat human responses to health problems. The end result of human responses to injury or orthopedic conditions can be the development of complications. Stringent adherence to patient monitoring protocols can promote timely nursing interventions to prevent, minimize, or detect complications or treatment side effects. Although definitive treatment is often physician directed, nurses are in a key role to impact final patient outcomes.     

Adherence in patients on dialysis: strategies for success.

Adherence is a major problem in patients with chronic kidney disease. Patients can be nonadherent with different aspects of their treatment, which includes medications, treatment regimens, and dietary and fluid restrictions. Although many lessons have been learned from adherence research, the evidence of how to modify adherence is somewhat mixed. To minimize nonadherence, interventions need to focus on both patient factors and the extent to which relationships and system problems compromise the patient's ability to adhere to medication and treatment plans. There continues to be a tendency to focus on the patient as the reason for problems with adherence, ignoring other factors such as the patient-health care provider relationships and the health care system that surrounds the patient. These latter factors can have a considerable effect on adherence. The nurse can develop a strong relationship of support with the patient, identify barriers, and offer strategies to help patients improve adherence.     

Determinants of patient adherence to an aerosol regimen

Patient adherence with prescribed inhaled therapy is related to morbidity and mortality. The terms "compliance" and "adherence" are used in the literature to describe agreement between prescribed medication and patient practice, with "adherence" implying active patient participation. Patient adherence with inhaled medication can be perfect, good, adequate, poor, or nonexistent, although criteria for such levels are not standardized and may vary from one study to another. Generally, nonadherence can be classified into unintentional (not understood) or intentional (understood but not followed). Failing to understand correct use of an inhaler exemplifies unintentional nonadherence, while refusing to take medication for fear of adverse effects constitutes intentional nonadherence. There are various measures of adherence, including biochemical monitoring of subjects, electronic or mechanical device monitors, direct observation of patients, medical/pharmacy records, counting remaining doses, clinician judgment, and patient self-report or diaries. The methods cited are in order of more to less objective, although even electronic monitoring can be prone to patient deception. Adherence is notoriously higher when determined by patient self-report, compared to electronic monitors. A general lack of adherence with inhaled medications has been documented in studies, and adherence declines over time, even with return clinic visits. Lack of correct aerosol-device use is a particular type of nonadherence, and clinician knowledge of correct use has been shown to be imperfect. Other factors related to patient adherence include the complexity of the inhalation regimen (dosing frequency, number of drugs), route of administration (oral vs inhaled), type of inhaled agent (corticosteroid adherence is worse than with short-acting beta2 agonists), patient awareness of monitoring, as well as a variety of patient beliefs and sociocultural and psychological factors. Good communication skills among clinicians and patient education about inhaled medications are central to improving adherence.     

Medication adherence and persistence: A comprehensive review

Estimates of adherence to long-term medication regimens range from 17% to 80%, and nonadherence (or nonpersistence) can lead to increased morbidity, mortality, and healthcare costs. Multifaceted interventions that target specific barriers to adherence are most effective, because they address the problems and reinforce positive behaviors. Providers must assess their patients’ understanding of the illness and its treatment, communicate the benefits of the treatment, assess their patients’ readiness to carry out the treatment plan, and discuss any barriers or obstacles to adherence that patients may have. A positive, supporting, and trusting relationship between patient and provider improves adherence. Individual patient factors also affect adherence. For example, conditions that impair cognition have a negative impact on adherence. Other factors—such as the lack of a support network, limited English proficiency, inability to obtain and pay for medications, or severe adverse effects or the fear of such effects—are all barriers to adherence. There are multiple reasons for nonadherence or nonpersistence; the solution needs to be tailored to the individual patient’s needs. To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them. This report describes the barriers to medication adherence and persistence and interventions that have been used to address them; it also identifies interventions and compliance aids that practitioners and organizations can implement.     

The psychologic distress in patients with cancer.

The psychologic distress in patients with cancer may be divided into three categories; depression, anxiety and neuro-cognitive changes including delirium. The supportive interventions of health care professionals along with the use of psychotropic medications have been shown to relieve depression, anxiety, and states of confusion in oncology patients. Oncology nurses are in a critical position to identify problems and intervene to provide appropriate symptom relief. The management of psychologic distress may improve adherence to treatment programs, reduce toxicity, achieve a better quality of life, and enhance grace and dignity at the end of life.     

La modificación de los hábitos y la adherencia terapéutica,clave para el control de la enfermedad crónica

Therapeutic adherence is defined as the extent to which a person's behavior (taking medications, following a diet and changes in lifestyle) coincides with health recommendations (WHO, 2004). We can deduce that is a multiple, complex and changing phenomenon, that there can be total or partial adherence to a treatment, and depending on timing and circumstances.Lack of adherence is a worrying problem; due to its great magnitude and complexity (over two hundred factors) it is responsible for the increased morbid-mortality, complications, hospital admissions, health costs, and dissatisfaction of the user and health professionals.In this paper we develop effective interventions in changing habits and improving adherence: cognitive (education and improved communication), behavior and motivation. Interventions areas include pharmacological treatments, habits and life style, as well as social and family support. The most effective model emphasizes self-care and self-responsibility of the user to manage their disease and increase adherence.     

Dealing with the obstacles in adhering to highly active antiretroviral therapy.

Improving patient adherence to highly active antiretroviral therapy (HAART) is essential to effective treatment and represents a major challenge confronting healthcare providers. Because of their holistic perspective, nurses are uniquely qualified to identify the psychosocial and practical obstacles to full adherence and help patients deal with these problems. Studies have shown that many factors related to the disease, the patient, the provider, and the treatment regimen all play important roles in adopting and maintaining adherent behavior. Therefore, any attempt toward improving adherence should include adherence assessment and an approach that targets the patient, the provider, and the regimen. The availability of antiretroviral agents that are administered once daily and/or are associated with lower toxicity can help to simplify treatment regimens and avoid certain side effects, thereby facilitating greater adherence to highly active antiretroviral therapy.