河南省艾滋病综合防治措施与成效分析

河南省在艾滋病防治上,加强疫情监测,有效实施预防艾滋病母婴传播、HIV单阳配偶管理等防控措施,全面开展抗病毒和抗机会性感染治疗,制定并落实帮扶救助政策,取得了显著效果。今后一个时期,抗病毒治疗耐药问题以及预防艾滋病经性途径传播问题将成为艾滋病防治的突出问题。     

艾滋病抗病毒治疗的新进展

抗病毒治疗的实施和广泛应用已使艾滋病从一种致死性疾病变为一种可以治疗的慢性疾病。随着基础和临床研究的进一步深入,艾滋病抗病毒治疗不断取得新进展。近年来,人们在艾滋病抗病毒治疗的时机与方案、抗病毒治疗的随访、特殊人群和合并其他感染患者的抗病毒治疗等方面提出了很多新的观点。目前认为,所有艾滋病患者均应尽早接受抗病毒治疗,而新型抗艾滋病药物的上市为临床治疗提供了新的选择。有关研究尤其是大型、随机、对照临床试验结果将不断更新和优化艾滋病抗病毒治疗方案,进而不断提高临床抗艾滋病治疗疗效,并使艾滋病最终被治愈也成为可能。为更多的艾滋病患者提供更高效的抗病毒治疗是目前改善艾滋病患者预后的最现实途径。     

2011年～2015年某区艾滋病母婴传播阻断效果的分析

目的了解广西防城港市防城区艾滋病病毒(HIV)感染孕产妇母婴传播综合干预措施的阻断效果,为制定HIV阳性孕产妇综合管理策略提供依据。方法对2011年1月至2015年12月母婴传播阻断20例HIV感染孕产妇及其所生儿童的信息,进行回顾性分析。结果HIV感染孕妇、新生儿应用抗病毒治疗,儿童随访至18个月龄HIV抗体检测均阴性,抗病毒治疗阻断成功率100%,2例HIV感染孕产妇及其所生儿童未抗病毒阻断治疗感染率50%。结论 HIV感染孕产妇母婴应用抗病毒治疗与儿童最终感染状态有关,母婴应用抗病毒治疗是降低母婴传播风险的关键性因素。     

30例艾滋病免费抗病毒治疗患者基本情况分析

目的分析大同市艾滋病免费抗病毒治疗患者流行病学特点,为制订适合我市艾滋病患者管理方案提供依据,同时也为相关部门全面开展艾滋病防治工作,有效遏制艾滋病传播、蔓延提供决策依据。方法收集和整理大同市辖区2007年8月1日至2011年7月31日接受免费抗病毒治疗、随访的30例艾滋病患者相关信息,从年龄、性别、职业、婚姻状况、文化程度、传播途径和地区分布等方面,进行分析。结果 30例长期居住大同市辖区接受国家免费抗病毒治疗的艾滋病患者以性传播为主,大多是20~49岁的青壮年汉族人群,学历层次普遍不高,农民所占比例最高,已婚男性人数较多,病例主要集中在大同市城区和南郊区。近年来艾滋病感染者向艾滋病患者转变的趋势增大。结论应进一步加大艾滋病监测检测工作力度,以发现更多的艾滋病感染者,对已发现艾滋病感染者采取针对性强的措施,控制疫情由高危人群向普通人群进一步蔓延。努力促进城、乡、村艾滋病防治工作一体化,形成多部门联动、全社会参与的防治氛围,确保宣传教育、咨询检测、告知随访及治疗关怀救助等工作措施落实到位。     

山西某市艾滋病免费抗病毒治疗效果分析

<正>艾滋病(AIDS)免费抗病毒治疗是艾滋病防治工作重要组成部分,也是国家对艾滋病患者实施的"四免一关怀"策略的重要内容之一。山西省自2004年开展国家免费艾滋病抗病毒治疗工作,取得了良好的治疗效果[1,2]。为评估艾滋病免费抗病毒治疗效果,现将山西省某市艾滋病免费抗病毒治疗情况进行效果分析。     

北京将免费治疗有本市户籍的艾滋病患者等

本刊讯北京市卫生局局长金大鹏近日说,北京市将对具有本市户籍的艾滋病病人和感染者提供免费抗病毒药物,以提高他们的生活质量,减低对其家庭和社会带来的负担。据介绍,北京市卫生局已指定地坛医院、佑安医院为艾滋病免费治疗定点医院,负责艾滋病免费治疗工作的临床部分,包括抗病毒治疗方案的制定、免费药品的登记、使用及管理、临床治疗的实施、建立病例及相关病案的管理、报告等。金大鹏介绍说,北京市为有效阻断母婴之间的艾滋病传播,还将加强孕妇艾滋病防治工作,在全市妇幼保健机构、卫生防疫机构以及综合医院中,建立孕妇艾滋病咨询、检查…     

预防艾滋病母婴传播的管理模式初探

目的 了解我市艾滋病母婴传播情况,探讨适合我市的预防艾滋病母婴传播的管理模式.方法 观察和分析南宁市第四人民医院收治的艾滋病感染孕产妇管理情况.结果 预防艾滋病母婴传播的有效管理模式,一是开展预防艾滋病母婴传播的VCT服务;二是预防母婴传播抗病毒药物的应用;三是安全分娩;四是选择人工喂养.结论 加强艾滋病孕产妇的管理,实施预防艾滋病母婴传播综合干预措施,是预防艾滋病母婴传播的有效途径.     

孕期与产时启动抗病毒治疗阻断艾滋病母婴传播效果评价

目的:对孕期与产时启动抗病毒治疗阻断艾滋病母婴传播效果进行评价分析,为今后的临床工作提供有价值的参考依据。方法:选择2016年1月-2017年12月间我院收治的,临产时发现感染HIV病采取紧急接受抗病毒治疗的孕产妇以及婴儿35例作为研究对象,定义为观察组,另取同期在孕期开始应用抗病毒治疗的HIV感染孕妇和婴儿35例作为对照组,对两组母婴传播情况进行对比分析。结果:观察组中,有1例婴儿在出生3个月后死亡,有2例婴儿在HIV-1脱氧核糖核酸的两次检测结果呈阳性,确诊为婴儿HIV感染,其余32例患者满12-18月龄婴儿的检测结果呈阴性;对照组婴儿早期诊断和满12-18月龄婴儿HIV抗体检测均呈现为阴性,观察组婴儿HIV感染率高于对照组(P0.05)。结论:孕产妇感染HIV后经抗病毒治疗,可以使母婴传播风险降低,在孕期开始启动抗病毒治疗,对预防艾滋病母婴传播的效果较产时紧急抗病毒治疗效果更佳理想,值得关注。     

中国每万人中6人“染艾”仍有3成感染者未被发现

中国疾控中心副主任梁晓峰在10月28日举行的中国－东盟疾病防控合作论坛上表示,截至2015年底,中国发现现存活的艾滋病感染者共计57.7万人,经测算估计全国人群总感染率0.06%,即每1万人中有6人“染艾”,仍有32.1%感染者未被发现。国家疾控中心统计数据显示,到2015年,异性传播、同性传播、注射毒品成为主要传播途径。同性传播占比从2005年的0.3%升至2015年的27.6%,异性传播占比从11.3%上升为66.5%。针对艾滋病的治疗,国家卫生计生委2016年修订了抗病毒治疗指南,推荐“全员治疗”,即检测发现感染后就开始治疗,不再考虑CD4细胞（艾滋病病毒主要攻击对象）水平。目前全国共有2415个县区的4226家医疗机构提供抗病毒治疗服务。     

HIV感染者/AIDS患者38例临床及治疗分析

目的探讨HIV感染者及AIDS病例的传播途径、临床特点及治疗结果,为本地区艾滋病防治提供参考依据。方法对本地区2006年10月以来确认的艾滋病病毒感染者及患者38例资料进行回顾性临床分析。结果 38例中HIV感染者27例,AIDS患者11例。异性传播31例(4例为夫妻间传播),同性恋传播7例。4例合并肺结核,1例合并淋巴结核。死亡4例,现存活34例。累计抗病毒治疗者23例,死亡3例,因副作用退出治疗1例,现治疗19例,明显好转者18例,治疗失败1例;治疗时间1年以上有17例,治疗前后CD4+T计数分别为(166.88±111.72)和(330.76±148.64)个/μl。结论本地区HIV感染以异性传播为主,经过正规的抗病毒治疗,可有效提高艾滋病患者的生活质量及生存率。     

The impact of generic antiviral drugs

The HIV/AIDS epidemic has spread worldwide, with approximately 40 million people who were infected by the end of 2006. Antiretroviral therapy (ART) has proven to be lifesaving, and can convert AIDS into a chronic but manageable disease. Until a few years ago, the annual cost of treating one patient with HIV/AIDS was between US $10,000 and $12,000--beyond the affordability of most individuals. In 2001, the offer of a triple generic therapy at a cost of less than US $1 per day from the Indian company Cipla stunned the world. Although there were some initial challenges, this approach to HIV/AIDS treatment galvanized a reaction that had never occurred previously. Governments, the WHO, NGOs and other bodies quickly attempted to make ART available in the developing world. By 2006, almost 1.3 million patients were receiving ART (comprising mostly generic drugs), a 5-fold increase compared with five years earlier; however, significant challenges in ART availability remain. With international patent laws now being applicable in India (and in most developing countries), generics companies may no longer be able to provide HIV/AIDS-afflicted countries with new third-generation drugs at low prices. Innovative solutions will need to be obtained urgently to address this issue.     

108例HIV感染者/AIDS病人临床分析

目的了解艾滋病重点村艾滋病病毒(HIV)感染者和获得性免疫缺陷综合征(AIDS)临床表现的特点,及抗逆转录病毒治疗(ART)的效果. 方法对HIV感染者和AIDS病人的流行病学和临床资料加以归纳总结. 结果 AIDS病人72例.28例进行了丙肝抗体检测,仅1例阴性.69例AIDS病人进行了抗逆转录病毒治疗,服药后34例患者出现了不同程度的不良反应,16例退出治疗,50例AIDS病人坚持抗病毒治疗半年至1年半临床症状改善率94% 结论 ART确实大大减轻了患者的临床症状,但不良反应较大,影响了患者的服药依从性,部分病人出现耐药,药物的组合和选择均受到限制,探索适合贫困地区抗逆转录病毒治疗的新路已是当务之急.     

抗艾滋病毒治疗的药物联用模式

抗艾滋病毒(HIV)治疗就是联用不同的抗HIV药物以达到抗病毒作用最大化。新型抗病毒药物的出现为抗HIV治疗提供了新的选择,且许多新的药物联用模式的有效性已被临床证实。目前,抗HIV治疗的药物联用模式主要是以双核苷类药物为基础,再联用非核苷类药物(依非韦仑)、蛋白酶抑制剂或整合酶抑制剂。美国2011年的抗病毒指南对抗HIV治疗的药物联用模式进行了更新,本文予于介绍以供国内临床医师参考。     

Cabenuva®: Differentiated service delivery and the community Pharmacists’ roles in achieving UNAIDS 2030 target in Nigeria

The approval of the novel long-acting HIV injection; Cabenuva®- Cabotegravir and Rilpivirine injectable formulation) and the recent call by the World Health Organization for promoting community-based ART management, underscore the remarkable progress towards meeting the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95–95 targets by 2030.As the availability of antiretroviral therapy (ART) for the treatment of HIV/AIDS has increased in resource-limited settings, there has been a move to develop and implement alternative treatment delivery models such as Differentiated Service Delivery (DSD) in high prevalence countries to meet the global targets for HIV treatment while maintaining the quality of care. However, there is limited data on the involvement of community pharmacies in the delivery of ART within the community. Although, in western countries, several studies have documented the different roles community pharmacists can play in the management of HIV/AIDS. Community pharmacists are the most accessible and first points of health care for most clients. They are trusted, highly trained health care professionals. They should be incorporated and allowed to administer the Cabenuva® injection if the battle against the HIV pandemic is to be totally won. In this paper, we, therefore, aim to explore how the community pharmacist can be positioned in HIV service delivery regarding the administration of the Novel long-acting Cabenuva® injection formulation. It is therefore recommended that the Nigerian government embrace community pharmacy-led drug administration initiatives and embark on accredited training programmes for the profession in line with drug administration services. The government should also put in place necessary funding mechanisms for community pharmacists for the extra workload placed on them in administering injection drug formulation in their respective pharmacies.     

Cabenuva®: Differentiated service delivery and the community Pharmacists’ roles in achieving UNAIDS 2030 target in Nigeria

The approval of the novel long-acting HIV injection; Cabenuva®- Cabotegravir and Rilpivirine injectable formulation) and the recent call by the World Health Organization for promoting community-based ART management, underscore the remarkable progress towards meeting the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95–95 targets by 2030.As the availability of antiretroviral therapy (ART) for the treatment of HIV/AIDS has increased in resource-limited settings, there has been a move to develop and implement alternative treatment delivery models such as Differentiated Service Delivery (DSD) in high prevalence countries to meet the global targets for HIV treatment while maintaining the quality of care. However, there is limited data on the involvement of community pharmacies in the delivery of ART within the community. Although, in western countries, several studies have documented the different roles community pharmacists can play in the management of HIV/AIDS. Community pharmacists are the most accessible and first points of health care for most clients. They are trusted, highly trained health care professionals. They should be incorporated and allowed to administer the Cabenuva® injection if the battle against the HIV pandemic is to be totally won. In this paper, we, therefore, aim to explore how the community pharmacist can be positioned in HIV service delivery regarding the administration of the Novel long-acting Cabenuva® injection formulation. It is therefore recommended that the Nigerian government embrace community pharmacy-led drug administration initiatives and embark on accredited training programmes for the profession in line with drug administration services. The government should also put in place necessary funding mechanisms for community pharmacists for the extra workload placed on them in administering injection drug formulation in their respective pharmacies.     

Prevalence and correlates of alcohol use disorders during antiretroviral treatment in injection-driven HIV epidemics in Vietnam

BackgroundAlcohol use disorders (AUD) negatively affects adherence to and outcomes of antiretroviral treatment (ART) for HIV/AIDS patients. This study determined the prevalence of AUD and identified correlates of alcohol consumption and drinking problems during ART in large injection-driven HIV epidemics in Vietnam.MethodsWe conducted a cross-sectional study of 1016 patients (36.2% women, mean age = 35.4) in 7 hospitals in Hanoi, Hai Phong, and Ho Chi Minh City. Alcohol use problems were assessed using the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C). Step-wise multivariate regression analyses determined the correlates of alcohol consumption, hazardous drinking, and binge drinking in HIV/AIDS patients.ResultsThere were 55.0% patients reported ever drinking, 30.1% had positive hazardous drinking and 22.3% had binge drinking. Patients who were male, drug users, working as free-lancers, asymptomatic stage, and poorer immune status were more likely to have severe alcohol consumption, hazardous drinking and binge drinking. Drug users taking both ART and Methadone Maintenance Treatment (MMT), were less likely to report AUD. In non-drug users, the longer duration of ART was also associated with lower alcohol consumption and likelihood of drinking problems. In drug users, those in the 1st year ART were more likely to be at-risk drinking than other patient groups.ConclusionAUD is highly prevalent in HIV/AIDS patients taking ART in large injection-driven HIV epidemics. ART guidelines should include AUD screening and interventions. Expanding the coverage of current services for drug users, including MMT and ART, might contribute to the reduction of AUD.     

Immunomodulants for the treatment of HIV infection: the search goes on

The natural history of HIV infection has been greatly modified by the introduction of powerful antiretroviral agents that act on multiple steps of HIV replication. Thus, antiretroviral therapy (ART) has prolonged the life of HIV-infected individuals, significantly impacting on the progression to AIDS. It was assumed that ART-induced suppression of HIV would have resulted in a degree of immune recovery sufficient enough to allow immune control over HIV replication independently of the use of drugs. Unfortunately, interruption of therapy, even after long periods of full suppression of viral replication, is almost inevitably associated with a prompt rebound of HIV viraemia. The outcome of this observation is that ART has to be considered as a lifelong therapy, with the associated resulting problems of the emergence of multi-drug resistant viral strains, toxic effects, costs and compliance. The use of immunomodulants in association with ART could achieve the goal of boosting the immune response to a threshold, permitting the immune response to indefinitely suppress HIV replication.     

Immunomodulants for the treatment of HIV infection: the search goes on

The natural history of HIV infection has been greatly modified by the introduction of powerful antiretroviral agents that act on multiple steps of HIV replication. Thus, antiretroviral therapy (ART) has prolonged the life of HIV-infected individuals, significantly impacting on the progression to AIDS. It was assumed that ART-induced suppression of HIV would have resulted in a degree of immune recovery sufficient enough to allow immune control over HIV replication independently of the use of drugs. Unfortunately, interruption of therapy, even after long periods of full suppression of viral replication, is almost inevitably associated with a prompt rebound of HIV viraemia. The outcome of this observation is that ART has to be considered as a lifelong therapy, with the associated resulting problems of the emergence of multi-drug resistant viral strains, toxic effects, costs and compliance. The use of immunomodulants in association with ART could achieve the goal of boosting the immune response to a threshold, permitting the immune response to indefinitely suppress HIV replication.