手机短信提醒方式应用于艾滋病患者抗病毒治疗的研究

目的:探讨使用手机短信提醒干预方式配合常规的依从性教育应用于艾滋病患者高效抗反转录病毒治疗(HAART)提高患者服药依从性,从而减少治疗失败现象的发生。方法:将HAART 80例患者按就诊顺序单双数交替入选方法分为两组,对照组(40例):HAART治疗前对患者进行常规的依从性教育。干预组(40例):HAART治疗前对患者进行常规的依从性教育并由医护人员在患者需要服药的时间进行每天两次手机短信提醒。监测两组患者HAART治疗第1年的依从性和治疗失败现象;HAART的基线、1,2,3,4年分别检测CD4+及病毒载量。结果:①HAART第一年服药依从性:对照组为91.7%;干预组为99.2%,两组比较差异有统计学意义(χ2=1823.981,P<0.05)。②对照组HAART第1年死亡3例、失访2例、第2年耐药1例;第4年死亡1例,耐药1例;干预组:HAART第1年时死亡1例,4年无失访、耐药发生;两组比较差异有统计学意义(χ2=6.135,P<0.05)。结论:使用手机短信提醒干预方式配合常规的依从性教育应用于艾滋病患者HAART有助于提高患者服药依从性,从而减少艾滋病患者HAART治疗失败现象的发生。     

吸毒感染艾滋病患者高效抗逆转录病毒治疗依从性及相关因素研究

目的 探讨吸毒感染艾滋病患者高效抗逆转录病毒治疗(HAART)依从性及相关因素.方法 在2007年7～9月抽取湖南省衡阳、岳阳、郴州3个地区HAART治疗点,对接受国家免费HAART疗法的111名吸毒感染艾滋病患者进行调查,采用美国社区艾滋病临床研究抗逆转录病毒用药自陈式问卷(CPCRA),来评估抗病毒治疗服药依从性,并分别用抑郁自评量表、家庭关怀度指数问卷来评估患者抑郁症状和家庭功能状况.结果 本组患者服药平均依从水平为83%,有30人(28.8%)服药量在90%或以下,达不到服药量的要求,属于服药依从性差.抑郁标准评分为(60.81±13.03)分,有抑郁症状者占83.9%,而家庭功能良好者仅占30.6%.非条件Logistic回归分析显示抑郁程度(β=-0.48,P=0.024)和治疗时间(β=-1.11,P=0.036)对服药依从率有负性影响,而家庭功能(β=0.65,P=0.043)、脱毒时间(β=0.55,P=0.040)对服药依从率有正性的影响.结论 吸毒感染艾滋病患者HAART治疗依从水平偏低,应通过综合干预如治疗抑郁、帮助脱毒、提高家庭功能、定期评价依从性等来提高患者的服药依从性.     

艾滋病病人对HAART的认知情况及依从性分析

目的了解艾滋病病人对高效抗逆转录病毒治疗(HAART)的认知情况、药物依从水平及影响因素,进而提高抗病毒治疗的依从性。方法采用横断面调查法,对2011年8～9月保山市第二人民医院在治的定期到门诊取药>18岁的43例艾滋病病人开展药物认知情况、社会支持、服药依从性等调查。结果 32.6%的病人极其明确按照要求服用药物;39.5%调查者极其明确服用的药物对身体有积极作用;32.6%的病人极其明确如不按要求服药,将导致耐药。自报告最近1个月服药依从性:79.1%的患者服药依从性达100%,20.9%的病人服药依从性<100%。影响服药依从性的主要因素为忘记掉、不想让别人知道自己在服药、特定时间内不方便。结论为提高HAART的依从性,有效抑制艾滋病病毒的复制,抗病毒治疗定点医院需对治疗病人定期开展干预活动以巩固及增进其对HAART的认识。     

河北省艾滋病抗病毒治疗初期病人依从性影响关键因素及相关对策研究

目的了解河北省艾滋病人抗病毒治疗初期影响依从性的关键因素,提出相对策略。方法对200例在治病人(治疗期>1年)开展调查问卷,对100例因依从性不良导致治疗失败的艾滋病人(包括死亡病例)进行档案资料查阅,对督导服药的医生进行面对面访谈。结果河北省艾滋病人抗病毒治疗初期影响依从性的关键因素为个人心理状态、家庭关系状况、病例自身劳动能力3方面。通过定性分析,初期治疗中病例可分为乐观、责任、悲观、痛苦、绝望5型。总结提出提高病例治疗依从性的工作策略:提高开展抗病毒治疗的及时性;对患者提出"适应"和"改变"的策略;对家庭成员进行对患者接受和关爱的思想疏导;病例可根据个人情况和意愿自行选择合适的治疗地点即家庭、当地定点医院或外地(省内或本市区内)定点医院。结论专业部门制订提高病例治疗依从性的工作策略,治疗医生加强岗位培训,对提高患者治疗依从性、保护艾滋病病人的权利有重要意义。     

心理护理干预对艾滋病患者高效联合抗反转录病毒治疗依从性的影响

综述了艾滋病患者HAART治疗服药依从性的重要性、现状及其心理影响因素,提出患者服药依从性较差,与多种影响因素相关,尤其是心理因素有关,给予其心理护理干预可提高服药依从性,从而提高患者生活质以及延长生命.     

河南农村地区艾滋病患者抗病毒治疗服药依从性分析

目的:探讨河南省农村地区艾滋病(AIDS)患者抗病毒治疗依从水平及其相关影响因素.方法:选取在河南省AIDS定点医疗机构接受高效抗逆转录病毒疗法(HAART)治疗的AIDS患者,采用整群抽样的方式抽取某2县AIDS定点医疗机构接受HAART治疗的全部AIDS患者,共2144人.调查内容包括患者的人口学特征、药物漏服情况和漏服原因等.结果:2县AIDS患者的HAART治疗率为99.2%;AIDS患者接受HAART治疗的依从性在年龄、性别和婚姻状况等方面差异无统计学意义(λ2=3.083,1.748,46.199,P＞0.05);每月按时服药无一次漏服药物者1056人,占49.3%;按照每月漏服低于2次者为达到95%的服药依从性计算,其服药依从性平均达到95%以上者占83.3%.药物漏服的主要原因是离家外出、事务繁忙和遗忘.结论:河南省AIDS患者的服药依从性有很大提高,但还需加大工作力度.     

我国免费艾滋病抗病毒治疗策略与“治疗即预防”进展情况

本文通过对比我国多年免费艾滋病抗病毒治疗的相关研究,阐述了自2003年始,我国免费艾滋病抗病毒治疗策略的调整和取得成效：随着治疗标准、用药方案和治疗点管理模式等的调整以及艾滋病患者社会人口学特征变化,艾滋病抗病毒治疗的效果不断提高,患者的死亡率显著降低,预期寿命不断提高,HIV耐药率也得到有效的控制;“治疗即预防”是减少HIV新发感染的最有效措施之一,在公共卫生层面早期开展抗病毒治疗可以有效降低HIV的传播。同时指出,随着免费艾滋病抗病毒治疗标准的降低,接受免费抗病毒治疗的患者服药依从性降低,脱失比例升高,病毒抑制率较理论值偏低等,这些是制约我国“治疗即预防”效果的关键因素。     

艾滋病合并糖尿病的治疗体会

目的 探讨艾滋病合并糖尿病的治疗策略.方法 通过对2例艾滋病合并糖尿病患者的治疗体会,就本病的治疗策略进行分析.结果2例艾滋病合并糖尿病患者并发症痊愈,血糖水平均得到控制,CD4+T淋巴细胞计数与治疗前相比分别上升了54.8%和30.4%,治疗效果满意.结论 艾滋病合并糖尿病患者采用HAART抗病毒治疗,胰岛素控制血糖,治疗并发症的同时,应注意艾滋病和糖尿病病程发展的相互影响、药物的相互作用及治疗时机的选择.     

艾滋病高效抗逆转录病毒治疗5例临床分析

目的 提高高效抗逆转录病毒治疗(HAART)在艾滋病治疗中的疗效。方法 根据患者病情选择治疗方案，观察治疗后药物毒副作用发生情况，HIV RNA、CD^4 T淋巴细胞计数的变化，分析治疗中影响疗效的主要因素。结果 几种治疗组合方案，均取得明显临床效果，同时获得CD^4 T淋巴细胞上升、HIV RNA栽量下降。影响疗效的主要因素有：治疗时机、治疗方案、患者依从性、抗病毒药毒副作用。结论 把握好的治疗时机，选择适合患者的治疗方案，注意回避药物的毒副作用，提高患者对治疗的依从性，HAART能够获得较好的治疗效果。     

艾滋病合并活动性结核患者30例的治疗效果观察

目的探讨艾滋病合并结核病患者应用高效抗反转录病毒治疗（HAART）和抗结核治疗时机,观察治疗效果。方法 HIV阳性/活动性结核病患者30例,抗结核治疗病情平稳后进行HAART治疗25例,同时行HAART、抗结核治疗5例,抗结核按2HREP/4HR方案,HAART按AZT/d4T＋3TC＋EFV方案。随访1年。结果 30例患者治疗后CD4＋T淋巴细胞由治疗前的（42.4±39.3）个/mm3,升至（226.1±106.8）个/mm3,治疗前后比较差异有统计学意义（P〈0.001）。1年后结核临床好转25例,仍抗结核治疗3例,死亡1例,丢失1例。结论早发现、早治疗结核并进行及时督导管理能提高艾滋病合并结核病患者治疗依从性,提高结核治愈率,确保HAART终身性,提高患者生活质量。     

艾滋病患者抗艾滋病毒治疗免疫学和病毒学失败情况分析

摘要：目的了解河北省艾滋病患者抗病毒治疗过程中病毒学失败和免疫学失败情况,为开展二线药物治疗工作提供依据。方法对河北省接受免费抗病毒治疗的病人进行免疫学和病毒学随访检测,分析其病毒学失败率,免疫学失败率和相关影响因素。结果63例病人中免疫学失败率为46．03％,病毒学失败率为58．73％,免疫学和病毒学均失败率33．33％。结论各级卫生部门应加强对艾滋病病人的随访和耐药检测,通过及时优化治疗方案、提高病人服药依从性等措施,进一步提高抗病毒治疗效果。     

The mean levels of adherence and factors contributing to non-adherence in patients on highly active antiretroviral therapy

OBJECTIVE: To determine the mean level of adherence and factors contributing to non-adherence in patients on Highly Active Antiretroviral Therapy (HAART). METHODS: An observational study was done on 101 HIV/AIDS patients attending the Centre for HIV/ AIDS Research, Education and Services (CHARES) - University Hospital of the West Indies, between May 2006 and August 2006. A questionnaire was administered asking questions re: prescribed and actual dosing frequency and number of antiretroviral tablets for the previous week, reasons for nonadherence, duration of Highly Active Antiretroviral Therapy, age, employment status and level of education. Mean levels of adherence were calculated using self and social worker/nurse reported dosing frequency and number of tablets. Good adherence was defined as 95% or greater. Multiple regression analysis was used to determine factors impacting on adherence. RESULTS: Ninety-six patients were included for final analysis. Mean levels of adherence were as follows: 87.66%--self-report for tablets; 88.70%--self-report for dosing frequency; 87.02%--social worker/ nurse report for tablets; 88.10%--social worker/nurse report for dosing frequency. There were significant positive correlations between self and social worker/nurse reports using dosing frequency (Spearman Rho correlation coefficient 0.943, p = 0.01) or number of tablets (Spearman Rho correlation coefficient 0.955, p = 0.01). Adherence to self-reported number of tablets and dosing frequency were 58.4% and 56.4% respectively. Duration of HAART was found to have a significant negative correlation with the level of self-reported adherence to tablets (p = 0.002). CONCLUSION: Adherence to HAART is sub-optimum in patients at the CHARES. This must be urgently addressed to prevent the development of resistant HIV strains and treatment failure.     

国产仿制抗逆转录病毒药物疗效分析

目的为目前大规模免费国产抗病毒药物治疗提供技术依据。方法分析116例使用国产抗逆转录病毒治疗患者的临床变化、依从性、副反应和部分免疫学及病毒学资料。结果国产抗病毒治疗药物对患者治疗有效。结论依从性是决定抗病毒治疗好坏的关键因素，基层因缺乏实验室检测会影响对疗效的判断。     

Viral opportunistic infections in HIV-infected adults

Despite the development of highly active antiretroviral therapy (HAART), opportunistic infections continue to be seen in HIV-infected patients throughout the world. The primary reason for this is the lack of access to HAART for most people living with HIV/AIDS. For patients that have access to HAART, some may not have an effective response to therapy, due to reasons such as medication toxicity, poor adherence, or drug-resistant strains of HIV. Viral infections, in particular, are a major cause of opportunistic infections in HIV-infected adults, and can lead to significant morbidity and mortality. We have reviewed the epidemiology, clinical manifestations, diagnosis, and treatment of the most common viral opportunistic infections, including cytomegalovirus, JC virus, varicella-zoster virus, herpes simplex virus, and human papillomavirus.     

Adherence to highly active antiretroviral therapy in a tertiary care hospital in West Bengal,India

INTRODUCTION

The introduction of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) has led to the reduction of mortality and the improvement of the quality of life of people living with HIV/AIDS (PLWHA). The present study was conducted to determine the pattern of adherence to HAART among PLWHA, and to assess the factor(s) affecting nonadherence, if any.

METHODS

This study was a hospital-based analytical, cross-sectional epidemiological study conducted between July and October 2011. A total of 370 adult HIV-positive patients registered in the Antiretroviral Therapy Centre of Burdwan Medical College and Hospital, West Bengal, India, were included. Nonadherence was defined as missing at least a single dose of medicine within the last four days. Data was analysed using the Statistical Package for the Social Sciences version 19.0 (IBM Corp, Armonk, NY, USA).

RESULTS

A total of 87.6% of patients were found to be adherent to HAART. Principal causes of nonadherence were forgetting to take medicine (70.2%), being away from home (65.2%), and busyness with other things (64.7%). Multivariate logistic regression analysis revealed that nonadherence was significantly associated with a positive family history of HIV/AIDS (odds ratio [OR] 16; 95% confidence interval [CI] 2.2–114.3; p = 0.01), occurrence of side effects with HAART (OR 9.81; 95% CI 1.9–51.7; p = 0.01) and employment (OR 5.93; 95% CI 1.5–23.2; p = 0.01).

CONCLUSION

Although overall adherence was high, the factors that affect nonadherence can be addressed with proper counselling and motivation of patients and their family members. Adherence to HAART could delay the progression of this lethal disease and minimise the risk of developing drug resistance.     

Interferon-alpha in treatment of chronic hepatitis C in co-infected HIV-patients in combination with ribavirin and as a pre-load therapy in treatment-naive HIV-positive patients. 8th European Conference on Clinical Aspects and Treatment of HIV Infection (8th ECCATH), 29-31 October, Athens Greece

Though AIDS-related morbidity and mortality are generally decreasing as a result of highly active antiretroviral therapy (HAART) and prevention of opportunistic infections, dual infection with HCV and HIV leads to an acceleration in the natural course of chronic hepatitis C (cHC) and worsening of associated liver disease and complications. Mortality from co-morbid HCV infection within this population is increasing and has become a major challenge in the management of HIV-related complications. As treatment strategies to fight cHC have been essentially ameliorated within the recent two years in using pegylated interferon-alfa2b (Peg-IFN-alfa2b) combined with ribavirin, t here is hope that the successful therapeutic outcomes in HCV-mono-infected individuals may be partly translated into benefits for the difficult-to-treat patients with HCV-HIV co-infection. A number of issues arise when beginning HCV treatment during HAART, as for instance possible interactions with antiretroviral therapies, increased risk of special side effects, and a compromise in adherence due to the addition of new medication in patients already taking several drugs. On the other hand there is also the chance that Peg-IFN-alfa2b fights HIV as well as HCV. First data of pre-load therapy with Peg-IFN-alfa2b in treatment-na ve HIV-positive individuals before the initiation of HAART have also been presented during the 8th European Conference on Clinical Aspects and Treatment of HIV Infection (8th ECCATH), October 2001 in Athens.     

Activation and coreceptor expression of T lymphocytes induced by highly active antiretroviral therapy in Chinese HIV/AIDS patients

Background At the end of 2005, 650 000 people lived with human immunodeficiency virus type-1 (HIV-1) in China, of whom 75 000 were AIDS patients. Many AIDS patients received highly active antiretroviral therapy (HAART) supported by the “China CARES” program but the immune responses of HAART were seldom reported. This study investigated the effect of HAART on the activation and coreceptor expression of T lymphocytes in Chinese HIV/AIDS patients and evaluated its effect on immune reconstitution. Methods Seventeen HIV/AIDS patients were enrolled and three-color-flow cytometry was used to detect the activation of HLA-DR CD38 and the coreceptor CCR5, CXCR4 expression on T lymphocytes in whole blood samples taken from the patients before and after 3- or 6-month HAART.Results The activation percents of CD4(+), CD8(+) T lymphocytes were significantly higher before therapy than the normal controls (HLA-DR/CD4: 40.47±18.85 vs 11.54±4.10; CD38/CD4: 81.34±10.86 vs 53.34±11.44; HLA-DR/CD8: 63.94±12.71 vs 25.67±9.18; CD38/CD8: 86.56±11.41 vs 58.84±6.16, all P&lt;0.01). After 6-month combined antiretroviral treatment, the activation of T lymphocytes in HIV/AIDS patients was significantly decreased (HLA-DR/CD4: 28.31±13.48; CD38/CD4: 69.88±12.64; HLA-DR/CD8: 46.56±18.64; CD38/CD8: 70.17±14.54, all P&lt;0.01 compared with the pre-treatment values). Before the treatment, CCR5 expression on CD8(+) T lymphocytes was up-regulated while CXCR4 expression on CD8(+) T lymphocytes downregulated in HIV/AIDS patients compared with the normal controls (CD8/CCR5: 70.91±10.03 vs 52.70±7.68; CD8/CXCR4: 24.14±11.08 vs 50.05±11.68, all P&lt;0.01). After 6-month HAART, CCR5 expression on CD8(+) T lymphocytes significantly decreased (56.35±12.96, P&lt;0.01), while CXCR4 expression on CD8(+) T lymphocytes increased (36.95±9.96, P&lt;0.05) compared with the pre-treatment and the normal controls. A significant statistical relationship was observed between the expression of activation markers, CCR5 and the CD4(+) T lymphocyte counts after HAART (P&lt;0.05).Conclusions Reduced activation of T lymphocytes and a normalization of coreceptor expression were observed in Chinese HIV/AIDS patients after HAART. Immunity can be restored in HIV/AIDS patients receiving HAART.     

出院后痛风患者诊断治疗依从性的相关因素分析

目的 探究出院后痛风患者诊断治疗依从性的相关因素,以期能为后期临床治疗提供参考.方法 选取2012年8月至2016年2月该院收治的390例住院治疗的痛风患者为研究对象,对所有患者进行电话随访,了解其出院后诊断治疗依从性,并探究出院后痛风患者诊断治疗依从性的相关因素.结果 390例痛风患者出院后诊断治疗依从性平均评分为(3.93土1.78)分.其中117例(30.00％)患者评分大于或等于6分,为依从者;273例(70.00％)患者评分小于6分,为不依从者.病程、文化程度、痛风发作频率、婚姻状况和医疗费用支付方式与出院后痛风患者诊断治疗依从性有密切相关性(P＜0.05).病程长、文化程度低、医疗费用支付方式为自费是出院后痛风患者诊断治疗依从性不良的独立危险因素(P＜0.05).结论 应当加强对病程长、文化程度低、自费患者出院后的监测和随访,以改善患者出院后的诊断治疗依从性,为后期临床治疗提供参考.