血友病合并HIV/HCV感染者52例高效抗反转录病毒疗效分析

目的探讨血友病合并人免疫缺陷病毒(HIV)/丙型肝炎病毒(HCV)感染者高效抗反转录病毒治疗(HAART)方案[司他夫定(d4T) 拉米夫定(3TC) 依非韦仑(EFV)]的疗效。方法观察52例合并HIV/HCV感染的血友病患者在接受“d4T 3TC EFV”抗HIV治疗后CD4T淋巴细胞计数、HIVRNA载量的变化情况及药物的不良反应。结果抗HIV治疗后,CD4T淋巴细胞计数均有不同程度的升高,平均每月增长(7.70±4.80)个/mm3,HIVRNA载量显示不同程度下降,50例患者的HIVRNA载量在治疗后2~7个月均低于检测水平;29例患者出现三酰甘油升高,22例出现血尿酸升高。结论“d4T 3TC EFV”方案是合并HIV/HCV感染的血友病患者安全、有效的HAART方案。     

艾滋病患者抗反转录病毒治疗毒副作用的观察与护理

目的探讨艾滋病（AIDS）抗反转录病毒治疗（HAART）的毒副作用及护理方法。方法对359例进行HAART的艾滋病患者进行治疗前咨询和依从性教育,观察药物的毒副作用,及时采取相应的护理措施。结果出现药物毒副作用的患者271例占75．5％,因严重毒副作用而更改方案的75例,2例因毒副作用大而暂时停抗病毒治疗,1例因乳酸酸中毒死亡。结论对患者加强治疗前咨询和依从性教育,按时随访和督导服药,密切观察病情,对毒副作用进行针对性护理,才能保障HAART顺利进行。     

艾滋病静脉吸毒人群抗反转录病毒治疗期间的观察及护理

目前,我国面临着艾滋病（acquired immune deficiency syndrome,AIDS）发病和死亡高峰期,而且感染人数仍然在持续增加.抗反转录病毒治疗（highly active antiretroviral therapy,HAART）能明显降低艾滋病病人机会性感染的发生率和病死率[1].吸毒人群存在依从性差、毒品成瘾性,合并结核、丙型肝炎、乙型肝炎等多重感染问题.如何使吸毒人群的抗病毒治疗更为有效,目前还面临许多挑战.我院为全国最大的艾滋病抗病毒治疗中心,现将我院行抗反转录病毒治疗的静脉吸毒人群治疗观察介绍如下.     

艾滋病病人抗反转录病毒治疗依从性的研究进展

介绍了依从性的概念及衡量标准,综述了艾滋病病人抗逆转录病毒治疗依从性现状及影响因素,并提出了提高依从性的策略。     

艾滋病病人抗反转录病毒治疗依从性的研究进展

介绍了依从性的概念及衡量标准,综述了艾滋病病人抗逆转录病毒治疗依从性现状及影响因素,并提出了提高依从性的策略.     

上海地区艾滋病患者初始一线抗反转录病毒治疗药物更换原因的比较研究

目的对上海地区接受国家免费抗病毒初始治疗艾滋病患者各种治疗药物更换的时间、原因及例次频率进行研究,从而比较各种药物的耐受性的差异。方法回顾性分析1 154例接受抗反转录病毒治疗(ART)艾滋病患者初始治疗方案中每种药物在开始使用后的不同时间段内被更换的最常见原因以及发生更换的例次频率。结果启动ART后的3个月内更换治疗药物的原因以奈韦拉平(NVP)导致的严重皮疹、依非韦伦(EFV)导致的严重皮疹和齐多夫定(AZT)导致的中性粒细胞(ANC)<0.75×109/L为主。随着治疗时间的延长因AZT导致的严重贫血、NVP导致的肝毒性更换药物的患者增多。治疗超过1年后患者更换药物的原因多集中于司他夫定(d4T)所致的外周神经损害、脂肪萎缩、血脂异常以及发生治疗失败。因各种原因更换药物共352例次,其中严重的药物不良反应为302例次(26.17%),治疗失败为50例次(4.33%)。d4T治疗满1年后因血脂异常、脂肪萎缩及治疗失败发生更换药物的例次频率逐渐增加;AZT的更换原因主要为重度骨髓抑制,发生的时间主要集中在开始ART后的6个月内;EFV更换的例次较少;NVP更换主要原因为严重皮疹和3级以上肝毒性,在开始治疗后的1个月内发生频率较高。结论在ART过程中,患者接受治疗的时间长短不同,发生的药物不良反应也不相同。部分药物不良反应发生的时间范围较大。不良反应仍是影响患者依从性、抗病毒疗效的主要原因。     

艾滋病高效抗反转录病毒治疗后并发血脂代谢异常的干预研究

高效抗反转录病毒治疗可以有效抑制病毒复制,降低艾滋病的病死率。但是抗病毒治疗可以影响脂肪酸结合蛋白、破坏脂质代谢、脂质在肝细胞内异常沉积,导致脂质代谢异常,而血脂代谢异常常增加心脑血管疾病风险。因此,对采用高效抗反转录病毒方法治疗后并发血脂代谢异常的艾滋病患者应进行积极干预。本文综述了艾滋病高效抗反转录病毒治疗后出现血脂代谢异常的相应干预措施,阐述了有效改善此类患者血脂代谢异常的临床方法。     

25例艾滋病儿童患者临床特征及治疗现状分析

目的 了解儿童艾滋病临床特征、抗病毒治疗及生存状态情况。方法 回顾收集重庆市公共卫生医疗救治中心在治儿童艾滋病25例患者临床资料。结果 25例患儿,男17例,女8例;人类免疫缺陷病毒(HIV)感染确诊时平均年龄(4.2±3.6)岁;22例患儿为母婴传播;1岁以内确诊HIV感染患儿占20%;确证HIV感染后达到快速启动抗病毒治疗患儿占52%。抗病毒治疗方案有10例(40%)患儿使用齐多夫定+拉米夫定+洛匹那韦/利托那韦;按时服药并进行随访的患儿有20例;治疗过程中有3例患儿发生了耐药。随访12个月时检测的患儿中74%(14/19) HIV RNA低于检测线;24个月时有88%(15/17)患儿HIV病毒载量低于检测线。抗病毒治疗后CD4⁺T淋巴细胞有所增长,与基线数值相比,差异有统计学意义(P<0.05)。结论 母婴传播是HIV感染患儿的主要感染途径,孕期全面检测、及时确诊HIV感染及快速启动抗病毒治疗是阻断母婴传播的重要环节,对于已确诊患儿,正确服用抗病毒治疗药物有助于免疫功能恢复。     

艾滋病抗病毒治疗的发展和启示

艾滋病(AIDS)自1981年被首次发现以来,在全世界迅速蔓延,目前现存人类免疫缺陷病毒(HIV)感染者达3 300多万,已造成2 500多万人死亡.而且,AIDS正逐渐从高危人群向普通人群扩散,当前AIDS疫情形势极其严峻.抗病毒治疗是AIDS防控的重要内容,得益于多种抗反转录病毒药物的相继问世,28年来AIDS的治疗发生了突飞猛进的变化,尤其是1996年高效抗反转录病毒疗法(highly active antiretroviral therapy, HAART)的提出和应用,给AIDS治疗带来了重大转折,HIV/AIDS患者病死率显著下降.本文将系统介绍AIDS自发现以来治疗的发展史、抗HIV药物概况、HAART的合理应用等内容.     

高效联合抗反转录病毒治疗对艾滋病患者生存质量的影响

目的:初步探讨高效联合抗反转录病毒治疗对艾滋病患者生存质量的影响。方法:使用WHOQOL-HIV生存质量简表对102例已经开始高效联合抗反转录病毒治疗的艾滋病患者进行6个月的动态追踪,分析抗病毒治疗时间、免疫学变化及药物毒副作用对生存质量的影响。结果:随着高效联合抗病毒时间的延长,艾滋病患者的独立领域得分逐渐升高,心理和环境领域的得分在开始抗病毒治疗7～24个月的患者得分最高,抗病毒治疗时间长短不同的组间存在差异(P<0.05);CD4+计数及Th/Ts的差异及变化对生存质量各领域得分未引起有显著性意义的变化,而在抗病毒过程中出现血液毒性及肝损害的患者在生理领域得分偏低,与未出现这两方面毒副作用的患者有不同的变化趋势(P<0.05)。结论:高效联合抗反转录病毒治疗对艾滋病患者生存质量的影响主要体现在提高患者独立领域得分,而抗病毒药物的血液毒性和肝损害对艾滋病患者生存质量生理领域得分有一定影响     

Characteristics of the cellular immune response in HIV/HCV patients with hemophilia during peginterferon/ribavirin therapy in southern China

Objective

The objectives of the study are to characterize the cellular immune response in hepatitis C virus (HCV) genotype 1 and HIV co-infected patients with hemophilia in southern China during treatment with interferon and ribavirin and to study its correlation with the virologic response (VR). Thirty-six HCV genotype 1 and HIV co-infected patients with hemophilia in southern China were enrolled into the study. Using an ELISpot assay, HCV antigen-specific interferon (IFN) γ, interleukin (IL) 2, IL-4, and IL-10 secreting cells were measured in peripheral blood mononuclear cells. Single nucleotide polymorphisms of IL28B were determined, and immunological, virologic, and clinical variables were collected to identify factors associated with HCV-sustained VR (SVR) at week 72 after treatment. At baseline, there were no significant differences in IFN-γ and IL-2 mediated immune responses in subjects with VR versus non-responders. Higher IL-10 specific responses to NS3 were observed in VR patients. Subjects who had significant decreases in IL-10 responses at week 72 compared with baseline for NS3 and NS5 were more likely to be VR. In SVR, IL-2 production decreased moderately, and the levels of IL-4 were low throughout. The main correlation for SVR in genotype-l infected subjects was sustained HCV-specific IFN-γ responses through the whole 72-week period. In subjects with HIV and HCV co-infection combined with hemophilia, IL28B genotype CC, a decrease in HCV specific IL-l0 and IL-2 responses, and the maintenance of IFN-γ responses during treatment were associated with a 12- or 72-week VR.     

HCV RNA对HIV合并HCV感染者高效抗逆转录病毒治疗的影响

目的 探讨HCV RNA对HIV和HCV合并感染者接受高效抗反转录病毒治疗(highlyactive antiretroviral therapy,HA.ART)后疗效、肝脏功能和血脂的影响.方法 招募我国河南既往有偿供血人群中接受HAART治疗的HIV/HCV合并感染者275例,每6个月随访一次,定期检测HCVRNA、HIV RNA、CD+4T淋巴细胞计数、肝脏功能指标和血脂等实验室指标,采用卡方检验、成组设计秩和检验比较HCV RNA阳性组和HCV RNA阴性组HAART治疗后HIV病毒抑制率、免疫学应答、肝损伤和血脂的差异.结果 HAART治疗6月以上患者中,HCV RNA阳性组和HCV RNA阴性组HIV完全抑制率差异无统计学意义(45.6%vs.38.5%,x2=1.150,P>0.05);HAART治疗前(286个/μ1 vs.209个/μ1,z=0.734,P=0.463)、治疗后6个月(310个/μ1 vs.362个/μ1,z=0.562,P=0.574)、12个月(378个/μl vs.289个/μ1,Z=1.091,P=0.275)、18个月(363个/μ1 vs.288个/μ1,z=1.435,P=0.151)、24个月(413个/μ1 vs.348个/μ1,z=0.939,P=0.348)CD+4;T淋巴细胞计数在HCV RNA阳性组和HCV RNA阴性组间差异无统计学意义.HCV HNA阳性组血清ALT(55.0 U/L vs 29.5 U/L,Z=6.789,P<0.01)、AST(46.0 U/L vs.33.0 U/L,Z=4.890,P<0.01)、TBIL(9.3 mmol/L vs.7.2 mmol/L,z=3.748,P<0.01)水平显著高于HCV RNA阴性组;HCV RNA阳性组HAART治疗后发生肝损伤的风险显著高于HCV RNA阴性组(调整后优势比aOR=3.8,P<0.01).HIV/HCV合并感染者HCV RNA阳性组TG水平显著低于HCV RNA阴性组(1.2 mmol/Lvs.1.4 mol/L,Z=1.936,P=0.043)、而HDL-C水平显著高于HCV RNA阴性组(1.5 mmol/L vs.1.3 mmol/L,z=2.251,P=0.024).结论 HCV RNA对HIV/HCV合并感染者HAART治疗后HIV病毒抑制率无影响,亦不影响HAART治疗后CD+4淋巴细胞的恢复;HCV RNA是HIV/HCV合并感染者HAART治疗后肝损伤的独立危险因素,但可能减轻HAART治疗引起的血脂异常.     

艾滋病患者抗逆转录病毒治疗出现认知功能障碍情况的调查分析

目的调查艾滋病患者对抗逆转录病毒治疗的认知功能障碍情况,为专业护理人员早期护理干预提供依据。方法采用一般资料问卷、蒙特利尔认知评估量表对140例感染科门诊艾滋病患者进行调查。结果蒙特利尔认知评估量表得分26分的患者40例,占28.57%;认知障碍患者中延迟回忆、执行功能、抽象平均得分均较低,其次为语言功能及注意;其中以女性、老年等患者发生认知功能障碍较多。结论护理人员应对所有艾滋病患者进行认知功能评估,尤其是对于老年、女性、感染艾滋病病毒时间较长的患者加以重视,对于主诉有近期记忆力下降、大脑执行功能方面障碍的患者要及时进行检查及评估,以便早期发现并进行护理干预。     

The prevalence and risk of hepatitis flares in a Serbian cohort of HIV and HCV co-infected patients treated with HAART.

Despite substantial benefits of HAART treatment of HIV-infected patients, cumulative long-term toxicity, including drug-induced hepatotoxicity, has emerged as an important complication. Thus, to examine the prevalence and risk of developing severe hepatic injury during HAART, we conducted a retrospective study in a cohort of 364 HIV-infected patients treated with HAART between January 1998 and May 2006, for whom data on alanine aminotransferase activity were available both before and during HAART. HCV co-infection was recorded in 35.4% of the series, but was found not to influence either the efficacy of HAART or survival (P>0.05). Severe hepatotoxicity occurred in a total of 24 patients (6.6%). Multivariate logistic regression defined HCV co-infection (OR 16.6, 95% CI 3.8-46.0, P<0.0001), and the use of SQV/RTV and d4T (OR 3.1, 95% CI 1.2-8.16, P=0.02, and OR 7.1, 95% CI 1.0-54.5, P=0.05, respectively) as independent risk factors for aggravation of hepatitis. In addition, there was a significant increase in the probability of developing liver damage over years of treatment (Log rank, P<0.01). Conversely, the probability of developing hepatotoxicity was not associated with an increase in the CD4 cell count to values greater than 350/microL (Log rank, P=0.59). In conclusion, in the setting of chronic viral hepatitis, hepatotoxicity during HAART may be attributed to the cumulative toxicity of drugs that induce mitochondrial toxicity, along with particular PIs and/or NNRTIs. Furthermore, our data suggest prudent use of D-drugs, still common in resource-limited countries, in HCV co-infected patients.     

Characteristics and outcomes of HIV-infected patients in the ICU: impact of the highly active antiretroviral treatment era

Objective To examine whether the introduction of highly active antiretroviral therapy (HAART) has changed the rate of admission, the clinical spectrum, and the mortality of HIV-infected ICU patients.Design Observational study.Setting Infectious diseases ICU in a teaching hospital, Paris, France.Patients All HIV-infected patients admitted during a pre-HAART era (1995–1996; n=189) and a HAART era (1998–2000; n=236).Interventions None.Measurements and results At the HAART era, 79% of patients had derived no or little benefit from the availability of HAART at ICU admission: 44% had no history of antiretroviral (ARV) medications and 35% had failed to respond to ARV. As compared with the pre-HAART era, the rate of hospitalized HIV-infected patients requiring the ICU stay increased (HAART, 5.9% vs pre-HAART, 4.4%; p=0.004). The admission was more likely to occur through the emergency room (45 vs 29%, p=0.0004), and the patients to be foreigners (38.1 vs 28.6%; p=0.04). After adjustment for significant prognostic covariates (AIDS-related tumors at admission, CD4 count <50/mm³, poor functional status (Knaus score C or D), SAPSII, and need for mechanical ventilation), ICU survival was unchanged (adjusted OR=0.613, 95% CI=0.312–1.206), but 3-month survival was significantly improved (adjusted OR=0.57; 95% CI=0.32–0.99; p=0.045).Conclusion The number of HIV-infected patients admitted to the ICU remained high in the HAART era. Underutilization of HAART and limited access to health care are possible explanations. The ICU mortality has remained unchanged, but 3-month mortality has decreased.     

Effect of antiretroviral therapy in thromboregulation through the hydrolysis of adenine nucleotides in platelets of HIV patients

The human immunodeficiency virus (HIV) infection results in biochemical and vascular dysfunctions. The highly active antiretroviral therapy (HAART) markedly reduces mortality and opportunistic diseases associated with acquired immunodeficiency syndrome (AIDS). This increased survival time predisposes the development of cardiovascular diseases. Platelets present purinergic system ectoenzymes such as E-NTPDase, E-5′-nucleotidase and E-ADA on its surface. In view of this, the aim of this study was to evaluate the activity of these ectoenzymes in platelets as well as the platelet aggregation and lipid profile of patients with HIV infection and also patients receiving HAART. The results showed an increase in the E-NTPDase activity for ATP hydrolysis in the HIV group compared with the control group and the HIV/HAART group. When assessing the activity E-NTPDase hydrolysis to ADP, the results revealed an increase in activity in the HIV group when compared to the control group, and a decrease in activity when in the HIV/HAART group when compared to the control and HIV groups. The activity of E-5′-nucleotidase revealed an increase in AMP hydrolysis in the HIV group, as the results from control and HIV/HAART groups showed no statistical difference. Regarding the E-ADA activity, the HIV and HIV/HAART groups revealed a decreased deamination of adenosine when compared with the control group. Furthermore, we observed an increased platelet aggregation of HIV/HAART group compared with the control group. Thus, our results suggest that antiretroviral treatment against HIV has a significant effect on the activity of purinergic system ectoenzymes demonstrating that thromboregulation is involved in the process.     

Power spectral analysis of heart rate variability in HIV-infected and AIDS patients

Background: In HIV‐infected patients the risks for cardiovascular disease are multifactorial. Autonomic dysfunction has been detected in the early phase of HIV infection as well as in AIDS patients with advanced cardiomyopathy. Methods: Forty AIDS patients receiving highly active antiretroviral therapy (HAART), 40 HIV+ naïve of HAART, and 40 control subjects were studied. Computerized analysis of heart rate variability was performed using an analog to digital converter. R‐R intervals were obtained from a standard ECG, recorded in DII lead in supine rest and after the cold‐face and tilt tests. The series of R‐R intervals were assessed in time and frequency domains using an autoregressive algorithm. Results: There was no difference regarding to mean values of R‐R intervals and variance in baseline. The normalized power of the low‐frequency (LF) component and the low‐frequency/high‐frequency (HF) ratio (LF/HF) was significantly decreased in the HIV group. Responses of normalized HF and LF/HF ratio during the cold‐face test were significantly decreased in the HIV group, as compared to the control. During the tilt test, a higher augmentation of normalized LF and the LF/HF ratio was observed in the HIV group compared with the control. The AIDS group was similar to the control in baseline and after cold‐face and tilt tests. Conclusion: The HIV group presented in baseline conditions, a shift of cardiac sympathovagal balance, an exacerbated response of the LF component during the tilt test, and an ineffective cardiac vagal response to the cold‐face test suggesting sympathetic and parasympathetic dysfunction. AIDS patients receiving HAART did not present these autonomic alterations.