HIV单阳家庭接受ART现状及影响因素

目的了解在艾滋病病毒（HIV）单阳家庭中,感染者抗病毒治疗（ART）的情况及相关影响因素,以提高单阳家庭HIV感染者ART的依从性。方法采用自行设计的调查问卷,对湖南省邵阳市和郴州市146对HIV单阳家庭进行调查,调查内容包括人口学资料、与配偶关系以及对抗病毒治疗的认知和态度;使用SPSS 17.0软件进行资料分析。结果 146对HIV单阳家庭中,感染者平均年龄（42.47±12.13）岁。单阳家庭阴性配偶对HIV感染者早期治疗的接受率（95.9%）高于HIV感染者（87.0%）（χ2=7.393,P=0.007）,接受治疗的最主要原因是：认为治疗可以延缓发病、预防配偶感染。结论 HIV单阳家庭配偶双方对ART的接受率均较高,主要影响因素为抗病毒治疗知识的了解及配偶的支持。     

移动医疗在HIV感染者抗病毒治疗依从性管理中的应用现状

本文综述了手机短信、电话、手机软件应用程序在艾滋病病毒(HIV)感染者抗病毒治疗(ART)依从性管理中的应用现状,多数研究以感染者自我报告的服药依从性作为结局指标,缺乏客观指标的评价;干预手段单一;感染者担心个人信息上传感染状态泄露。未来研究应关注移动医疗在改善ART依从性客观指标的长期有效性,利用循证通过改变认知和提高知识促进行为转变,联合多种移动医疗手段提高干预效果,加强网络安全建设,为HIV感染者全程个性化的专业照护提供强有力的支持。     

渗透式同伴教育促进HIV感染者接受ART的效果

抗反转录病毒治疗（Antiretroviral therapy，ART）对艾滋病病人有较好的效果。目前，艾滋病病毒（Human immunodefieiency virus，HIV）感染者接受ART与实际需要存在一定差距，为了寻求促进HIV感染者接受ART，2011年在天津男男性行为人群（Men who have sex with men，MSM）中通过开展“渗透式”同伴教育推动ART接受度尝试取得了较好效果。     

HIV感染者合并糖尿病的风险与管理北大核心CSCD

ART延长了HIV感染者的生命。但HIV感染者生存期的延长也引发了非艾滋病定义相关疾病（如代谢综合征、心脑血管疾病等）防治的重视。糖尿病已成为HIV感染者常见的并发症,但我国尚缺乏HIV感染合并糖尿病的风险数据,也缺少相关并发症、预后及治疗干预等循证医学证据,故HIV感染合并糖尿病患者的风险与临床管理需要进一步的规范。随着新一代ART药物在我国的广泛应用,HIV感染合并糖尿病患者的特殊治疗策略尤其是药物之间的相互作用需要进一步的探讨。本文概述了国内外HIV感染合并糖尿病的流行病学、风险因素、新一代ART对糖代谢的影响以及HIV感染合并糖尿病患者的筛查和治疗最新进展,并提出了未来可能的研究方向和趋势。     

个案管理模式下HIV/AIDS抗病毒治疗效果研究进展

目前HIV感染者/AIDS患者（HIV/AIDS）的生存质量得到保障,艾滋病（AIDS）逐渐发展成为一种无法治愈的慢性传染病,需要长期复杂的个性化服务。本文从艾滋病个案管理内容、个案管理师以及个案管理模式下ART的应用及效果等方面开展综述,为个案管理在HIV/AIDS抗病毒治疗中的应用提供更多依据。     

人类免疫缺陷病毒感染相关血脂异常研究进展

人类免疫缺陷病毒(HIV)感染者常见脂质代谢异常, 导致该类人群心血管疾病患病率增加。HIV全病程管理使包括心血管疾病在内的非艾滋定义性疾病(NAD)得到关注, 抗反转录病毒疗法(ART)与血脂异常的关系以及不同类别的ART药物对血脂水平的影响差异需要引起重视。本文基于临床证据和国内外文献、指南及专家共识, 对HIV感染者/AIDS患者(PLWHA)血脂异常的危险因素与诊疗管理方式进行总结和展望。     

抗反转录病毒治疗对血脂代谢及心血管系统的影响

未得到控制的艾滋病病毒（HIV）感染是心血管疾病（cVD）的独立危险因素。抗反转录病毒治疗（ART）明显改善了HIV感染者的预后,降低了HIV感染所致的CVD风险。但是,ART药物可引起血脂代谢紊乱,从而影响CVD患病风险。艾滋病患者生存期的延长以及ART所引起的血脂异常,增加了艾滋病患者患cVD的风险。但是ART对于降低发病率和病死率的益处远超过了ART引起的CVD风险的增加。与ART药物相比,传统的CVD危险因素可能对CVD有更为负面的影响。临床医生应对每位HIV感染者进行CVD危险性评估,并将对其处理和干预作为整个医疗关怀的一部分。在临床实践中,尽可能选择对血脂代谢影响小的抗病毒药物,在更换抗病毒治疗方案时应权衡药物疗效和不良反应之间的关系,在选择降血脂药物时应注意药物间的相互作用。     

HIV/AIDS合并梅毒患者 临床特征及长期抗病毒治疗研究

[摘要]　目的　探讨HIV/AIDS合并梅毒患者临床特征及长期抗反转录病毒治疗（anti-retroviral therapy, ART）的病毒学、免疫学效果以及梅毒复发和/或再感染情况。方法?收集2017年1月1日—2019年12月31日在首都医科大学附属北京佑安医院进行初始ART的HIV/AIDS患者的基本信息和实验室检测数据，分析患者的临床特征及其ART后病毒学、免疫学效果以及梅毒复发及再感染情况。结果?共纳入728例HIV合并梅毒感染者，其中99.6%为男性，97.7%为同性性传播感染者，ART时间中位数为950（691，1217） d，从诊断到开始ART的中位时间为15.5（8.0，41.0） d，诊断至开始ART时间≥180 d以上的患者占14.7%（107/728）。经过治疗，患者CD4+ T淋巴细胞计数增加了242（130，369）个/μl，99.3%（723/728）的患者HIV载量控制在400拷贝ml以内。经足量、规律驱梅治疗6～12个月后，梅毒复发和/或再感染率为18.4%（134/728）。结论?HIV/AIDS合并梅毒患者经长期ART后病毒学、免疫学效果良好，梅毒的复发和/或再感染率较高，梅毒足量规则治疗的同时，加强性健康宣教和定期随访复查至关重要。     

抗病毒治疗对于艾滋病疫情影响的研究

抗病毒治疗（ART）可降低艾滋病病毒（HIV）感染者／艾滋病（AIDS）病人（HIV／AIDS病人）的病毒载量,从而对AIDS的流行和发展产生影响。文章针对国内外ART对AIDS疫情影响的相关研究进行综述。从传染源的影响来看,ART能抑制HIV／AIDs病人血液、生殖道、直肠壁的病毒复制,但仍存在感染的风险。从传播途径的影响来看,ART是否会增加危险性行为尚存争议。从高危人群的影响来看,ART应用于高危人群的预防具有一定的效果,但还存在药物不良反应、耐药性等诸多负面效应。因而亟须更多研究对ART所带来的AIDS疫情趋势影响进行预测、评估和验证。     

艾滋病快速抗病毒治疗策略的研究进展

快速抗病毒治疗(ART),即在艾滋病病毒(HIV)感染诊断后14天内(包括当天)快速启动ART,可以有效控制HIV广泛流行,提高HIV感染者/艾滋病病人健康水平和生活质量,目前正受到广泛关注。来自全球各个国家的随机对照试验和队列研究结果显示:快速ART能显著减低HIV新发感染率,改善感染者的临床结果,对于实现联合国艾滋病规划署的2020年90-90-90目标,乃至第4个90目标都将有着至关重要的影响,值得进一步探索。     

Successful optimization of antiretroviral regimens in treatment‐experienced people living with HIV undergoing liver transplantation

Modern antiretroviral therapy (ART) extends life expectancy for people living with HIV (PLWH). However, most older PLWH (≥50 years) “aged” with HIV and were exposed to historical HIV care practices and older, more toxic ART. In PLWH with exposure to older and multiple ART regimens, the drug interactions between ART frequently used in treatment‐experienced persons and commonly used immunosuppressants remain a significant challenge. However, the advent of newer ART classes (eg, integrase non‐strand transfer inhibitors) and more advanced HIV genetic resistance testing may allow optimization of ART regimens with minimal drug interactions. Here, we present a case series of three PLWH whose complicated ART interacted (or was at risk for interacting) with their post–liver transplant immunosuppression. After a review of their proviral DNA resistance testing, they successfully transitioned onto safer integrase non‐strand transfer inhibitor‐containing ART regimens without viral blips or evidence of organ rejection.     

109例HIV/AIDS病人抗病毒治疗临床观察

目的观察都安县艾滋病（AIDS）病人抗病毒治疗的临床疗效、不良反应及全血CD4淋巴细胞水平的变化。方法对近两年来县人民医院收治的109例艾滋病病毒感染者/艾滋病病人（HIV/AIDS病人）,采用高效抗反转录病毒治疗（HAART）3个月后,观察其体重、机会性感染控制情况、生存状况和生活质量改善情况、不良反应及全血CD4水平的变化。结果 109例病人中,78例病人治疗前体重下降,治疗后所有病人体重上升,治疗前后体重变化差异有统计学意义（P〈0.001）。81例合并机会性感染的病人病情得到明显控制,治疗前不能从事体力劳动,治疗后有69例恢复了劳动能力;58例病人出现不良反应,经更换方案或对症处理后不良反应消失;104例病人全血CD4水平上升,治疗前后CD4对比差异有统计学意义（P〈0.001）。结论 HAART治疗HIV/AIDS病人临床疗效良好;有一定的不良反应,经对症处理后不良反应消失;能提高病人全血CD4的水平。     

广东省某市871例HIV/AIDS病人生存影响因素的回顾性队列研究

目的利用艾滋病综合防治信息系统了解艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）生存的影响因素。方法采用回顾性队列研究方法,了解HIV/AIDS病人被确证感染后的转归及相关情况。结果 HIV/AIDS病人被确证时的年龄是影响生存时间的重要因素[风险值（HR）=1.04,95%可信区间（CI）：1.01-1.06,P〈0.01]。是否接受抗病毒治疗（HR=0.10,95%CI：0.03-0.33,P〈0.01）及初次CD^＋_4T淋巴细胞计数分级则是影响HIV/AIDS病人生存的保护性因素（HR=0.69,95%CI：0.58-0.82,P〈0.01）,接受抗病毒治疗、初次CD＋4T淋巴细胞计数分级高的生存时间长,差异具有统计学意义。结论早发现、早治疗有利于提高HIV/AIDS病人的生存时间。     

Liver transplantation for patients with human immunodeficiency virus and hepatitis C virus co‐infection: update in 2013

Because of the progress of anti‐retroviral therapy (ART) for human immunodeficiency virus (HIV), mortality due to opportunistic infection resulting in AIDS has been remarkably reduced. However, meanwhile, half of those patients have died of end‐stage liver cirrhosis due to hepatitis C virus (HCV) with liver cirrhosis and early occurrence of hepatocellular carcinoma. Recently, in 2013, non‐cirrhotic portal hypertension due to ART drugs or still unknown mechanisms have become problematic with early progression of the disease in this patient population. Liver transplantation (LT) could be one treatment of choice in such cases, but the indications for LT perioperative management, including both HIV and HCV treatments and immunosuppression, are still challenging. In this review, we update the literature on HIV/HCV co‐infection and LT as well as recent effort for modifying allocation system for those patients.     

Malarial infection among HIV patients on antiretroviral therapy (ART) and not on ART: a case study of Federal Medical Centre Makurdi,Benue State,Nigeria

ObjectiveMalarial infection among patients on antiretroviral therapy (ART) attending Federal Medical Centre Makurdi, Benue State was investigated between April and August 2008.MethodsA total of 1080 HIV patients were examined (800 on ART and 280 not on ART considered as control). Questionnaire was administered to each participant to collect socio-demographic data. The Cytoflow and Leishman's staining techniques were used to count CD⁴⁺ and conduct parasitological examination respectively.ResultsOf the 800 HIV/AIDS patients on ART examined for malaria parasites, 20.5% (164/800) were found positive for malaria infection, while those not on ART had an infection rate of 63.9% (179/280). There was no statistically significant difference of malarial infection between patients not on ART and those on ART (χ²= 14.05, p= 0.0805). The age group 9–15 years recorded the highest infection rate with 55.6% (5/9), while the lowest infection, 15.8% (41/260) was observed in the 30–36 years age group. Malarial infection was higher in patients with CD⁴⁺count less than 1073/μL. Females showed higher infection rate (12.6%) than males (7.9%) but with no statistically significant difference (χ²=1.95, P=0.85).ConclusionsIt was observed that ART boosts immunity of HIV/AIDS patients against malarial infection, which indirectly is a possible implication for malaria control.     

Relation of physician specialty and HIV/AIDS experience to choice of guideline-recommended antiretroviral therapy

BACKGROUND: Controversy exists regarding who should provide care for those with HIV/AIDS. While previous studies have found an association between physician HIV experience and patient outcomes, less is known about the relationship of physician specialty to HIV/AIDS outcomes or quality of care. OBJECTIVE: To examine the relationship between choice of appropriate antiretroviral therapy (ART) to physician specialty and HIV/AIDS experience. DESIGN: Self-administered physician survey. PARTICIPANTS: Random sample of 2,478 internal medicine (IM) and infectious disease (ID) physicians. MEASUREMENTS: Choice of guideline-recommended ART. RESULTS: Two patients with HIV disease, differing only by CD4+ count and HIV RNA load, were presented. Respondents were asked whether ART was indicated, and if so, what ART regimen they would choose. Respondents' ART choices were categorized as "recommended" or not by Department of Health and Human Services guidelines. Respondents' HIV/AIDS experience was categorized as moderate to high (MOD/HI) or none to low (NO/LO). For Case 1, 72.9% of responding physicians chose recommended ART. Recommended ART was more likely (P <.01) to be chosen by ID physicians (88.2%) than by IM physicians (57.1%). Physicians with MOD/HI experience were also more likely (P <.01) to choose recommended ART than those with NO/LO experience. Finally, choice of ART was examined using logistic regression: specialty and HIV experience were found to be independent predictors of choosing recommended ART (for ID physicians, odds ratio [OR], 4.66; 95% confidence interval [95% CI], 3.15 to 6.90; and for MOD/HI experience, OR, 2.05; 95% CI, 1.33 to 3.16). Results for Case 2 were similar. When the analysis was repeated excluding physicians who indicated they would refer the HIV "patient," specialty and HIV experience were not significant predictors of choosing recommended ART. CONCLUSIONS: Guideline-recommended ART appears to be less likely to be chosen by generalists and physicians with less HIV/AIDS experience, although many of these physicians report they would refer these patients in clinical practice. These results lend support to current recommendations for routine expert consultant input in the management of those with HIV/AIDS.     

四川省艾滋病定点抗病毒治疗机构HIV感染者个案管理情况调查

目的调查四川省21个市州艾滋病定点抗病毒治疗(ART)机构个案管理情况。方法采取便利抽样法,于2019年5-7月调查四川省21个市州598家艾滋病定点ART机构的个案管理情况及艾滋病病毒(HIV)感染者的随访管理水平。结果 598家艾滋病定点ART机构参与艾滋病门诊随访工作的专职医生平均为0.55人,专职护士平均为0.69人;有455家(76.09%)机构的个案管理人员未参加过个案管理相关培训,对个案管理人员来说:最难管理的前三类患者分别是有过脱失经历重新治疗、老年(≥60岁)、外出务工者。结论四川省艾滋病ART机构个案管理情况并不乐观,存在人员短缺、个案管理知识技能缺乏的状态,建议政府在政策上给予重视和支持,并对基层人员开展艾滋病个案管理相关培训。     

Thirty years of HIV and AIDS: future challenges and opportunities

As the third decade since AIDS was first recognized comes to an end, extraordinary advances have occurred in the understanding, treatment, and prevention of HIV infection and AIDS. As a result of these successes, it is now time to focus on future challenges. Paramount among these is reaching the goal of truly controlling and ultimately ending the HIV and AIDS pandemic. To that end, AIDS researchers and public health personnel worldwide are aggressively pursuing 3 key areas of scientific research. Given the availability of highly effective therapeutic regimens for HIV infection, the first challenge is efficiently identifying a maximum number of HIV-infected persons through voluntary HIV testing and initiating antiretroviral therapy (ART). Second, scientists are trying to develop a cure for HIV infection, which would alleviate the need for lifelong ART. Finally, preventing new cases of HIV infection, which currently number approximately 2.6 million per year globally, is critical to any attempt to end this pandemic. This article addresses each of these challenges and provides directions for the future.