Evolution of the incidence and aetiology of fever of unknown origin (FUO), and survival in HIV-infected patients after HAART (Highly Active Antiretroviral Therapy)

BackgroundFever of unknown origin (FUO) is common among HIV-infected patients with a CD4+ T-lymphocyte cell count below 200 cells/ml. The use of HAART has transformed the evolution of AIDS and related diseases.Design and methodCase-control study, nested on a historical cohort of 3777 HIV-infected patients who were attended at “12 de Octubre” University Hospital in Madrid, Spain, between 1994 and 2000.Results276 FUO episodes were recorded, 58 of which occurred in patients receiving HAART. The significant decrease on the accumulated FUO incidence along the study period of 7.3 episodes per 100 HIV-infected patients after 1997 corresponded with the introduction of HAART. FUO was more frequent in patients who did not receive HAART. The aetiological spectrum of FUO was transformed by the introduction of HAART: the incidence of tuberculosis decreased while that of leishmaniasis increased. The four year survival in the non-FUO group increased when compared to that of patients who had had FUO. Similarly, this four year survival increased in patients who received HAART at the time of FUO versus those not receiving it.ConclusionsOur results confirm that the incidence of FUO has significantly decreased with the introduction of HAART. HAART has also transformed the aetiological spectrum related to FUO considerably. The most frequent cause of FUO in non-HAART patients on this study was the disseminated infection by Mycobacterium avium intracellulare (MAI), followed by tuberculosis, while leishmaniasis was its most common cause in patients receiving HAART. Survival decreased in patients who developed FUO; however, patients who received HAART at the time of FUO had longer survival than patients who did not.     

河南省部分艾滋病患者抗病毒治疗效果及耐药性研究

目的了解艾滋病患者高效联合抗病毒治疗（HAART）效果及耐药毒株的出现对其治疗产生的影响。方法对自愿接受调查者知情同意,进行个人访谈填写耐药性研究调查表;对治疗和未接受抗病毒治疗的HIV感染人群进行免疫学、病毒学实验室指标评价和服药依从性调查;采集抗凝血10ml,测定CD4^＋T淋巴细胞计数、血浆病毒载量（VL）;用RT—PCR方法扩增HIV—POL区基因,进行基因型耐药性分析。结果正在接受治疗的艾滋病患者124例,CD4^＋T淋巴细胞缓慢上升,有8．69％的HIV患者其血浆病毒载量〈LDL（最低检测限）。高度耐药突变率及总耐药性突变率分别为20．97％和33.87％。结论抗病毒治疗患者AIDS症状已得到较好的缓解,HIV耐药性毒株的产生已达到较高的水平。     

ＡＢＶ方案化疗对艾滋病相关晚期卡波氏肉瘤外周血ＣＤ４淋巴细胞的影响

目的　探讨艾滋病相关晚期卡波氏肉瘤（ＫＳ）在高效抗逆转病毒治疗（ＨＡＡＲＴ）耐药后联合应用ＡＢＶ方案化疗的疗效及其对患者ＣＤ４的影响。方法　收集经ＨＡＡＲＴ无效且ＣＤ４降低,进展为晚期ＫＳ的１７６例患者,给予６个周期ＡＢＶ方案化疗,观察化疗前、后ＣＤ４的变化及其与临床疗效之间的关系。结果　ＡＢＶ方案化疗后的临床有效率（ＣＲ＋ＰＲ）为９３.７％,无效（ＰＤ＋ＮＣ）为６.３％。ＣＤ４增加占８９.８％,ＣＤ４降低占１０.２％;化疗前ＣＤ４数值在有效组和无效组之间差异无统计学意义,化疗后ＣＤ４数值在两组之间有显著的统计学差异,有效组化疗后ＣＤ４升高（Ｐ＜０.０５）,无效组化疗后ＣＤ４略降低（Ｐ＞０.０５）。结论　ＡＢＶ方案化疗能有效治疗艾滋病相关晚期ＫＳ,并能有效提高患者ＣＤ４数值。     

HIV generations? Generational discourse in interviews with Australian general practitioners and their HIV positive gay male patients

The introduction of highly active antiretroviral therapy (HAART) is typically represented as a turning point in the social and medical history of HIV/AIDS, leading to a conceptual division into pre- and post-HAART eras. This paper explores how generational discourse is produced in interviews with general practitioners (GPs) and their HIV positive gay male patients in making sense of this moment and related changes in the Australian HIV epidemic. A theme of ‘HIV generations’ was identified in in-depth interviews with GPs who have HIV medication prescribing rights (based in Sydney, Adelaide and rural-coastal New South Wales) and the HIV positive gay men who attend their practices. In a closer analysis, generational discourse was identified across the interviews with GPs, characterising pre- and post-HAART HIV generations through three main features: treatment histories, socioeconomic status, and modes of survivorship. While generational discourse was less common in the accounts of HIV positive gay men, many of their examples wove together two narrative forms – ‘a different time’ and ‘difference today’ – suggesting that concepts of time and inequity are deeply embedded in these men’s understandings of the HIV experience. Our analysis indicates that generational concepts play a significant role in shaping both professional and ‘lay’ understandings of changes and patterns in the HIV epidemic.     

云南省盈江县924例接受高效抗逆转录病毒治疗HIV／AIDS患者的死亡情况分析

目的通过分析参加高效抗逆转录病毒治疗HIV／AIDS患者的死亡情况,为研究感染者的死亡及提高其生存率提供参考。方法利用SPSS统计软件包对924例HIV／AIDS患者的人口学资料、死亡情况进行分析。结果接受高效抗逆转录病毒治疗的924例HIV／AIDS患者有52例退出,81例死亡。发现近50％（40例）的死亡时间是发生在刚开始治疗的当年内,有36％（29例）的死亡时间是在治疗后的一年内,病死率为9．3％,结论高效抗逆转录病毒治疗方法能够有效地减少HIV／AIDS患者的死亡。     

Retinal manifestations of patients with human immun- odeficiency virus, a multiethnics study in Malaysia

· AIM: To investigate the fundus findings of patients infected with human immunodeficiency virus (HIV) in correlation to Highly Active Antiretroviral Therapy (HAART) and CD4 count. · METHODS: Two hundred and two patients of the three major races (Chinese, Malay and Indian) in Malaysia were recruited in this population-based cross-sectional study. This consisted of confirmed HIV sero-positive patients with HAART treatment (n=95) or without HAART therapy (n=107) from December 2007 to March 2008. They were further classified into the HIV infected group, AIDS related complex (ARC) group and AIDS group. Each group was then subdivided according to their CD4 count. Clinical fundus findings were recorded. · RESULTS: Sixty six patients (32.7%) showed presence of fundus manifestation, majority of which was HIV microangiopathy (89%) and the rest being Cytomegalovirus (CMV) retinitis (11%). The most common fundus lesion was cotton wool spot (34%). There was a higher incidence of fundus manifestation in the non HAART group than the HAART group (P =0.04) and in patients with CD4 count less than 200 cells/ml in both groups (P =0.01). The HAART therapy had remarkably reduced the percentage of fundus manifestation by 20% but CD4 count remains the marker for fundus manifestations. There were no significant differences noted in the retinal manifestation among the different races. (ANOVA, P =0.25). · CONCLUSION: The fundus manifestations were higher in patients with CD4< 200 cells/ml and in the non HAART group. Hence the HAART therapy is capable of reducing the incidence of fundus manifestations, however the CD4 count determines the occurrence of fundus manifestations. ·     

Comparative performances of serologic and molecular assays for detecting human T lymphotropic virus type 1 and type 2 (HTLV-1 and HTLV-2) in patients infected with human immunodeficiency virus type 1 (HIV-1)

The present study evaluated several techniques currently available (commercial kits and in-house assays) for diagnosing human T lymphotropic viruses types 1 and 2 in two groups of patients enrolled at HIV/AIDS specialized care services in São Paulo: Group 1 (G1), n = 1608, 1237 male/371 female, median age 44.3 years old, majority using highly active antiretroviral therapy (HAART); G2, n = 1383, 930 male/453 female, median age of 35.6 years old, majority HAART naïve. Enzyme immunoassays [(EIA) Murex and Gold ELISA] were employed for human T lymphotropic viruses types 1 and 2 screening; Western blotting (WB), INNO-LIA (LIA), real-time PCR pol (qPCR), and nested-PCR-RFLP (tax) were used to confirm infection. Samples were considered human T lymphotropic viruses types 1 and 2 positive when there was reactivity using at least one of the four confirmatory assays. By serological screening, 127/2991 samples were positive or borderline, and human T lymphotropic virus infection was confirmed in 108 samples (three EIA-borderline): 56 human T lymphotropic virus type 1 [G1 (27) + G2 (29)]; 45 human T lymphotropic virus type 2 [G1 (21) + G2 (24)]; one human T lymphotropic virus type 1 + human T lymphotropic virus type 2 (G2); six human T lymphotropic virus [G1 (2) + G2 (4)]. Although there were differences in group characteristics, human T lymphotropic viruses types 1 and 2 prevalence was similar [3.1% (G1) and 4.2% (G2), p = 0.113]. The overall sensitivities of LIA, WB, qPCR, and PCR-RFLP were 97.2%, 82.4%, 68.9%, and 68.4%, respectively, with some differences among groups, likely due to the stage of human T lymphotropic virus infection and/or HAART duration. Indeterminate immunoblotting results were detected in G2, possibly due to the seroconversion period. Negative results in molecular assays could be explained by the use of HAART, the occurrence of defective provirus and/or the low circulating proviral load. In conclusion, when determining the human T lymphotropic virus infection, the findings highlight that there is a need to consider the blood samples with borderline results in screening assays. Of all the tested assays, LIA was the assay of choice for detecting human T lymphotropic virus type 1 and human T lymphotropic virus type 2 in human immunodeficiency virus type 1-infected patients.     

定点医疗机构开展艾滋病抗病毒治疗工作积极性调查

摘要:目的 评估定点医疗机构开展抗病毒治疗工作积极性,为探索艾滋病抗病毒治疗工作管理模式提供建议。方法 采用面对面定性访谈方法,调查抗病毒治疗工作人员24人和在治病人14人,运用主题分析方法对访谈资料进行归纳总结。结果 定点医疗机构开展抗病毒治疗工作1年期间,在治人数迅速增加,治疗覆盖比例提高5~10百分点。政策支持、工作考核与激励机制可推进抗病毒治疗工作。抗病毒治疗工作经济效益少、医务人员工资薪酬与工作量不相称、职业暴露风险大、缺乏科学绩效考核体系等影响定点医疗机构和医务人员工作积极性。结论 定点医疗机构主动开展抗病毒治疗工作是可行的,但诸多因素影响工作实施和工作质量,建议采取针对措施充分调动其工作积极性。