HIV/AIDS病人合并HCV感染对HAART不良反应的影响

目的研究合并丙型肝炎病毒(HCV)感染,对艾滋病病毒(HIV)/艾滋病(AIDS)病人接受高效抗反转录病毒治疗(HAART)后,不良反应发生的影响,为HIV/AIDS合并HCV感染的综合治疗提供依据。方法前瞻性观察167例合并HCV感染的HIV/AIDS患者(HIV/HCV组),接受HAART治疗2-5年出现不良反应的类型、频率、严重程度,以同期264例HIV/AIDS患者(HIV组)作为对照组。结果 167例合并HCV感染的HIV/AIDS患者中,163例(97.6%)出现疲乏症状,163例(97.6%)发生胃肠道反应,107例(64.1%)出现肝功能异常,98例(58.7%)出现血脂升高,83例(49.7%)出现药物性皮疹,56例(33.5%)出现腹泻,52例(31.1%)出现贫血。与HIV组相比,HIV/HCV组出现肝功能损害的频率较高(P<0.05),但严重程度无明显差异(P>0.05),其余不良反应发生的类型、频率及严重程度无显著性差异(P>0.05)。结论 HIV/AIDS病人在HAART过程中可发生多种不良反应,合并HCV感染时更容易发生肝功能损害,选择HAART方案时应尽量选择肝毒性少的药物。     

Perspectives of middle-aged African-American women in the Deep South on antiretroviral therapy adherence

Despite evidence of stabilization in some areas of the USA, HIV infection in black women is not declining in the Deep South. Using a phenomenological approach to qualitative inquiry, we investigated women's experiences influencing their adherence to highly active antiretroviral therapy (HAART) in an urban setting. Inclusion criteria specified black women who had been aware of their HIV status for at least two years and were engaged in HIV outpatient care. Twelve single face-to-face confidential in-depth semi-structured interviews were conducted from a sample of predominantly middle-aged women retained in care at an HIV clinic in Atlanta, Georgia. Data were analyzed by two independent reviewers and three themes emerged from the group of women's accounts of their experiences. First, sentinel events led to changes in perspective and motivated women to adhere to HAART. Second, recognition that one had the personal strength necessary to cope with HIV fostered adherence. Finally, relationships with healthcare providers especially trust issues surrounding this relationship, impacted adherence both positively and negatively. These findings suggest that HAART adherence is a complex issue among middle-aged urban black women with HIV in the Deep South. Providers caring for this patient population should recognize that sentinel events, personal strength, and positive healthcare relationships are opportunities to improve adherence.     

甘肃省接受HAART的AIDS病人的生活质量测评

目的通过调查接受抗病毒治疗前后艾滋病病人的生活质量,评估抗病毒治疗对艾滋病病人生活质量的影响,为进一步提高病人的生活质量提供参考。方法应用简体中文版MOS-艾滋病病毒（HIV）量表,在定点收治医院抽取艾滋病病人,在其接受抗病毒治疗前后进行调查,内容包括病人的生活质量、人口学特征和与HIV感染相关特征,采用t检验、方差检验等对调查资料进行统计分析。结果共调查病人99例,治疗前其生理领域得分为（49.44±9.85）分,心理领域得分为（24.85±11.17）分;健康转变0.31分、健康压力0.37分、心理功能0.46分、总体健康感0.46分,4个维度得分率较低;治疗后,其生理领域得分为（57.84±3.59）分,心理领域得分为（56.00±5.01）分,11个维度的得分均较治疗前提高,差异有统计学意义（P〈0.001）。结论在艾滋病抗病毒治疗过程中,医务人员在给予病人必要的临床治疗的基础上,提供心理咨询和关怀服务,可以改善他们的生活质量,同时亦提示要进一步拓展艾滋病病人医疗服务的内容,将有助于提高病人的生活质量。     

TTV Viral Load As a Marker for Immune Reconstitution After Initiation of HAART in HIV-Infected Patients

Abstract

Purpose: To investigate whether TT virus (TTV) viral load may be used as a surrogate marker for functional immune reconstitution in HIV-infected patients receiving highly active antiretroviral therapy (HAART). Method: Fifteen protease inhibitor-naÏve HIV-infected patients were included in a longitudinal study. From each patient, three serum samples taken before HAART initiation and three samples taken during HAART were analyzed. TTV was detected by polymerase chain reaction (PCR) and was quantitated by competitive PCR. TTV viral heterogeneity was determined by restriction fragment length polymorphisms (RFLPs) and sequencing. Results: All 15 HIV-infected patients were TTV positive. No significant change in HIV RNA or TTV viral load was observed at the three time points before HAART initiation. Even though HAART lead to an immediate and significant reduction in HIV RNA (p = .0001), a significant reduction in TTV viral load (p = .0002) was not observed until after 3-5 months of HAART. Four patients did not have an increase in CD4+ T cell count after 1 year of HAART; however, a decrease in TTV viral load was still observed, and three of these patients had a reduction in HIV RNA. RFLPs and sequencing revealed that TTV is represented as a heterogeneous population of virus in HIV-infected patients. Conclusion: This pilot study suggests that HAART leads to improved immunological responses, even in patients who do not have an increase in CD4+ T cell counts. We propose that the change in TTV viral load may be useful in the evaluation of cellular immune response at a functional level in HIV-infected patients who receive HAART.     

Treatment Durability,Effectiveness, and Safety with Atazanavir/Ritonavir-Based HAART Regimen in Treatment-Naïve HIV-lnfected Patients

Abstract

Purpose: To describe the durability of treatment, virological and immunologi-cal response, and safety of an atazanavir/ritonavir (ATV/RTV)-based highly active antiretroviral therapy (HAART) regimen in treatment-naïve HIV-infected patients. Methods: This was a multicentre retrospective study. Medical charts of antiret-roviral-na’i’ve HIV-infected adults who initiated ATV/RTV (300/100 mg) from January 2004 to December 2007 in 10 Canadian clinics were reviewed. Data were collected from time of ATV/RTV treatment initiation until discontinuation of ATV. Durability of treatment and time to virological response were estimated with Kaplan-Meier functions. Change in viral load, CD4 cell counts, and lipid parameters were assessed with linear regression analyses. Results: 176 patients were enrolled, 153 (86.9%) were male, and the majority (52.3%) were 40 to 54 years old. Duration of observation ranged from 1.6 to 56 months. The mean (S£) durability of treatment was 33.5 (0.7) months. There were 37 (21.0%) patients who discontinued ATV/ RTV, among whom 18 (10.2%) discontinued due to toxicity, suboptimal virological response, loss to follow-up, or death. The mean (S£) time to HIV viral load of <50 and <400 copies/mL was 6.6 (0.4) and 4.3 (0.3) months, respectively. At 96 weeks of treatment, least squares mean (LSM) estimated change in log₁₀(HIV copies/mL) was -2.94 (P < .001) and +245 cells/mL (P < .001) for CD4 cell count. A significant LSM increase in HDL-C of 0.24 mmol/L (P = .007 for trend over time) was also observed; total cholesterol, triglycerides, and LDL-C increased over time but their change did not reach statistical significance. The most frequently reported adverse event was increased bilirubin (16.5%). Conclusions: ATV/RTV-based first-line HAART regimen demonstrated durability and effectiveness and was well tolerated in treatment-naïve HIV-infected patients.     

Factors associated with the failure of HIV-positive persons to return for scheduled medical visits

Abstract

PURPOSE: To assess in an HIV-positive cohort the cumulative probability of failing to return for scheduled medical visits and to address the factors associated with follow-up discontinuation. METHOD: This was a hospital-based cohort study conducted from January 1985 through September 1999. Out of 3,300 HIV-1 infected patients, 1,680 patients with CD4 count <500 cells/mL or with AIDS diagnosis were included in the analysis because they received scheduled medical visits for follow-up at our center. Baseline visit was the first visit when patients met the criteria for enrollment. The main outcome measure was failure to return for scheduled medical visits for at least 12 consecutive months. RESULTS: The probability of returning decreased rapidly in the first months after the baseline visit. After 1 year since enrollment, 25% of patients failed to return and after 2 years 34% of patients failed to return. Most patients who failed to return for visits (78%) discontinued their follow-up within 6 months since enrollment. In multivariate analysis, patients in the intravenous drug use (IDU) category were most likely to fail to return for scheduled appointments, as were patients with higher CD4 count (CD4 >50 cells/μL) or patients without AIDS diagnosis. Patients with shorter follow-up had a higher risk of failing to return (odds ratio [OR]: 0.12, 0.36, 0.45, and 0.74 for >36, 24-36, 12-24, and 6-12 months of follow-up respectively vs. <6 months). Patients who were enrolled in more recent years had a higher compliance to follow-up visits (OR: 0.33, 0.63, and 0.61 for ≥1997, 1995-1996, and 1988-1994 vs. <1988). CONCLUSION: Patients in the IDU category, patients without AIDS diagnosis, or patients with higher CD4 counts are more likely to miss medical appointments and discontinue their follow-up. More recently enrolled patients have a lower risk of failing to return. It is possible that the recent and more effective anti-HIV treatment played a major role in increasing adherence to follow-up.     

STRUCTURED THERAPY INTERRUPTION (STI) AND DECEPTIVE IMPRINTING

The immune response in individuals chronically infected with HIV-1 is unable to prevent progression of disease. Diversion of immune recognition via ‘Deceptive Imprinting’ allows virus variants to continue the infection. Stuctured Interrupting of (HAART) therapy (STI) causes rebound of virus with ‘wild-type’ strains that stimulate the immune system. Combining STI with suppression of the dominant response against anti-wild–type virus is proposed to enhance the beneficial effects of STI.