结核性脑膜炎临床诊断评分体系的建立及评价研究

背景 结核性脑膜炎（TM）是临床常见的中枢性感染的一种，其起病较慢，症状不典型，病原学诊断困难，误诊率高。目前有效的TM诊断工具较少。利用常见的临床症状、检查指标等建立诊断评分系体可提高诊断准确率，减少误诊。 目的 建立TM临床诊断评分体系（TMCDS），并对其应用价值进行初步评价。 方法 选取2011年11月至2021年9月在柳州市人民医院感染病科住院并诊断为脑膜炎的患者187例为研究对象，采用SPSS 21.0统计软件将患者随机分成建模组（147例）和验模组（40例）。根据是否为TM将建模组分为非TM亚组（76例）和TM亚组（71例）。收集患者的一般资料，主要包括性别、年龄、临床症状（发热、头痛、意识障碍、颈抵抗），实验室及影像学检查结果，包括人类免疫缺陷病毒（HIV）感染情况、CD4+ T淋巴细胞计数、C反应蛋白、颅内压、脑脊液常规生化检查（糖、氯、蛋白、细胞数）。建模组采用多因素Logistic回归分析探讨TM的影响因素；根据每个因素的β值所占比重设立相应分值，建立TMCDS；采用受试者工作特征曲线（ROC曲线）分析TMCDS诊断TM的价值。 结果 两亚组头痛、HIV感染、CD4+ T淋巴细胞计数<200/μl、C反应蛋白升高、颅内压>200 mm H2O（1 mm H2O=0.009 8 kPa）、脑脊液糖降低、脑脊液氯降低、脑脊液蛋白升高、脑脊液单核细胞升高情况比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，头痛、CD4+ T淋巴细胞<200/μl、C反应蛋白升高、脑脊液糖降低、脑脊液蛋白升高均是TM的影响因素（P<0.05）。将以上5个影响因素同时结合临床经验纳入脑脊液氯、脑脊液细胞数再次进行多因素Logistic回归分析，结果显示，头痛、CD4+ T淋巴细胞<200/μl、C反应蛋白升高、脑脊液糖降低、脑脊液蛋白升高均是TM的影响因素（P<0.05）。根据上述7个因素β值建立评分系统，将脑脊液氯降低β值设定为1分，其他因素β值与其的倍数即为该因素所对应的分值，因2个影响因素评分为负值，为方便临床，每个因素对应分值增加2.5分，最终建立TMCDS。TMCDS诊断建模组TM的ROC曲线下面积（AUC）为0.807〔95%CI（0.735，0.879），标准误=0.037，P<0.001〕，最佳诊断界值为21.50分。TMCDS诊断验模组TM的AUC为0.766〔95%CI（0.610，0.921），标准误=0.079，P=0.004〕，灵敏度为0.789，特异度为0.667。 结论 通过7个变量建立的TMCDS简单易行，对于早期TM具有较高的临床诊断价值。     

南京某国际高中学生艾滋病知识知晓率及影响因素分析

目的 分析南京市某国际高中学生艾滋病知识知晓率及其影响因素,为制定高中生艾滋病健康教育策略提供依据。方法 对南京市某国际高中所有学生开展纸质问卷调查,统计分析艾滋病知识知晓率及其影响因素。 共纳入171名高中生为调查对象,艾滋病和梅毒的知识知晓率分别为56.1%和46.8%;有过性行为的占14.6%,其艾滋病知识知晓率最高为32.0%,(χ2=10.799,P=0.005);有吸毒史的学生占9.3%,其艾滋病知识知晓率最高为31.2%,(χ2=21.062,P<0.001);梅毒知识知晓者与不知晓者的艾滋病知识知晓率差异具有统计学意义(χ2=21.716,P<0.001)。 该国际高中学生性病和艾滋病知识知晓率较低,对高中生开展毒品危害教育和性病艾滋病防治应作为健康教育工作重点。     

艾滋病合并肺结核中的CT影像学特征和诊断价值分析

目的探讨艾滋病合并肺结核患者行胸部CT检查的影像学特征及其在疾病诊断上的价值。方法选取本院在2018年3月至2019年4月诊治的40例艾滋病合并肺结核患者作为观察组,同时选择同期入院诊治40例单纯肺结核患者作为对照组。给予两组胸部CT检查,分析影像学特征,并探讨其诊断价值。结果与对照组比较,观察组淋巴结或胸膜受累所占比较明显更高,差异有统计学意义(P<0.05);与综合检查诊断结果比较,胸部CT检查继发性肺结核、血行播散型肺结核诊断准确率分别为96.55%、91.67%,漏诊2例(5.00%);艾滋病伴肺结核患者接受胸部CT检查时,影像学特征主要表现为双肺肺叶、肺段可见明显渗出性病变,肺内纤维索条影显示明显,同时还呈现明显空洞影、斑片状影,伴有明显腋窝、纵隔淋巴结肿大及心包、胸腔积液等情况。结论胸部CT检查方式用于艾滋病伴肺结核患者诊断,能够获得明显影像学特征,有助于诊断准确率提高。     

某高校大学生艾滋病主动检测意愿与影响因素

目的 了解青年学生艾滋病主动检测意愿的现状,提出促进青年学生主动检测意愿的建议,为进一步提高青年学生艾滋病检测意愿的策略和措施提供科学依据。方法 采用自编促进大学生HIV主动检测意愿调查问卷,用整群抽样方法抽取成都某高校778名在校大学进行问卷调查。结果 在被调查的778名大学生中,91.6%的学生有艾滋主动检测意愿,在不同年级(χ2=11.416,P=0.010)、认为自己感染艾滋病风险情况(χ2=18.615,P＜0.001)等因素上差异均有统计学意义。多因素 logistic 回归分析显示年级为大二或大三、认为自己艾滋病感染风险为非常低或比较低或一般(P均＜0.05)的青年学生更愿意进行艾滋病主动检测。结论 该高校大学生艾滋病主动检测意愿较高。应该结合该高校学生的特性,开展有针对性的艾滋病宣传教育活动,以此提高大学生HIV主动检测率。     

广西高校新生对HIV尿液自助采样包的使用意愿及关注因素调查

目的 了解广西高校新生对HIV尿液自助采样包的使用意愿及关注因素,为进一步在高校开展HIV尿液自我采样传递检测提供依据和参考。 方法 采取整群随机抽样方法,分别选取广西A、B两所高校新生进行匿名问卷调查,其中,A校在健康教育讲座前问卷调查,B校在健康教育讲座后问卷调查。 结果 本次调查中,共发放问卷500份,A、B两所高校新生的问卷回收率分别是88.0%(132/150),96.9%(339/350),差异有统计学意义(P<0.001)。A、B两所高校新生艾滋病基本知识平均知晓率分别为73.7%,87.7%,差异有统计学意义(P<0.001)。受访的大学新生中有2.3%(11/471)曾接受过HIV检测。A、B两所高校新生对HIV尿液自助采样包的使用意愿率分别是63.6%(84/132),88.5%(300/339),差异有统计学意义(P<0.001)。男生对HIV尿液自助采样包的使用意愿率均要稍高于女生,但差异无统计学意义(P>0.05)。在阻碍HIV尿液自助采样包的使用因素调查中,54.0%(47/87)认为操作流程不方便,37.9%(33/87)怀疑结果的准确性,8.1%(7/87)认为容易污染。此外,在大学新生对HIV尿液自助采样包的关注因素调查中,首要关注的是保密性(85.4%,402/471),其次是准确性(72.4%,341/471)。超过一半的新生认为100~150元是HIV尿液自助采样包的可接受价格范围,高达97%的新生认为检测结果的反馈时长应小于7 d。 结论 广西高校新生对HIV尿液自助采样包的态度积极,使用意愿较高,对HIV尿液自我采样传递检测持相对开放态度。HIV尿液自助采样包的保密性和准确性是大学新生最为关注的两个因素。举办健康教育讲座对HIV尿液自助采样包进行适当的介绍和宣传,可有效提高使用意愿。     

The importance of how research participants think they are perceived: results from an electronic monitoring study of antiretroviral therapy in Uganda

Novel monitoring technologies in HIV research, such as electronic adherence monitors (EAMs), have changed the nature of researcher-participant interactions. Yet little is known about how EAMs and the resulting interaction between researchers and participants affect research participation and the data gathered. We interviewed participants and research assistants (RAs) in an observational cohort study involving EAMs for HIV antiretroviral therapy (ART) in Uganda. We qualitatively explored interviewees’ views about ethical issues surrounding EAMs and assessed data with conventional and directed content analysis. Participants valued their relationships with RAs and were preoccupied with RAs’ perceptions of them. Participants were pleased when the EAM revealed regular adherence, and annoyed when it revealed non-adherence that contradicted self-reported pill-taking behavior. For many, the desire to maintain a good impression incentivized adherence. But some sought to creatively conceal non-adherence, or refused to use the EAM to avoid revealing non-adherence to RAs. These findings show that participants’ perceptions of the study staff's perceptions of them affected the experience of being monitored, study participation, and ultimately the data gathered in the study. Investigators in monitoring-based research should be aware that social interactions between participants and study staff could affect both the practical and ethical conduct of that research.     

HIV Protease: Historical Perspective and Current Research

The retroviral protease of human immunodeficiency virus (HIV) is an excellent target for antiviral inhibitors for treating HIV/AIDS. Despite the efficacy of therapy, current efforts to control the disease are undermined by the growing threat posed by drug resistance. This review covers the historical background of studies on the structure and function of HIV protease, the subsequent development of antiviral inhibitors, and recent studies on drug-resistant protease variants. We highlight the important contributions of Dr. Stephen Oroszlan to fundamental knowledge about the function of the HIV protease and other retroviral proteases. These studies, along with those of his colleagues, laid the foundations for the design of clinical inhibitors of HIV protease. The drug-resistant protease variants also provide an excellent model for investigating the molecular mechanisms and evolution of resistance.     

Adherence to antiretroviral treatment and quality of life among transgender women living with HIV/AIDS in São Paulo,Brazil

ABSTRACT

This study focused on factors associated with antiretroviral therapy (ART) adherence and quality of life among transgenderwomen in Sao Paulo, Brazil, using univariable and adjusted analysis. Adherence was evaluated with a self-report tool and with HIV viral load (VL) measurement. PROQOL-HIV was used to assess quality of life. 106 TGW with median 41 years old were included; most were white (56%) and had >10 years of education (57%). Median time since HIV/AIDS diagnosis was 10 years. Overall, participants had high T CD4+ counts (median 659 cells/mm³) and most (75%) had undetectable HIV VL. 85% were considered adherent using self-report (95%CI 77-91), whereas 72% (95%CI 62-80) were considered adherent when self-report and undetectable HIV VL were analyzed jointly. Older age was associated with higher ART adherence; each year increase in age was associated with 5% higher odds of adherence (p?=?0.021). Quality of life ranged from good-excellent in 5 of 8 domains. Younger age, lower education, higher time since HIV diagnosis, comorbidities, illicit drugs use and depression were associated with lower PROQOL scores in specific domains in univariable analysis, while depression was also associated with lower total PROQOL score even after adjustment for age, comorbidities and time since HIV diagnosis (p?=?0.048).     

Choroidal Thickness in Patients Diagnosed with Human Immunodeficiency Virus Infection: Results from Two Populations of Different Ethnicities

Purpose: To measure the choroidal thickness among subjects with human immunodeficiency virus (HIV) infection from two diverse ethnic populations and to compare it with healthy controls.

Methods: Subjects with HIV infection and healthy controls were enrolled in two referring centers in Italy and India. Clinical data were collected. All subjects underwent enhanced-depth imaging optical coherence tomography and measurement of choroidal thickness.

Results: A total of 68 eyes from 68 patients with HIV (44 Caucasian, 24 Indians) and 60 eyes from 60 healthy volunteers (36 Caucasian, 24 Indians) were included. Mean choroidal thickness was significantly higher in HIV patients compared to controls (312.91 ± 65 µm vs. 266.57 ± 47 µm; p < 0.001). Choroidal thickness was higher among subjects with HIV-related retinopathy compared to HIV without retinopathy (285 ± 30 µm vs. 352 ± 17 µm; p < 0.01).

Conclusions: Patients with HIV infection, especially with HIV microangiopathy, have thicker choroid compared to age- and gender-matched healthy control subjects. These changes may be related to HIV-associated choroidal vascular dysfunction.