艾滋病患者合并阴茎癌24例临床分析

目的 探讨艾滋病患者合并阴茎癌的临床诊断与治疗.方法 收集作者2012年3月至2015年2月援助博茨瓦纳期间所诊治的艾滋病合并阴茎癌患者共24例,对其临床表现、诊断、手术治疗方案、术后疗效等影响因素进行分析总结.结果 24例患者平均年龄38.6岁.临床表现为局部肿块(11/24,45.8％)、溃疡(9/24,37.5％)及丘疹(4/24,16.7％).发病时22例患者正接受HAART治疗,18例(75.0％)患者CD4水平较低(低于350/μL),存在明显的免疫抑制状态.病理类型为鳞状细胞癌22例,鳞癌合并卡波西肉瘤2例.22例患者进行手术治疗,2例T4期患者未手术治疗.2例阴茎鳞癌合并卡波西肉瘤,于发病后4个月和6个月得到确诊,并行阴茎全切加尿道会阴部造口术,术后恢复良好,未见肿瘤转移.结论 卡波西肉瘤是艾滋病患者常见的皮肤病损,阴茎卡波西肉瘤容易掩盖阴茎鳞状细胞癌的症状,从而耽误阴茎癌诊断与治疗,需要引起足够的注意.     

The relationship between immunogenic red blood cell antigens and Human Immunodeficiency Virus infection

Introduction

Evidence suggests that red cell antigens may act as receptors for viruses and bacteria and therefore could be associated with HIV infection. Previous studies have been controversial and therefore the aim of this exploratory study was to analyse the expression of immunogenic red cell antigens in HIV-seropositive individuals and to compare the results to negative donors from South Africa.

Manganese Encephalopathy among Ephedron Abusers‐Case Reports

Ephedrone encephalopathy is referred to as a group of symptoms of manganese deposition within the central nervous system (CNS), resulting from the abuse of ephedrone (methcathinone), obtained in reaction using the excess amount of manganese‐containing oxidants. The diagnosis is based on the contrast‐enhanced head MRI findings characteristic for this syndrome, clinical manifestation and history of ephedrone use. The syndrome has been reported in recent years in young people from Eastern Europe and Russia with a history of ephedrone overuse. However, no report has ever been published on ephedrone encephalopathy in Polish patients.     

HIV感染者/AIDS患者的家属及朋友感染HIV的相关因素分析

目的 探讨人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者的家属及朋友感染HIV的现状和相关影响因素.方法 采取横断面研究设计,通过方便抽样方法和自行设计的调查问卷,于2013年3～6月对广州市第八人民医院感染科住院及门诊部的192名HIV感染者/AIDS患者的家属及朋友进行面对面问卷调查.结果 192位HIV感染者/AIDS患者的家属及朋友中,感染者家属占86.5％(166/192),感染者家属及朋友的HIV感染率为36.5％(70/192).多因素Logistic回归分析表明,与感染者的关系为配偶或性伴(OR=4.464,95％ CI:2.128 ～9.366)、同性恋/双性恋(OR=4.523,95％ CI:1.676 ～ 12.209)、吸毒(OR=6.755,95％ CI:1.720 ～26.528)是感染者家属及朋友感染HIV的危险因素;与感染者感情关系亲密(OR=0.229,95％ CI:O.097～0.539)是其感染HIV的保护因素.结论 HIV感染者/AIDS患者的配偶或性伴与其存在着性关系,故感染HIV风险较其他亲友高,但与HIV感染者/AIDS患者感情亲密的配偶或性伴较感情疏远者感染HIV风险低.同性恋/双性恋、吸毒是感染HIV的高危因素.关于与HIV感染者/AIDS患者感情关系和除配偶或性伴以外其他亲友感染HIV的相关关系,仍需进一步研究.     

西部地区HIV/AIDS流行特征及其影响因素

通过了解近十多年中国西部地区主要省市HIV/AIDS感染及感染比例上升、感染人群的分布及对感染途径的统计等情况,掌握西部地区主要省市HIV/AIDS流行的主要特征。结果显示,影响HIV/AIDS流行特征的有社会经济、流动人口及素质、高危人群行为、公众对HIV认知水平、公共卫生体系建设的不均衡等因素。最终为HIV防控工作提供有效的决策依据。     

Sarcoma de Kaposi conjuntival gigante por el virus de inmunodeficiencia humana: remisión total tras terapia antirretroviral y quimioterapia sistémica

Case report

A 35-year-old male patient with a large unilateral haemorrhagic conjunctival tumour lesion and another contralateral haemorrhagic conjunctival flat lesion associated with violaceous cutaneous macules on the extremities and angiomatous lesions in the upper gastrointestinal tract as initial clinical manifestation of HIV-related immunodeficiency. Cutaneous, gastric mucosal and conjunctival biopsy was consistent with Kaposi's sarcoma with complete remission after highly active antiretroviral therapy and systemic chemotherapy.

Complex decisions: correlates of injectable contraceptive discontinuation following HIV-1 seroconversion in an HIV prevention trial

Contraceptive adherence during acute and recent HIV-1 infection is important to maternal and child health given the elevated risk of vertical HIV-1 transmission and additional complications of pregnancy. Injectable contraception (IC) is the most common non-barrier modern contraception method used in sub-Saharan Africa (SSA). Adherence to IC after HIV-1 seroconversion is not well understood. We examined factors associated with IC discontinuation among women in SSA diagnosed with HIV-1 infection while participating in a clinical trial of biomedical HIV-1 prevention. After diagnosis with HIV-1 infection in the VOICE trial, 255 women from South Africa, Uganda, and Zimbabwe enrolled in a longitudinal observational study (MTN-015). Contraceptive method was assessed at MTN-015 baseline and at 3, 12, and 24 months post-seroconversion. Correlates of IC discontinuation were examined by Cox proportional hazard modeling. IC use was reported at baseline by 78% of women enrolled (198/255), of which 92% (182/198) completed at least one follow-up visit. Two-thirds of women (66%, 121/182) continued on IC during the follow-up period (median 24 months). Lower rates of IC discontinuation were observed in women who reported having had at least one child (HR 0.39, 95% CI 0.20–0.82) or earning a personal income (HR 0.51, 95% CI 0.30–0.87) at baseline. These findings suggest that many women with HIV-1 infection face complex decision-making regarding family planning in the years that follow seroconversion and highlight that some women may discontinue IC use despite on-site provision of family planning services. Understanding the broader context of family planning choices in recently seroconverted women may be key to more effective linkages between family planning services and HIV-1 testing and care.     

Atención sanitaria e impacto económicoHealthcare and economic impact

This chapter reviews the current model of HIV patient care and its economic impact. There are clinical and geographical differences in the care HIV patients receive and a need to develop new models of comprehen-sive HIV care has been identified.HIV infection in Spain is an important and expensive public health problem. The main costs are due to an-tiretroviral therapy, indirect costs and the cost of admission, consultation and diagnostic testing. A strong correlation between severity and cost has been identified.Patients diagnosed late have a poorer clinical course, increased mortality and require more medical and therapeutic resources.Early detection of the disease significantly improves the clinical outcomes of patients.The increased number of patients receiving treatment and their progressive ageing will increase costs of HIV healthcare in the coming years.