抗病毒治疗对艾滋病感染者CD4+T淋巴细胞计数的影响

目的：探讨抗病毒治疗对艾滋病感染者CD4+T淋巴细胞计数的影响。方法选择2014年1月至2015年6月期间中山市疾病预防控制中心确诊的92例艾滋病患者，均接受高效抗逆转录病毒疗法(HAART)治疗，记录治疗前及治疗3个月、6个月时患者血CD4+T淋巴细胞计数的变化，分析影响CD4+T淋巴细胞计数增加量的相关因素。结果 HAART治疗3个月后，患者血CD4+T淋巴细胞计数出现上升者占88.04%；治疗6个月后，所有患者CD4+T淋巴细胞计数均有不同程度的上升，CD4+T淋巴细胞计数增加量在年龄<40岁、治疗前CD4+T淋巴细胞计数≥200、BMI≥23及无药物漏服的患者中明显高于年龄≥40岁、治疗前CD4+T淋巴细胞计数<200、BMI<23及有药物漏服者，差异均有统计学意义(P<0.05)。结论高效抗逆转录病毒疗法可显著增加艾滋病患者外周血CD4+T淋巴细胞计数，其疗效与年龄、治疗时机、BMI及用药依从性有关。     

Successful voriconazole treatment of Talaromyces marneffei infection in an HIV-negative patient with osteolytic lesions

Talaromyces marneffei (T. marneffei) is a dimorphic fungus that causes systemic infection in immunocompromised patients. Here, we present a case of T. marneffei infection in an immunocompetent patient with an osteolytic lesion. Diagnosis was established by fungal culture. The patient responded rapidly to intravenous voriconazole, followed by oral voriconazole. We reviewed 18 reported cases of T. marneffei infection with osteolytic lesions, which suggests a much higher rate of osteolytic lesions in immunocompetent patients than previously thought.     

Right Ventricular Hypertrophy and Dilation in Patients With Human Immunodeficiency Virus in the Absence of Clinical or Echocardiographic Pulmonary Hypertension

Background

Involvement of right-sided heart chambers (RSHCs) in patients infected with human immunodeficiency virus (HIV) is common and is usually attributed to pulmonary arterial or venous hypertension (PH). However, myocardial involvement in patients with HIV is also common and might affect RSHCs even in the absence of overt PH. Our aim was to define morphologic and functional alterations in RSHC in patients with HIV and without PH.

A low prevalence of H pylori and endoscopic findings in HTV-positive Chinese patients with gastrointestinal symptoms

AIM: To compare the prevalence of H pylori infection,peptic ulcer, cytomegalovirus (CMV) infection and Candida esophagitis in human immunodeficiency virus (HIV)-positive and HIV-negative patients, and evaluate the impact of CD4 lymphocyte on H pylori and opportunistic infections.METHODS: A total of 151 patients (122 HIV-positive and 29 HIV-negative) with gastrointestinal symptoms were examined by upper endoscopy and biopsy. Samples were assessed to determine the prevalence of H pylori infection,CMV, candida esophagitis and histologic chronic gastritis.RESULTS: The prevalence of H pylori was less common in HIV-positive patients (22.1%) than in HIV-negative controls (44.8%; P ＜ 0.05), and the prevalence of H pylori displayed a direct correlation with CD4 count stratification in HIV-positive patients. In comparison with HIV-negative group, HIV-positive patients had a lower incidence of peptic ulcer (20.7% vs 4.1%; P ＜ 0.01), but a higher prevalence of chronic atrophy gastritis (6.9% vs 24.6%; P ＜ 0.05), Candida esophagitis and CMV infection. Unlike HIV-negative group, H pylori infection had a close relationship to chronic active gastritis (P＜0.05). In HIV-positive patients, chronic active gastritis was not significantly different between those with H pylori infection and those without.CONCLUSION: The lower prevalence of H pylori infection and peptic ulcer in HTV-positive patients with gastrointestinal symptoms suggests a different mechanism of peptic ulcerogenesis and a different role of H pylori infection in chronic active gastritis and peptic ulcer.The pathogen of chronic active gastritis in HIV-positive patients may be different from the general population that is closely related to H pylori infection.     

MSM中HIV快速检测实际利用情况及需求调查

目的了解男男性行为人群（MSM）对艾滋病病毒（HIV）快速检测的实际利用情况,获取影响MSM接受HIV快速检测的相关需求。方法 2012年10-12月,在杭州市下城区、江干区和富阳市MSM活动场所、自愿咨询检测门诊招募MSM,开展问卷调查。结果在接受调查的501名MSM中,268人回答知道HIV快速检测,占53.5%,其中93.7%（251/268）接受过快速检测,74.3%（199/268）知道快速检测可以较快获得检测结果。在需要做HIV检测时,52.7%（264/501）选择快速检测。在接受快速检测同时,希望接受艾滋病/性病咨询、梅毒检测和丙型肝炎病毒检测的比例分别为71.5%、60.9%、48.9%。79.6%希望接受快速检测的场所为疾病预防控制中心,89.2%愿意动员性伴接受快速检测。影响调查对象接受快速检测的主要因素为获得检测结果的时间（54.7%）、检测结果的准确性（54.5%）、个人信息的保密性（45.7%）等。结论 MSM对检测场所、隐私以及其他检测咨询等有不同的服务需求。因此,要加强对快速检测及相关特点的宣传,在开展快速检测时,从MSM实际需求出发进行改进,促进更多的MSM接受快速检测,扩大检测覆盖面。     

Prevalence and severity of ventricular dysfunction in patients with HIV-related pulmonary arterial hypertension

Objectives

To evaluate the occurrence of ventricular systolic dysfunction in human immunodeficiency virus (HIV)-related pulmonary arterial hypertension (PAH).

Background

Patients with HIV-related PAH may develop ventricular systolic dysfunction both as a consequence of PAH progression or of the myocardial involvement from the HIV infection itself.

Methods

Cardiac magnetic resonance imaging was applied to measure ejection fraction for the left ventricle and the right ventricle in patients with HIV-related PAH (n = 27) and in patients with PAH from other aetiologies (n = 115).

Results

In HIV-related PAH, ejection fraction values were lower and a higher proportion of patients presented with an advanced stage of ventricular dysfunction (55% vs. 25%; p = 0.009). In a multivariate model, PAH related to HIV infection remained independently associated with advanced ventricular dysfunction (p = 0.011).

Conclusions

Patients with HIV-related PAH have more prevalent and severe ventricular systolic dysfunction compared to patients with PAH from other aetiologies.     

Diagnosis and treatment of Pneumocystis jirovecii pneumonia in HIV-infected or non-HIV-infected patients—difficulties in diagnosis and adverse effects of trimethoprim-sulfamethoxazole

The clinical characteristics of Pneumocystis jirovecii pneumonia (PCP) in patients with immunodeficiency virus (HIV) infection (HIV-PCP) differ from those in patients without HIV infection (non-HIV-PCP). We analyzed 31 adult HIV-PCP cases and 44 non-HIV-PCP cases between 2008 and 2018. The symptomatic period before the diagnosis was shorter in non-HIV-PCP (5 [3–8] days vs. 29 [14–55] days, P < 0.001) and the overall survival rate was lower in the non-HIV-PCP group (P = 0.022). Serum β-D glucan positivity (72.7% vs. 93.5%, P = 0.034) and Grocott stain positivity for Pneumocystis jirovecii in the bronchoalveolar lavage fluid (4.3% vs. 73.3%, P < 0.001) were significantly lower in the non-HIV-PCP group. This difficulty in laboratory diagnosis possibly resulted in the administration of concurrent antibiotics such as quinolones and macrolides (56.8% vs. 19.4% P = 0.002) in the non-HIV-PCP group. The adverse effects due to trimethoprim-sulfamethoxazole were more frequently observed in HIV-PCP (86.2% vs. 35.3%, P < 0.001). The duration of discontinuation of trimethoprim-sulfamethoxazole was 11 [8–14.5] days in HIV-PCP cases. Co-administration of adjunctive corticosteroid therapy did not mitigate hypersensitivity to trimethoprim-sulfamethoxazole. Our analysis indicated that the characteristics of PCP in patients with or without HIV was quite different. HIV-positive patients with PCP should be monitored closely to avoid adverse effects due to trimethoprim-sulfamethoxazole. Because positivity polymerase chain reaction test for P. jirovecii remained high (91.7%), it is suggested that bronchofiberscopy is warranted for diagnosis of PCP in HIV-negative patients.