高效抗反转录病毒疗法治疗艾滋病效果分析

目的分析高效抗反转录病毒疗法治疗艾滋病临床效果。方法选择2011年3月—2013年2月在我院进行治疗的HIV患者200例进行抗病毒药物治疗。对临床疗效、药物不良反应等进行跟踪随访。结果患者服药的依从性平均97．5％．其临床表现均有不同程度的改善,无严重不良反应,无死亡。结论高效抗反转录病毒疗法治疗艾滋病具有一定的疗效,18个月抗病毒治疗有效率为86．7％,患者高度服从性对HIV治疗成功起到非常关键的作用。     

22例接受抗病毒治疗艾滋病儿童死亡原因分析

目的了解艾滋病儿童接受高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)死亡病例的临床特征、死亡原因,为降低艾滋病儿童死亡率提供参考。方法回顾性分析截至2015年6月广西壮族自治区疾病预防控制中心收治的艾滋病儿童接受HAART后的死亡病例。结果 22例研究对象均为母婴传播,世界卫生组织(WHO)临床分期以Ⅲ/Ⅳ期为主,分别为45.45%、50.00%;主要症状、体征有生长发育缓慢95.45%、不同程度贫血81.82%、中-重度营养不良81.82%、发热50.00%。合并机会性感染中以支气管肺炎(50.00%)和鹅口疮(45.45%)为常见。63.64%患儿在治疗6个月内发生免疫重建炎性综合征。50.00%患儿在抗反转录病毒治疗3个月内死亡;死亡原因以艾滋病相关感染居首位68.18%。入组治疗后生存时间与基线CD4数值呈正相关。结论艾滋病儿童死亡主要与较晚接受抗病毒治疗有关,早发现、早治疗是降低艾滋病儿童死亡率的重要手段。     

157例AIDS患者临床分析

目的了解荆州市2007-2014年艾滋病机会性感染的临床特点,为临床诊治提供依据。方法对我院收治的AIDS病例进行统计学分析。结果 157例AIDS病例发生机会性感染349例,细菌最常见,其次为真菌、病毒、原虫;其中结核分枝杆菌感染32.95%,白色假丝酵母菌17.77%,肺孢子菌14.90%。患者常合并多种并发症,如药物性皮炎、贫血、药物性肝炎等。结论艾滋病机会性感染临床表现复杂,病变部位广泛,患者发现时间晚,各种药物的毒副作用叠加,诊治困难。临床医生应加强HIV筛查,以早期发现、治疗患者。     

艾滋病相关骨科疾病的临床研究进展

随着高效抗反转录病毒治疗的应用，艾滋病患者生存时间明显延长，预期寿命甚至已接近一般人群，艾滋病已成为一种慢性疾病。近年来，艾滋病相关骨科疾病的发生率逐渐升高，因此需要骨科手术治疗的艾滋病患者越来越多，艾滋病相关骨科疾病的诊治已经逐渐引起临床专家的高度重视。本文回顾性复习了艾滋病合并各类骨科疾病的临床研究进展，以期为医生提供更多该领域的临床进展信息。     

HIV／AIDS抗病毒治疗县乡村三级管理模式实践与探索

介绍陇川县HIV／AIDS抗病毒治疗县乡村三级管理模式和探索实施县乡村三级管理的实用价值。结果表明：HAART（联合高效抗反转录病毒治疗）实行三级管理具有良好的可操作性与临床实用价值，其对促进服药依从性、提高临床治疗效果、降低机会性感染发生率与死亡率具有良好的推动作用。     

艾滋病100例临床分析与机会感染治疗转归

目的了解艾滋病的临床特点、并发症及其治疗效果。方法回顾性分析某院住院的100例艾滋病患者的临床资料。结果100例艾滋病患者主要临床表现为:消瘦、发热、贫血、咳嗽咳痰、腹痛腹泻、胸闷气促、肝大、淋巴结肿大;主要并发症为机会性感染和继发性肿瘤,居前6位的感染分别是口腔念珠菌病58例、结核46例、感染性腹泻31例、细菌性肺炎19例、肺孢子菌肺炎16例、颅内感染10例。经治疗后,机会性感染治愈或好转出院83例,死亡9例(包括中枢神经系统病变4例,结核2例,肺孢子菌肺炎1例,败血症1例,全身衰竭1例),未愈8例。结论艾滋病并发呼吸系统和消化系统感染多见,大部分治疗效果好,但结核和颅内感染预后较差。     

艾滋病患者机会性感染43例分析

目的 提高对艾滋病机会性感染临床表现的认识,总结艾滋病患者机会性感染治疗经验.方法 收集本院艾滋病患者机会性感染治疗的相关资料,并进行分析.结果 43例艾滋病患者机会性感染主要临床表现为发热、乏力、消瘦、咳嗽、腹泻等.感染部位主要为呼吸道和消化道.结论 呼吸道感染是艾滋病患者晚期的主要机会性感染,其次为感染性腹泻.机会性感染呈多样性、混合性,且多数患者伴有机体多系统损害,治疗困难.     

艾滋病患者粪便HIV-1 RNA的研究

目的研究艾滋病患者粪便HIV-1 RNA,分析其与血液HIV-1 RNA的相关性,并比较它们在治疗(抗反转录病毒治疗)和未治疗(未抗反转录病毒)患者中的区别。方法收集32例艾滋病患者粪便和血液标本,两者一一对应,根据临床资料将其分为治疗组和未治疗组,分析粪便和血液HIV-1 RNA的组内相关性和组间相关性。结果2组都表现出粪便HIV-1 RNA检出率低于血液且粪便中病毒载量低于血液,且2组间粪便和血液阳性率对比差异均有统计学意义(P<0.001),其中未治疗组粪便和血液的HIV-1 RNA阳性率较高。结论粪便中可以检测到HIV-1 RNA,其在未经过抗反转录病毒的患者中易检出,同一患者粪便中的HIV-1病毒载量比血液低。     

122例艾滋病机会性感染临床分析

目的通过对艾滋病合并机会性感染患者的临床资料分析,总结其临床特点,提高对艾滋病机会性感染的认识和诊治水平。方法回顾性分析122例艾滋病合并机会性感染患者的临床资料,分析和探讨艾滋病合并机会性感染的临床特点、诊断和治疗。结果艾滋病合并机会性感染具有多样性、复杂性和难治性,以呼吸道和消化道感染多见,随着CD4+T细胞计数的下降,艾滋病合并机会性感染发生的频率增加,发病更严重,病死率更高。结论呼吸系统和消化系统是艾滋病常见的机会性感染,CD4+T细胞计数和临床表现对于指导诊治具有重要意义,诊断上能够早期明确诊断,及时预防和控制各种机会性感染,有利于提高患者生活质量,延长生命。     

艾滋病合并沙门氏菌感染6例临床分析

目的 了解艾滋病合并沙门氏菌感染病例的临床特征.方法 对6例艾滋病合并沙门氏菌感染患者的临床资料进行分析总结.结果 6例艾滋病合并沙门氏菌感染病例以发热为主要症状,消化道症状不典型,CD4细胞水平均低于200个/uL.经血培养和骨髓培养检查确定为沙门氏菌感染,细菌鉴定结果为伤寒沙门菌3例、沙门菌C1群1例、沙门菌丙型副伤寒血清型2例,给予敏感抗生素治疗疗效满意.结论 艾滋病合并沙门氏菌感染热型不规律,血嗜酸性粒细胞正常,确诊靠细胞培养,沙门氏菌是艾滋病常见机会性感染的主要病原菌之一.     

Opportunistic infections in HIV-positive patients hospitalized in the Clinic of Infectious Diseases AMG

Opportunistic infections are one of the major problem among HIV infected patients still connected with high mortality. The aim of the investigation is to evaluate the incidence and mortality from opportunistic infections in HIV infected population in Pomeranian region of Poland. The paper presents analysis of incidence of opportunistic infections among 141 AIDS patients hospitalised in Clinic for Infectious Diseases in Gdańsk from 1988 to 2001/June/. In examined group 179 opportunistic infections were diagnosed. Most frequent was oesophageal candidiasis 58%, tuberculosis 29%, pneumocystis carinii pneumonia 21% and central nervous system toxoplasmosis 13%. The occurrence of opportunistic infections depends on CD4 count and rises with CD4 decline. Opportunistic infections were the reason of death in 33 from 74 cases/45%/. CONCLUSIONS: In examined group 28% of patients did not know about HIV infection when first opportunistic infection was diagnosed. Most frequent opportunistic infections in AIDS patients were oesophageal candidiasis, tuberculosis, pneumocystis carinii pneumonia and toxoplasmosis. In 98% of cases opportunistic infection developed when no HAART nor infection prophylaxis was administered. Opportunistic infection was the reason of death in 45% of cases, the most frequent were PCP and CNS toxoplasmosis.     

复方新诺明预防用药对艾滋病患者发生机会性感染的影响

目的在HAART治疗的基础上给予艾滋病患者复方新诺明预防用药,分析预防服药对患者发生机会性感染的影响。方法对91例进行HAART治疗的患者给予复方新诺明预防用药,分别观察服药前及服药后半年内机会性感染的发生情况,对机会性感染高发年龄、发病率等进行对比分析。结果机会性感染的好发年龄发生于41～50岁,占人群中的45.1%,1 a内发生1～3次机会性感染占54.9%,4～5次占6.6%,>5次占1.1%;给予预防用药进行6个月的随访,1～3次机会性感染占11.0%,4～5次、>5次均为0。结论在HAART治疗的基础上同时给予复方新诺明预防用药,机会性感染的发病率、发生频率明显下降。     

Liver transplantation in a HIV-positive patient receiving potent antiretroviral therapy; the first case in The Netherlands

In a 49-year-old woman infected with HIV who was receiving highly-active antiretroviral treatment (HAART), terminal liver failure developed. She also had an acute exacerbation of hepatitis B. She was treated by means of liver transplantation and was in good condition two years later. At that time she was treated with tacrolimus, lamivudine, tenofovir, nelfinavir and hepatitis-B immunoglobulin. HIV-RNA and the DNA of hepatitis-B virus could not be detected, her CD4-count was not abnormal and the liver transplant functioned well. No opportunistic infections had developed. HIV infection has long been considered an absolute contraindication to solid organ transplantation, due to the increased risk of infection and rapid progression to AIDS. With HAART, restoration of immune function is possible. Currently, international experience with liver transplantation for HIV-positive patients that are not infected with hepatitis C has shown promising results. Specifically, the risks of transplant rejection, opportunistic infections and progression to AIDS are not increased. Therefore, criteria have been defined for solid organ transplantation in HIV-positive recipients.     

新疆地区40例艾滋病患者临床特点分析

目的分析某院收治的40例艾滋病患者的临床特征。方法回顾性研究2003年1月-2004年8月以发热或腹泻、消瘦为主诉收治诊断为人免疫缺陷病毒（HIV）感染患者的临床资料。结果40例患者的临床分期均已到艾滋病期，CD4+T淋巴细胞计数为（156.54±131.26）/μL（正常参考值为800～1 200/μL）。发热、咳嗽咳痰、消瘦、腹痛腹泻以及颈部淋巴结大为主要临床表现，部分患者有卡波西肉瘤；机会性感染及合并症以肝炎病毒感染（30例，75.00%）、肺结核（15例，37.50%）多见。HIV感染方式以静脉吸毒为主（32例，80.00%），其次为性途径感染（4例，10.00%）。距可能暴露（静脉吸毒、性接触、输血）HIV时间2～12年，平均（7.31±1.30）年。结论艾滋病期患者临床表现多样化，静脉吸毒是主要的感染传播方式。需采取多种措施预防控制HIV的传播，对患者加强抗病毒治疗与监测、随访，及时控制机会性感染以及病毒复制。     

The incidence of Cytomegalovirus (CMV) antigenemia and CMV disease is reduced by highly active antiretroviral therapy

Cytomegalovirus (CMV) infection was one of the most common opportunistic infections in AIDS patients, leading to blindness or life-threatening disease in about 40% of patients in the later stages of AIDS before highly active antiretroviral therapy (HAART). In a retrospective multicenter study we investigated the incidence of CMV retinitis and organ involvement in Northern Italy before (1995 and 1996) and after the introduction of HAART (1997 and 1998) as well as the data regarding CMV antigenemia. We found a sharp drop in the incidence of CMV disease in AIDS patients as well as a decline in the incidence of relapses of CMV-disease after the widespread introduction of HAART.c Moreover, there was a decrease in the incidence of antigenemia-positive cases in AIDS patients in the era of HAART and the median CMV viral load was significantly higher in patients who didn't receive HAART than in patients who received HAART (p= 0.001, ttest).     

Impact of highly active antiretroviral therapy (HAART) on the incidence of opportunistic infections, hospitalizations and mortality among children and adolescents living with HIV/AIDS in Belo Horizonte, Minas Gerais State, Brazil

The impact of highly active antiretroviral therapy (HAART) can be evaluated using indicators, such as rates of opportunistic infections, hospitalizations by cause of infection, and associated death. This study aimed to estimate the impact of HAART on the incidence of these indicators, in children and adolescents with HIV/AIDS. It was a hybrid cohort study; 371 patients were followed from 1989 to 2003. In December 2003, 76% of the patients were still being followed, while 12.1% had died, 9.5% had dropped out, and 2.4% had been transferred. The overall rate of opportunistic infections was 18.32 infections/100 persons-year and 2.63 in the pre- and post-HAART periods, respectively. In the multivariate analysis, the risk of developing an opportunistic infection was 5.4 times greater and 3.3 times greater for hospitalization risk before HAART. Respiratory causes represented 65% of the hospitalizations and they were reduced by 44.6% with therapeutic intervention. The average hospital stay of 15 days was reduced to 9. There was a post-HAART decline in deaths of 38%. This study demonstrates the effectiveness of HAART in significantly reducing opportunistic infections, hospitalizations, and deaths in this Brazilian cohort.     

37例住院艾滋病患者临床分析

目的 分析住院艾滋病患者主要的实验室指标异常、常见的机会感染、临床表现及治疗情况。方法 将湘雅二医院37例住院艾滋病患者临床资料作回顾性分析。结果 艾滋病患者临床表现主要有发热、乏力、纳差、消瘦和淋巴结肿大等，部分有皮疹、咳嗽、吐痰、恶心、呕吐、腹痛和腹泻等症状，实验室化验和其它检测指标显示多器官受累和多种病原感染，其中以呼吸系统感染、皮肤病变和消化系统病变为最常见，也可见神经系统和泌尿系统等病变。结论 艾滋病患者临床表现呈多样性，检验结果均提示多器官受累和多种病原感染，临床处理多需抗菌素、抗病毒药和抗霉菌药合理联合用药，同时应加强对症支持治疗和心理护理。在病情缓解后应根据情况及时进行HAART治疗。     

艾滋病严重疾病期合并中性粒细胞减少症与再感染的关系

目的 研究艾滋病严重疾病期患者接受抗病毒治疗(HAART)前后中性粒细胞减少症与发生机会性感染的关系。 方法 回顾性分析138例已经确诊为艾滋病严重疾病期的患者,所有患者的机会性感染均已得到控制而进入机会性感染的二级预防及HAART阶段。患者按HAART前基线的血常规检测,分为中性粒细胞绝对数≤2×10⁹/L组77例(低下组)和中性粒细胞绝对数＞2×10⁹/L组61例(正常组)。接受HAART6个月后,对比两组患者再感染率及平均抗生素使用天数,分析患者基线中性粒细胞计数水平与抗生素使用天数、再感染次数的相关性。 结果 经过6个月的观察,低下组患者的再感染率为59.7%,正常组患者的再感染率为34.4%,两者差异有统计学意义(χ²=8.732,P<0.05)。患者的基线中性粒细胞数值与患者再感染次数存在负相关(r_s=-0.31,P<0.05),与抗生素使用天数存在负相关(r_s=-0.299,P<0.05)。 结论 合并中性粒细胞减少症可使艾滋病严重疾病期患者在抗病毒治疗早期出现再感染的危险性增加,监测患者中性粒细胞水平,及时发现并治疗再感染,具有重要临床意义。     

Subcutaneous abcesses due to Mycobacterium avium due to a reconstitution syndrome in AIDS patients

Clinical presentations of opportunistic infections in AIDS patients have dramatically changed since the introduction of HAART. The immune reconstitution syndrome (IRS) is typical of this change. The authors discuss the case of an AIDS female patient presenting with subcutaneous abcesses and abdominal lymph node enlargement due to Mycobacterium avium and occurring 10 weeks after initiation of HAART. This was related to the exacerbation of immune response against the bacteria that had previously infected the patient. Many cases of IRS involving M. avium have now been described, but cutaneous localisations remain infrequent. The treatment consists in HAART continuation associated with anti mycobacterial antibiotics and possibly anti inflammatory drugs.