人类免疫缺陷病毒感染者手术安全问题探讨

人类免疫缺陷病毒(HIV)感染者合并多种外科疾病需要手术治疗,由于艾滋病患者有不同程度的免疫功能损害,手术并发症多、病死率高、手术风险大。因此做好围术期治疗对预防术后并发症有重要意义。     

97例人类免疫缺陷病毒感染者分析

目的分析97例人类免疫缺陷病毒感染者流行病学特点及意义。方法用进口快速胶体金试剂和国产抗-HIV(1+2)ELISA试剂检测抗-HIV。结果2000~2008年,在该院71 848例门急诊、体检及住院患者送检标本中,共检测出HIV阳性患者97例,阳性率为0.135%,其中男女比例为2.23∶1,年龄5~93岁,患者因各病种分散就诊于各个科室。结论人类免疫缺陷病毒感染者由青壮年高危人群向着各年龄阶段的普通人群发展,人类免疫缺陷病毒感染的及时诊断,对感染者的治疗、对机会性感染的预防及减少医护人员的职业暴露都具有重要的意义。     

广西部分地区人类免疫缺陷病毒感染者合并丙型肝炎病毒感染情况分析

目的 了解广西人类免疫缺陷病毒(HIV)感染者中HIV/丙型肝炎病毒(HCV)的混合感染率及其HCV RNA的阳性率,为今后HIV患者丙肝筛查及预防提供参考.方法 采用ELISA法检测HIV感染者血清中的丙肝病毒抗体,按结果分成抗-HCV(+)组和抗-HCV(-)组,再用巢式PCR法检测血清的HCV RNA,分析比较HCV RNA阳性率.结果 在300例HIV感染者中,有146例抗-HCV阳性,154例抗-HCV阴性;在抗-HCV阳性组中,HCV RNA的阳性率为78.08％(114/146);在抗-HCV阴性组中,HCV RNA阳性率为26.62％(41/154);ELISA法和巢式PCR法检测HCV感染的符合率为75.67％[(113+114)/300].结论 在广西的HIV感染者中HCV感染状况较严重.对HIV感染者进行丙肝筛查时,为减少漏诊率,建议采用PCR方法检测抗-HCV阴性血清中的HCV RNA.     

男同性恋人类免疫缺陷病毒感染者精液质量分析

目的：分析男同性恋人类免疫缺陷病毒（HIV）-1感染者的精液质量特点。方法：对27例HIV-1男同性恋感染者的精液量,精子密度、活率、活力、畸形率及其膜功能进行检测与分析。结果：本组25.9%的精液量异常,18.5%精子密度异常,55.6%精子活率异常,92.6%精子活力异常。精子畸形率范围43.0%～94.0%,平均（70.4±13.7）%。精子低渗肿胀率28.8%～86.2%,10例异常。结论：男同性恋HIV-1感染者普遍精液质量显著低下。     

人类免疫缺陷病毒感染者手术部位感染发生情况分析

目的探讨人类免疫缺陷病毒(HIV)感染者手术部位感染的发生情况。方法选取2008年10月—2011年9月在上海市复旦大学附属公共卫生临床中心外科进行手术治疗的HIV感染者242例。根据术前CD4T淋巴细胞计数水平分为A组(≤199 cell/μl)123例、B组(200～349 cell/μl)70例、C组(≥350 cell/μl)49例,比较各组手术部位感染发生率。根据手术切口类型分为Ⅰ、Ⅱ、Ⅲ类切口,比较各类切口手术部位感染发生率。结果 242例HIV感染患者中发生手术部位感染115例(47.5%);其中浅表切口感染93例(38.4%),深部切口感染13例(5.4%),器官或无菌体腔感染9例(3.7%)。4例术后死于腹腔感染脓毒症。A组发生手术部位感染62例(50.4%),B组32例(45.7%),C组21例(42.8%),3组手术部位感染发生率比较差异无统计学意义(χ2=0.344,P>0.05)。Ⅰ类手术切口患者手术部位感染发生率为2.6%(2/77),Ⅱ类66.2%(102/154),Ⅲ类100.0%(11/11),3类手术切口患者手术部位感染发生率比较差异有统计学意义(χ2=96.083,P<0.001)。结论 HIV感染患者手术部位感染发生率较高,术前CD4T淋巴细胞计数不影响手术部位感染率,但是切口类型与手术部位感染率相关,适当的围术期防治措施可减少HIV感染者外科手术部位感染率。     

8例人类免疫缺陷病毒感染者的眼部临床表现

目的 观察8例人类免疫缺陷病毒(HIV)感染者的眼部临床表现。方法 回顾总结8例HIV感染者的眼部临床表现。并对其主诉、年龄、性别分布、感染途径、疾病类型进行分析。结果 8例中男6例。女2例．男女之比3：1。8例中年龄最大45岁．最小23岁。8例均有视力下降的主诉,眼部临床表现包括虹膜睫状体炎、眼部带状疱疹、角膜炎、白内障、视网膜棉绒斑和出血、眼部肿瘤。结论 在HIV感染的高危人群中,对双眼虹膜睫状体炎、年轻的白内障,反复发作不易治愈的角膜炎、眼部带状疱疹、不明原因的非感染性血管病变性眼底病变等患者,要详细询问病史和个人史,及时行AIDS的相关检查。     

女性人类免疫缺陷综合征42例临床分析

在非洲,人类免疫缺陷综合征(AIDS)已成为黑人妇女最常见的死亡原因.为探讨和总结女性AIDS的临床表现治疗,现将中非友谊医院妇科门诊收治的42例AIDS患者的临床资料分析报告如下.     

人类免疫缺陷病毒感染者的口腔病变及医务人员职业防护

艾滋病是一种严重的血液传播疾病,因传播速度快、波及传播地区广和病死率高而备受关注。大多数艾滋病患者首诊于口腔科且出现特殊的口腔症状如白色念珠菌病、口腔白斑、牙周病、坏死性牙龈炎、Kaposis肉瘤等,因此口腔医务人员应警惕人类免疫缺陷病毒感染患者的口腔表现,以便早期发现。同时医护人员在治疗中直接与患者接触,手易被唾液、血液的分泌物等污染,所以口腔医护人员做好防护显得尤为重要。     

血友病合并人类免疫缺陷病毒感染患者的手术安全与护理研究

目的探讨血友病合并人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)患者的围术期治疗和护理措施。方法对14例血友病合并HIV感染者(均为男性,年龄20～54岁)进行手术,术前检测免疫功能,规范手术操作程序,精细操作减少手术损伤,术中持续输注凝血因子Ⅷ,常规应用抗生素预防感染。重视患者的心理护理,用专业性的沟通技巧对患者进行心理疏导,帮助其面对现实,对疾病树立正确的态度,增加生活的信心。结果 6例术后发生脓毒症,经抗生素控制感染和支持治疗后治愈,无手术死亡。脓毒症组术前血清清蛋白(Alb)水平明显低于非脓毒症组,差异有统计学意义(P<0.05)。术后2周复查各项指标,脓毒症组血红蛋白(Hb)明显减少(P=0.047),其他指标差异均无统计学意义(P>0.05)。术前CD4与CD4/CD8,术前CD4与Alb,术前CD4与术后CD4/CD8,术前白细胞计数(WBC)与术后血小板计数(PLT),术后CD4与术前Alb呈正相关(P<0.05)。术前Hb与PLT呈负相关(P<0.05)。术后随访3～35个月,患者均恢复正常生活,心理状态良好,对抗病毒治疗依从性良好。结论对血友病合并HIV感染者采用适当围术期治疗和护理措施可以取得较好的疗效。     

监狱囚犯肺结核合并人类免疫缺陷病毒感染的临床分析

目的 探讨监狱囚犯肺结核合并人类免疫缺陷病毒(HIV)感染的流行病学特征和临床特点.方法 回顾性分析收治的53例监狱囚犯中肺结核合并HIV感染者的临床资料,抽取同期收治的60例HIV阴性的肺结核囚犯作对照,分析两组患者的流行病学特征、临床特点和抗结核治疗效果.结果 HIV阳性肺结核囚犯以男性多见(77.3% vs 56.7%,P<0.05),男女之比为3.4:1.HIV阳性肺结核囚犯的注射毒品史(90.6% vs 0.0%,P<0.001)和多性伴侣史(54.7% vs 11.7%,P<0.001)显著多于HIV阴性肺结核者.两组患者的呼吸症状、抗酸杆菌痰涂片阳性率、痰结核杆菌培养阳性率和特征性胸部X线表现差异均无统计学意义(P>0.05).HIV阳性肺结核囚犯的结核菌素皮肤试验以无反应者多见(64.1% vs 15.0%),而HIV阴性者以强阳性反应者多见(71.7% vs 18.9%,P<0.001).HIV阳性肺结核囚犯的抗结核治疗总有效率低于HIV阴性者(56.6% vs 88.3%,P<0.01).结论 注射毒品史和多性伴侣史是监狱囚犯中肺结核合并HIV感染的主要原因,其临床表现和胸部X线表现极不典型,抗结核治疗效果差.对肺结核囚犯强制进行HIV检测并对HIV阳性肺结核囚犯早期联合应用抗病毒治疗可能是控制监狱系统中结核/HIV双重感染的重要措施.     

Cardiovascular disease risk factors among HIV-infected Nigerians receiving highly active antiretroviral therapy

Background:

Highly active antiretroviral therapy (HAART) has become more accessible to Human immunodeficiency virus infection/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients worldwide. There is growing concern that the metabolic complications associated with HIV and HAART may increase cardiovascular risk and lead to cardiovascular diseases. We, therefore, set out to describe the cardiovascular risk profile of HIV/AIDS patients receiving HAART at a health facility in northern part of Nigeria.

Materials and Methods:

This cross-sectional study was conducted at the Aminu Kano Teaching Hospital, Kano, Nigeria. Consenting patients, who had been receiving HAART, were compared with age and sex matched HAART-naive subjects. Questionnaire interview, electrocardiography, anthropometric and blood pressure measurements were conducted under standard conditions. Blood samples were obtained for the determination of plasma glucose, uric acid and lipid levels.

Results:

Two hundred subjects were studied, 100 were on HAART (group 1) and the other 100 (group 2) were HAART-naive. Subjects’ mean age for all the participants was 32.5 (7.6) years. The prevalence of hypertension was 17% in group 1 and 2% in group 2 (P < 0.001). Similarly, 11% and 21% of group 1 subjects were obese or had metabolic syndrome compared with 2% and 9% of group 2 patients (P < 0.05 for both).

Conclusion:

HAART treatment was associated with significantly higher prevalences of hypertension, obesity and metabolic syndrome.     

人类免疫缺陷病毒合并乙型肝炎病毒感染患者高效抗反转录病毒治疗效果和肝脏损伤研究

目的 对人类免疫缺陷病毒(HIV)合并乙型肝炎病毒(HBV)感染患者高效抗反转录病毒治疗(HAART)的临床效果和伴随的肝脏损伤情况作出评价.方法 将患者按有无HBV合并感染分为HIV单纯感染组75例和HIV/HBV合并感染组69例,应用HAART方案治疗1年,对比观察患者血浆HIV载量,外周血CD4+T淋巴细胞计数、丙氨酸氨基转移酶等指标变化.结果 治疗前,HIV单纯感染组和HIV/HBV合并感染组的HIV载量均值分别为6.31和5.85 log10copies/mL,治疗12个月后,分别降低至2.90 log10 copies/mL(P＜0.05)和2.93log10 copies/mL(P＜0.05),两组HIV RNA抑制率分别为82.67％和92.75％.HIV单纯感染组和HIV/HBV合并感染组CD4+T细胞均值由治疗前的77.8个/μL和75.4个/μL,分别上升到221.4个/μL和214.3个/μL(P＜0.05).1年内HIV单纯感染组和HIV/HBV合并感染组的肝功能异常率分别为6.4％和19.7％ (P ＜0.05),但HAART期间无因发生严重肝脏损伤而停止治疗的患者.结论 应用HAART的HIV/HBV合并感染患者,短期内可以有效抑制HIV病毒复制,重建患者的免疫功能;HBV可能因促进HIV复制而加重肝损伤与免疫损伤,但并不影响HAART的效果.     

Highly active antiretroviral therapy per se decreased mortality and morbidity of advanced human immunodeficiency virus disease in Hong Kong

Background Morbidity and mortality of advanced human immunodeficiency virus infection (HIV) have declined in Western industrialized countries since the availability of highly active antiretroviral therapy (HAART). It is unclear if this has also happened in Hong Kong.Methods We studied a retrospective cohort of patients with advanced HIV disease in Hong Kong, China. First, the mortality of advanced HIV disease per year was calculated for the decade 1993 to 2002, both annually and according to patient observation before and after 1997. Second, the event rates were estimated for the clinical end points of acquired immune deficiency syndrome (AIDS) and death. Univariate and multivariate analyses were then performed to identify associated factors. Results The crude mortality of advanced HIV disease declined from 10.8-30.4 per 100 patients during 1993-1996, to 0.8-6.9 per 100 patients during 1997-2002. A rate ratio of 4.04 (95% CI, 2.52-6.47) was evident for those observed in 1993-1996, compared to those in 1997-2002. In a multivariate analysis where calendar period was adjusted, use of highly active antiretroviral therapy was associated with rate ratios of 0.13 (95% CI, 0.05-0.33) for death after AIDS, 0.08 (95% CI, 0.04-0.19) for AIDS after a CD4 cell count &lt;200/μl, and 0.21 (95% CI, 0.07-0.67) for death after CD4 cell count &lt;200/μl. In the same analysis, calendar period ceased to be a significant factor after adjustment for use of HAART.Conclusions The mortality and morbidity of advanced human immunodeficiency virus disease have declined in Hong Kong. This improved prognosis was attributable to the use of highly active antiretroviral therapy.     

Premature atherosclerosis in patients with acquired immunodeficiency syndrome

Background Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus （HIV）infection since highly active antiretroviral therapy （HAART） has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients.Methods One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients （41HAART-treated and 41 antiretroviral therapy （ART） naive patients） and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity （PWV） was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage.Results A higher PWV （（1358.3±117.8） cm/s vs. （1270.2±189.2） cm/s, P=0.010） was found in ART na（i）ve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART na（i）ve patients （（1283.8±181.4） cm/s vs. （1358.0±117.8） cm/s, P=0.033）. Multiple regression analysis revealed that age （B=5.218, 95% confidence interval （CI） 1.420-9.016, P=0.008）, current smoking （B=-74.671, 95% CI -147.003 to -2.339, P=0.043） and HAART （92.7% patients on a protease inhibitor-free regimen） （B=-169.169, 95% CI-272.508 to -65.831, P=0.010） were associated with reduced PWV in HIV-infected patients.Conclusions Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.     

艾滋病HAART治疗免疫重建炎性综合征的好发因素和临床特征

目的 观察我国艾滋病患者(AIDS)启动高效抗反转录病毒治疗(HAART)后,发生免疫重建炎性综合征(IRIS)的发病率、病死率、临床特征及其好发易感影响因素.方法 以2007年10月到2009年9月来自湖南省和江四省的接受HAART治疗的238例AIDS患者建立前瞻性研究队列,在24周内进行定期随访.将此期间发生IRIS的47例患者纳入IRIS组,24周时仍未发生IRIS的191例患者纳入非IRIS组.收集两组患者的一般资料、临床发病表现和诊断治疗的相关资料,在HAART的0、12和24周采集患者的血标本检测HIV病毒载量和CD4+细胞计数,对所有资料进行统计学处理和对比分析.结果 IRIS发生率为19.7%(47/238),病死率6.2%(2/47);HAART起动后发生IRIS的平均天数为28(9～36)d.IRIS中以结核感染占多数(61.7%,29/47),IRIS组与非IRIS组在年龄、性别、传播途径以及抗病毒治疗的方案上差异均无统计学意义.在0、12和24周时两组的病毒载量均逐步明显下降,CD4+细胞数均逐步明显上升.但是启动HAART时IRIS组的CD4+细胞数明显低于非IRIS组(48×106个/L比146×106个/L,P＜0.01),IRIS组的CD4+细胞数在100×106个/L以内者占85.1%(40/47).结论 IRIS多发生在HAART治疗启动后的1～3个月内,接受HAART治疗者的年龄、性别、传播途径以及抗病毒治疗的方案均与IRIS的发生无明显相关.在治疗24周内IRIS组与非IRIS组的HIV RNA病毒载量下降幅度和CD4细胞上升数量均无明显差别,但起动HAART前CD4+细胞计数＜100 × 106个/L的感染者更容易出现IRIS.我国HAART发生IRIS多为结核感染,一般无须停用抗病毒药物,对症处理即可,但对结核病或其他严重的感染仍须抗感染治疗.

Abstract：

Objective To summarize the morbidity, mortality, clinical manifestations and risk factors for IRIS (immune reconstruction inflammatory syndrome) during HAART (highly active antiretroviral therapy) in China. Methods From October 2007 to September 2009, a prospective cohort of 238 AIDS (acquired immunodeficiency syndrome) patients on HAART from Hunan and Jianxi provinces was recruited for a follow-up of 24 weeks. And 47 and 191 patients were assigned into the IRIS and non-IRIS groups respectively. The data of general information, clinical manifestations and treatment of two groups were collected and compared. Blood samples were collected in both groups at pre-and post-HAART 12 weeks, 24weeks for HIV viral load and CD4 + cell count examinations. A statistical analysis was performed. Results A total of 47 ( 19. 7% ) IRIS cases was analyzed. The median onset of IRIS was 28 (9 -36) days. And 29(61.7%) cases of tuberculosis IRIS were found. There was no significant difference in age, gender, route of transmission and antiretroviral regimens between the IRIS and non-IRIS groups. At baseline, Weeks 12 and 24, both groups showed a significant decline of viral load. And there was no significant difference between them. Both groups showed a significant increase of CD4 + cell count. But there was no significant difference between two groups. However, the baseline CD4+ cell count was markedly lower in the IRIS group than that in the non-IRIS group. In 85. 1% (40/47)of cases, the CD4+ cell count was ＜ 100 × 106/L in the IRIS group at the baseline of HAART. Conclusion IRIS mostly occurs during 3 months of HAART initiation.The age, gender, route of transmission and antiretroviral treatment regimens of patients on HAART are not risk factors for the development of IRIS. The HIV RNA viral load decreases in both IRIS and non-IRIS groups without any significant difference. The patients with a CD4 + cell count ＜ 100/μl are more vulnerable to develop IRIS.     

江苏省HIV感染者和艾滋病患者抗病毒治疗1年后CD4+T淋巴细胞检测结果分析

目的 :了解江苏省首次接受艾滋病免费抗病毒治疗的HIV/AIDS患者治疗1年后CD4+T变化及影响因素。方法 :收集江苏省首次接受抗病毒治疗的基线和治疗随访1年时均有CD4+T细胞检测结果记录的HIV/AIDS患者资料,随访截止时间为2014年5月31日。建立Excel数据库并用SPSS16.0软件进行分析。结果:首次接受抗病毒治疗的基线和随访1年时均有CD4+T检测结果记录的HIV/AIDS共3 290例。81.4%为江苏省籍,男女比例为4.36∶1,平均年龄(39.7±12.1)岁。感染途径主要为性传播。入组时基线CD4+T细胞计数均数为185.81个/μl。治疗1年后的CD4+T细胞均数为312.20个/μl。Logistic回归分析显示,年龄大、基线CD4+T高、在疾控中心治疗和临床Ⅰ期的HIV/AIDS患者,其CD4+T较基线增长值≥100个/μl的比例低。结论:江苏省HIV/AIDS抗病毒治疗对免疫功能恢复效果显著,应继续规范、早期开展抗病毒治疗工作。     

Activation and coreceptor expression of T lymphocytes induced by highly active antiretroviral therapy in Chinese HIV/AIDS patients

Background At the end of 2005, 650 000 people lived with human immunodeficiency virus type-1 (HIV-1) in China, of whom 75 000 were AIDS patients. Many AIDS patients received highly active antiretroviral therapy (HAART) supported by the “China CARES” program but the immune responses of HAART were seldom reported. This study investigated the effect of HAART on the activation and coreceptor expression of T lymphocytes in Chinese HIV/AIDS patients and evaluated its effect on immune reconstitution. Methods Seventeen HIV/AIDS patients were enrolled and three-color-flow cytometry was used to detect the activation of HLA-DR CD38 and the coreceptor CCR5, CXCR4 expression on T lymphocytes in whole blood samples taken from the patients before and after 3- or 6-month HAART.Results The activation percents of CD4(+), CD8(+) T lymphocytes were significantly higher before therapy than the normal controls (HLA-DR/CD4: 40.47±18.85 vs 11.54±4.10; CD38/CD4: 81.34±10.86 vs 53.34±11.44; HLA-DR/CD8: 63.94±12.71 vs 25.67±9.18; CD38/CD8: 86.56±11.41 vs 58.84±6.16, all P&lt;0.01). After 6-month combined antiretroviral treatment, the activation of T lymphocytes in HIV/AIDS patients was significantly decreased (HLA-DR/CD4: 28.31±13.48; CD38/CD4: 69.88±12.64; HLA-DR/CD8: 46.56±18.64; CD38/CD8: 70.17±14.54, all P&lt;0.01 compared with the pre-treatment values). Before the treatment, CCR5 expression on CD8(+) T lymphocytes was up-regulated while CXCR4 expression on CD8(+) T lymphocytes downregulated in HIV/AIDS patients compared with the normal controls (CD8/CCR5: 70.91±10.03 vs 52.70±7.68; CD8/CXCR4: 24.14±11.08 vs 50.05±11.68, all P&lt;0.01). After 6-month HAART, CCR5 expression on CD8(+) T lymphocytes significantly decreased (56.35±12.96, P&lt;0.01), while CXCR4 expression on CD8(+) T lymphocytes increased (36.95±9.96, P&lt;0.05) compared with the pre-treatment and the normal controls. A significant statistical relationship was observed between the expression of activation markers, CCR5 and the CD4(+) T lymphocyte counts after HAART (P&lt;0.05).Conclusions Reduced activation of T lymphocytes and a normalization of coreceptor expression were observed in Chinese HIV/AIDS patients after HAART. Immunity can be restored in HIV/AIDS patients receiving HAART.     

Prevalence and risk factors for bone mineral density changes in antiretroviral therapy-naive human immunodeficiency virus-infected adults: a Chinese cohort study

BackgroundStudies have reported that low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected patients; however, the factors that contribute to HIV-related BMD changes are yet to be fully understood. Due to the application of dual X-ray absorptiometry (DXA) among a select group of hospitals only, the prevalence and risk factors of low BMD in HIV-infected populations have not been intensively investigated in China. Thus, the aim of our study was to investigate the prevalence of and risk factors associated with BMD changes among antiretroviral therapy (ART)-naive HIV-positive patients in China.MethodsThe assessment of the prevalence of and risk factors associated with BMD changes was conducted among 156 ART-naive HIV-infected patients. Demographic and clinical data, as well as results of fasting blood tests were obtained from patients. Further, all patients underwent DXA scans to determine BMD, which was then used to classify patients with osteopenia/osteoporosis. The risk factors of reduced BMD were then evaluated using binary logistic regression.ResultsAmong the 156 ART-naive HIV-infected participants, osteopenia and osteoporosis were diagnosed in 48.7% (76/156) and 4.5% (7/156) of patients, respectively. The lumbar spine was most likely to have reduced BMD (49.4% [77/156]), and the proportion of osteopenia in the left hip (32.7% [51/156]) was higher than in the right hip (24.4% [38/156]). In the lumbar spine, bone loss rate in the L1 section (60.9% [95/156]) was the most significant (L2, 53.2% [83/156]; L3, 45.5% [71/156]; L4, 52.6% [82/156]). Further analysis showed that, compared with the neck (26.9% [42/156] in the left, 18.6% [29/156] in the right) and the interior (15.4% [24/156] in the left, 13.5% [21/156] in the right), the trochanter had the greatest probability of reduced BMD (46.2% [72/156] in the left, 28.8% [45/156] in the right). In the risk factor analysis, low body mass index (BMI: <18.5 kg/m²) was positively associated with reduced BMD (Exp (B) = 39.743, 95% confidence interval: 3.234–488.399, P = 0.004), and was specifically positively correlated with BMD values at three sites (r = 0.335 at right hip, r = 0.327 at left hip, r = 0.311 at lumbar spine).ConclusionReduced BMD was found in the majority of ART-naive HIV-infected patients and BMI was identified as an additional risk factor for reduced BMD. Our results show that BMD reduction was simultaneously present in the left hip, right hip, and lumbar spine among nearly one fifth of patients. Our work highlights the importance of closely monitoring BMD in ART-naive patients and provides a foundation for the clinical intervention of bone demineralization in them.     

Impact of baseline CD4^＋ T cell counts on the efficacy of nevirapinebased highly active antiretroviral therapy in Chinese HIV/AIDS patients： a prospective,multicentric study

Background CD4^＋T cell counts have been used as the indicator of human immunodeficiency virus type 1 （HIV-1） disease progression and thereby to determine when to start highly active antiretroviral therapy （HAART）. Whether and how the baseline CD4^＋T cell count affects the immunological and viral responses or adverse reactions to nevirapine （NVP）-containing HAART in Chinese HIV-1 infected adults remain to be characterized. Methods One hundred and ninety-eight HIV-seropositive antiretroviral therapy （ART）-naive subjects were enrolled into a prospective study from 2005 to 2007. Data were analyzed by groups based on baseline CD4^＋T cell counts either between 100-200 cells/μl or 201-350 cells/μl. Viral responses, immunologic responses and adverse events were monitored at baseline and at weeks 4, 12, 24, 36, 52, 68, 84, 100. Results Eighty-six and 112 subjects ranged their CD4^＋T cell counts 100-200 cells/μl and 201-350 cells/μl, respectively. The pre-HAART viral load in CD4 201-350 cells/μl group was significantly lower than that in CD4 100-200 cells/μl group （P=0.000）. After treatment, no significant differences were observed between these two groups either in the plasma viral load （pVL） or in the viral response rate calculated as the percentage of pVL less than 50 copies/ml or less than 400 copies/ml. The CD4^＋T cell counts were statistically higher in the 201-350 group during the entire follow-ups （P 〈0.01） though CD4^＋ T cell count increases were similar in these two groups. After 100-week treatment, the median of CD4^＋ T cell counts were increased to 331 cells/μl for CD4 100-200 cells/μl group and to 462 cells/μl for CD4 201-350 cells/μl group. Only a slightly higher incidence of nausea was observed in CD4 201-350 cells/μl group （P=0.05） among all adverse reactions, including rash and liver function abnormality. Conclusions The pVLs and viral response rates are unlikely to be associated with the baseline CD4^＋T cell counts. Initiating HAART in Chinese HIV-1 infected patients with higher baseline CD4^＋T cell counts could result in higher total CD4^＋T cell counts thereby achieve a better immune recovery. These results support current guidelines to start HAART at a threshold of 350 cells/μl.     

Crystalluria in HIV/AIDS patients on highly active anti-retroviral therapy in the Kumasi metropolis; a cross sectional study

Background:

Crystalluria is associated with some highly active anti-retroviral therapies (HAART''s) used in the management of HIV/AIDS. Aims: This study used light microscopy to establish the prevalence of crystalluria among HIV/AIDS patients on HAART and identified the routine crystals present in their urine.

Materials and Methods:

In this simple randomised cross-sectional study, 200 HIV/AIDS participants, comprising 150 on HAART and 50 HAART-naïve were recruited from the HIV clinic at the Komfo Anokye Teaching Hospital (KATH). Urine and blood samples were collected, for urinalysis and the determination of the CD4 count, respectively. A well-structured pre-tested questionnaire was used to obtain socio-demographic data and clinical history of the participants.

Results:

The prevalence of crystalluria was higher among HIV-infected persons on HAART than those not on HAART (6.7% vs 4%; P = 0.733). Calcium oxalate and triple phosphate crystals were the crystal types present in their urine (3.5% and 2.5%, respectively) and was present only in HIV subjects on first line of treatment (without protease inhibitors). Participants aged between 40-50 years and those with hypersthenuria and acidic urine had the highest amount of crystalluria (41.6%, 83.3%, and 58.3%, respectively).

Conclusion:

HAART is associated with crystalluria in HIV patients. Light microscopy will be of disgnostic value in resource limited settings.