HIV感染者皮肤黏膜表现的回顾性临床分析

目的:对HIV感染者皮肤黏膜表现展开回顾性临床分析,旨在为临床HIV感染者的临床表现与诊断提供有利依据。方法:对2011年12月至2013年12月期间两家医院收治的100例HIV感染者表现进行回顾性分析,并研究其一般资料与临床资料。结果:100例研究对象中,有皮肤黏膜表现患者68例(68.0%),其中男性65例(95.6%),女性3例(4.4%);大部分患者年龄20~50岁;未婚人数超过患者总人数一半35例,(51.4%);患者职业以农民为主,25例(36.8%);性接触传播61例(89.7%);有皮肤黏膜表现组相比于无皮肤黏膜表现组,CD4+细胞不足50个/μI者有皮肤黏膜损害的例数对比例数超过200个/μI者显著提升,即皮肤黏膜损害与低CD4+细胞间存在统计学相关性(P<0.05);有皮肤黏膜表现组出现艾滋定义性疾病患者例数显著高于无皮肤黏膜表现组,数据差异具有统计学意义(P<0.05);100例感染者的皮肤黏膜损害涉及4个种类,主要为真菌感染,合计24例(35.3%);病毒感染,合计13例(12.9%);呈现出其他皮肤病者,合计18例(26.5%);合并2种(含2种)以上皮肤黏膜疾病者,合计13例(19.1%)。结论:HIV感染者皮肤黏膜损害多见为真菌、感染,性传播途径为HIV感染重要途径之一,频发的皮肤黏膜病变以及合并性病感染可作为临床诊断HIV感染的重要依据。     

1 512例卖淫妇女性传播感染的流行病学分析

对2001~2004年朝阳区1 512例卖淫妇女进行多种性传播感染(STI)检测和流行病学调查分析。结果:检出性传播疾病感染者1 186例,总感染率为78.44%;其中非淋菌性尿道(宫颈)炎,感染率为65.28%;支原体感染率为46.69%;检出HIV感染者11例。非淋菌性尿道(宫颈)炎及HIV感染率呈现明显上升趋势,且许多为双重或多重感染者。提示该人群是艾滋病性病的重要传染源。     

北京地坛医院HIV/AIDS首诊患者690例临床分析

目的观察HIV感染的临床特征,为艾滋病防治提供依据。方法回顾性分析本院690例HIV/AIDS首诊病例的临床特征。结果感染者平均年龄35.3岁,男女之比为1:2;感染途径以性传播为主,男男性行为和异性性行为的感染率分别为17.5%和16.7%,夫妻性传播7.8%,双性性行为感染11.6%,示艾滋病已由"桥梁人群"的高危性行为向普通人群蔓延;90年代非法采供血/血浆和接受过HIV污染血液的受血者首诊时CD4<50个/μL占37.3%,且合并多种疾病和机会性感染。约49.6%的患者为筛查时被发现;因皮肤病性病症状(主要是梅毒、尖锐湿疣)首诊被发现占10.1%。首诊时临床表现依次为皮肤疾病、肺炎、上呼吸道感染、肝炎及消化道念珠菌病。结论艾滋病感染以性传播为主;桥梁人群临床医生应加强对性病/艾滋病的筛查,早发现、早治疗,以遏制艾滋病的蔓延。     

2002-2012年大连皮肤病医院182例HIV感染者情况分析

目的:调查大连市皮肤病医院HIV感染情况。方法:2002-2012年对280万皮肤病性病患者进行了HIV筛查。结果:共检出HIV感染者182例(6.5/10万),男173例,女9例,男男性传播115例(63.19%),异性性传播20例(10.99%),献血传播4例(2.20%),静脉吸毒3例(1.65%),传播途径不详40例(21.98%)。结论:HIV感染率有所上升,感染的主要途径是性传播,尤其是男男性传播。     

抗HIV药物所致皮肤黏膜改变

人类免疫缺陷病毒(HIV)感染者的皮肤黏膜损害突出,某些皮损或皮损组合是诊断HIV感染的重要线索,也是反映其不同分期的临床标志。抗HIV药物使艾滋病从一种致死性疾病变为可以治疗、但尚不能完全治愈的慢性疾病,目前已经成为治疗艾滋病最重要的措施并明显改善了艾滋病患者的预后。本文对临床上常用的抗HIV药物对艾滋病皮肤黏膜疾病的治疗作用及其副作用在皮肤黏膜上的表现进行介绍。     

2005-2009年重庆市一院性病门诊9562例HIV筛查情况分析

目的了解性病患者的HIV感染情况,为指导性病、艾滋病防治提供科学依据。方法对2005年1月-2009年12月重庆市一院性病门诊HIV自愿咨询检测的患者,进行HIV抗体筛查,并对确诊阳性者进行流行病学调查。结果 5年该院性病门诊HIV自愿咨询检测患者9562例,共确诊HIV感染者77例,感染率0.81%,其中2005-2008年HIV阳性者分别为8例、8例、14例、24例和23例,呈逐年上升趋势。结论性病门诊患者是HIV感染的高危人群,性接触传播是HIV感染的主要途径之一,大力推广安全套的使用,能有效控制性病、艾滋病传播。     

2005-2009年重庆市-院性病门诊9562例HIV筛查情况分析

目的 了解性病患者的HIV感染情况,为指导性病、艾滋病防治提供科学依据.方法 对2005年1月-2009年12月重庆市-院性病门诊HIV自愿咨询检测的患者,进行HIV杭体筛查,并对确诊阳性者进行流行病学调查.结果 5年该院性病门诊HIV自愿咨询检测患者9562例,共确诊HIV感染者77例,感染率0.81%,其中2005-2008年HIV阳性者分别为8例、8例、14例、24例和23例,呈逐年上升趋势.结论 性病门诊患者是HIV感染的高危人群,性接触传播是HIV感染的主要途径之一,大力推广安全套的使用,能有效控制性病、艾滋病传播.     

直肠部位淋球菌及沙眼衣原体感染的诊治

直肠位于肛缘2 cm以上,长约12～15 cm,上接乙状结肠,下接肛管,通过直肠黏膜与肛管皮肤之间的齿状线与肛管分界,表面覆盖柱状上皮,是性传播疾病在男男同性恋人群(MSM)中的好发部位,女性也可因接受肛交在此部位发生性传播感染.事实上,直肠部位的性传播疾病并不少见[1-6],而且直肠部位的性传播疾病可以增加HIV的易感性[7],因此加强直肠部位性传播疾病的预防及治疗对控制HIV的流行有重要意义.本文就直肠部位较为常见的淋球菌及沙眼衣原体感染的临床特点、检查方法及治疗做一综述.     

梅毒合并其他性传播疾病和/或HIV感染情况的分析

目的探讨梅毒合并其他性传播疾病和/或HIV感染的发生率及其流行情况。方法对确诊梅毒的患者进行生殖器疱疹、非淋菌性尿道炎(宫颈炎)、淋病、生殖器念珠菌病等性传播疾病及HIV感染的实验室检测。结果在470例入选病例中,合并感染256例,占54.5%,其中男107例(占男性病例的36.1%),女149例(占女性病例的85.6%),女性合并感染率明显高于男性(P(0.001);在梅毒合并其他性传播疾病和/或HIV感染病例中,HIV感染8例(1.7%),生殖器疱疹77例(16.4%),沙眼衣原体41例(18.7%),解脲脲原体86例(18.3%),人型支原体19例(4.0%),淋球菌34例(7.2%)及念珠菌52例(11.1%);其中合并一种病原体201例(42.8%),合并两种病原体47例(10%),合并三种及3种以上病原体8例(1.7%)。结论梅毒易合并其他性传播疾病感染,促进HIV感染;梅毒患者应全面进行其他性病实验室项目及HIV抗体检查。     

广州地区女性阴部皮肤黏膜疾病532例临床分析

目的探讨女性阴部疾病的发生部位、种类及病原体感染情况。方法回顾性分析532例女性阴部疾病患者资料,对其皮损部位、疾病种类、有无合并其他系统疾病、常见病原体感染情况进行检查和分析。结果在发病部位中同时累及皮肤及黏膜的238例(44.7%);患皮肤病351例(66.0%),性病164例(30.8%);47例(8.8%)患者合并有系统性疾病;在315例接受病原体检查的患者中,以支原体、念珠菌及衣原体的检出率较高,分别为17.4%,14.3%,13.0%。结论女性阴部皮肤黏膜疾病病因复杂,临床表现多样,临床医生细致的查体和必要的实验室检测手段是明确诊断的关键。     

关于当前梅毒诊治中的几个问题探讨

梅毒的传染力强,危害性大,与HIV又相互协同,已成为重大的公共卫生问题和社会问题之一。我国梅毒2006年上报病例数首次超过淋病,2007年全国梅毒报病225601例,较2006年上升21．19％,尤其是潜伏梅毒和胎传梅毒发病率直线上升,应引起临床各科医生的重视。为减少误诊误治,本文就当前梅毒的临床表现多样性提出探讨,梅毒的高峰期已经来了,在艾滋病经性传播日趋严重的情况下,提示控制性病来控制艾滋病,控制胎传梅毒作为消除梅毒的步骤之一。     

Hiv infection in patients of sexually transmitted disease

A total of 1027 male patients suffering from sexually transmitted diseases (STD) during 1990 to 1996 were screened for HIV infection. All cases were in the age group 17 years to 48 years. One hundred and sixty-seven STD cases (16.3%) were found to have HIV infection. A rising trend in incidence of HIV infection in STD patients from 1990 (2.8%) to 1996 (27.8%) was noticed countrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The incidence of HIV infection was 30.3% in lymphogranuloma venereum, 19.5% in chancroid, 13.5% in syphilis, 17.6% in herpes genitatis, 6.7% in gonorrhoea and 11.2% in other STD cases.     

珠海市HIV/AIDS初治病人123例流行病学及临床特征分析

目的观察珠海市HIV/AIDS初治病例的流行病学和临床特征,为本地区艾滋病防治提供依据。方法回顾性分析2005年1月-2011年12月本院收治的123例HIV/AIDS初治病例的临床资料。结果 HIV/AIDS初治病例中男:女1.93:1,20～50岁年龄组占91.05%;感染途径以性传播为主,其中异性间性传播47.97%,同性间性传播11.38%;常见临床症状为发热、腹泻和淋巴结肿大等,常见机会性感染有口腔真菌感染、肺孢子菌肺炎、结核病和带状疱疹等;CD4+淋巴细胞<100个/μL占47.15%,100～200个/μL占28.46%,200～350个/μL占23.58%,>350个/μL占0.81%。结论珠海市HIV/AIDS初治病例男性多于女性,以青壮年为主,感染途径以性传播为主。临床医生应加强对艾滋病的筛查及宣教工作,做到早发现和早治疗,遏制艾滋病蔓延。     

2007～2009年性病门诊HIV感染者情况分析

目的:了解性病门诊HIV感染人群的分布情况。方法:采用ELISA(酶联免疫)法,对2007年1月～2009年12月性病门诊做HIV检测的6895例患者进行了检测,并对经确诊试验阳性的47例患者情况进行了分析。结果:6895例做HIV检测的患者中47例HIV阳性(0.70%)。47例HIV阳性患者中男性同性恋41例(87.23%)、双性恋14例(29.79%)、多性伴22例(46.81%)、异性恋6例(12.77%),37例梅毒血清阳性(78.72%)。结论:男性同性恋存在传播HIV的高危行为,是HIV传播的桥梁人群。对这一人群的STD/AIDS监测、检测及干预工作已刻不容缓。同时,有效控制性病特别是梅毒的发病率,对于控制艾滋病的流行有着重要意义。     

Mucocutaneous disorders in Hiv positive patients

Twenty eight HIV positive patients were included in this study. They were evaluated for their mucocutaneous disorders, sexually transmitted diseases and other systemic disorders between 1994-95 in the department of Dermatology and STD Dr R M L Hospital of New Delhi. The heterosexual contact with commercial sex workers (CSWs) was the most common route of HIV transmission. Chancroid, syphilis and genital warts were common STDs found in HIV positive patients. Oral thrush (67.9%) was the commonest mucocutaneous disorder found in these patients followed by herpes zoster (25%) and seborrhoeic dermatitis (21.4%). There was no unusual clinical presentation seen in mucocutaneous disorders and STDs.     

性病门诊男性就诊者性病感染现状及艾滋病知晓率影响因素分析

目的:了解性病门诊男性就诊者性病感染的现状,分析影响其艾滋病知识的因素,为下一步开展针对性的干预提供科学依据。方法:采用方便抽样的方式,利用问卷调查来进行数据收集,问卷内容包括病人的一般人口学特征、艾滋病知识、性病感染状态等。结果:研究共纳入456名就诊者,平均年龄为(34.06±11.40)岁;HIV感染率为3.29%,尖锐湿疣感染率为16.23%,生殖器疱疹为6.80%,生殖道沙眼衣原体为5.48%,淋病为4.17%,梅毒为3.95%;26.75%的就诊者仅感染1种性病,2.41%的就诊者同时感染2种,0.44%就诊者同时感染4种,0.66%同时感染5种,无就诊者同时感染3种性病。艾滋病知识知晓率仅为37.94%,教育程度低、年龄较大、已婚、月收入低和未接受过健康教育的就诊者艾滋病知识知晓率低。结论:应加强性病门诊男性就诊者各种性病的筛查,为其提供一整套规范化的诊疗服务,同时加强重点人群健康宣教,做好重点人群性病艾滋病的一级预防。     

From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection

OBJECTIVES: To review the scientific data on the role of sexually transmitted diseases (STDs) in sexual transmission of HIV infection and discuss the implications of these findings for HIV and STD prevention policy and practice. METHODS: Articles were selected from a review of Medline, accessed with the OVID search engine. The search covered articles from January 1987 to September 1998 and yielded 2101 articles. Methods used to uncover articles which might have been missed included searching for related articles by author, and combing literature reviews. In addition, all abstracts under the category "sexually transmitted diseases" from the XI and XII International Conferences on AIDS (Vancouver 1996 and Geneva 1998) and other relevant scientific meetings were reviewed. Efforts were made to locate journal articles which resulted from the research reported in the identified abstracts. All original journal articles and abstracts which met one of the following criteria were included: (1) studies of the biological plausibility or mechanism of facilitation of HIV infectiousness or susceptibility by STDs, (2) prospective cohort studies (longitudinal or nested case-control) which estimate the risk of HIV infection associated with specific STDs or STD syndromes, or (3) intervention studies which quantitate the effect which STD treatment can have on HIV incidence. RESULTS: Strong evidence indicates that both ulcerative and non-ulcerative STDs promote HIV transmission by augmenting HIV infectiousness and HIV susceptibility via a variety of biological mechanisms. These effects are reflected in the risk estimates found in numerous prospective studies from four continents which range from 2.0 to 23.5, with most clustering between 2 and 5. The relative importance of ulcerative and non-ulcerative STDs appears to be complex. Owing to the greater frequency of non-ulcerative STDs in many populations, these infections may be responsible for more HIV transmission than genital ulcers. However, the limited reciprocal impact of HIV infection on non-ulcerative STDs and the evidence that non-ulcerative STDs may increase risk primarily for the receptive partner (rather than bidirectionally) may modulate the impact of these diseases. The results of two community level randomised, controlled intervention trials conducted in Africa suggest that timely provision of STD services can substantially reduce HIV incidence, but raise additional questions about the optimal way to target and implement these services to achieve the greatest effect on HIV transmission. CONCLUSIONS: Available data leave little doubt that other STDs facilitate HIV transmission through direct, biological mechanisms and that early STD treatment should be part of a high quality, comprehensive HIV prevention strategy. Policy makers, HIV prevention programme managers, and providers should focus initial implementation efforts on three key areas: (i) improving access to and quality of STD clinical services; (ii) promoting early and effective STD related healthcare behaviours; and (iii) establishing surveillance systems to monitor STD and HIV trends and their interrelations.


     

HIV-1 infection-associated risk factors among sexually transmitted disease patients in Athens, Greece: 1990 to 1996

OBJECTIVE: To determine trends in HIV seroprevalence and related risk factors among patients with sexually transmitted diseases (STDs) and to report the respective epidemiologic history characteristics. METHODS: A cross-sectional seroepidemiologic study conducted from 1990 to 1996 among 5,669 symptomatic STD cases was carried out. RESULTS: The overall HIV test acceptance was 98.9%, and 1.2% patients (n = 66) were seropositive. Highest rates were detected among those who were born or resided in Sub-Saharan Africa. Seropositivity fluctuates significantly by age, and is excessive in persons 45 years and older (2.6%). A significant decreasing trend in STD incidence and HIV seroprevalence among patients younger than 25 years was detected. Male homosexuals and bisexuals (MSM) exhibited the highest overall rate of infection (5.8%) followed by intravenous drug users (2%). Highly promiscuous STD patients (ie, those who had more than 10 partners during the past 6 months) presented a significantly increased HIV seroprevalence when compared with patients of the same sexual orientation. STD patients infected with HIV mostly belonged to notable risk categories of AIDS (men who have sex with men, 72.7%). Awareness of serostatus was low (13.6%). In male patients, the HIV seropositivity rate was significantly higher among early syphilis and proctitis cases, whereas in females this higher rate occurred with herpes genitalis. CONCLUSIONS: Promiscuity and sexual orientation significantly influence the seroprevalence rate. Exposure to HIV remained stable despite the above declining time trends, which implies the need for additional preventive interventions targeted to the real health and illness behavior of the partner.     

Sexually transmitted disease in young people: the importance of health education

In most cultures sexually transmitted diseases (STD) and unwanted pregnancy are major health problems for sexually active youths aged 15-24. Since the early 1970s contraceptive use has increased in developed countries, but as few as 4-6% of young people in developing countries have access to reliable, modern contraceptives. In most countries the age-specific rates for STD are highest in the younger age groups. One of the few methods available to limit the extent of these problems, and particularly the problem of infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), is health education directed toward behavioral change. The content, timing, and characteristics of the source presenting the information are all important. This article reviews international data on the problems of STD and AIDS in young people and the experience of various countries in preventive efforts through health education.     

An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients

The HIV epidemic has dramatically altered the field of sexually transmitted diseases (STDs). HIV infection is unique among sexually transmitted diseases because it can modify the clinical presentation and features of other STDs. Conversely, other STDs can affect the transmission of HIV. This review is the third part of a series that has provided a general overview of STDs. In this article, genital ulcer diseases (genital herpes, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale), human papillomavirus infection (anogenital warts and subclinical infections), molluscum contagiosum, human herpesvirus 8 infection, viral hepatitis, and ectoparasitic infestations (scabies and pediculosis pubis) are discussed as they occur in HIV-infected hosts. Additional features as they relate to HIV-infected patients, such as epidemiology and transmission, are discussed when applicable. Learning objective: At the conclusion of this learning activity, participants should improve their understanding of sexually transmitted diseases in the HIV-infected host.