浅谈我国结核分枝杆菌感染人数及其调查方法

Mtb感染率是了解一个国家或地区结核病疫情的重要指标之一,也是制定结核病防控策略的重要依据。据估计,全球有1/3的人(约20亿）感染了Mtb;我国作为世界第二大结核病高负担国家,Mtb感染人数高达5.5亿,占全国人口的44.5%。通常认为Mtb感染人群中有5%～10%的人会发生结核病,Mtb已感染人群是新发结核病的主要来源。但我国及全球Mtb感染的实际人数是否真的高达总人口的1/3甚至更高,值得进一步探讨。笔者试图从目前Mtb感染率调查方法对其感染人数作一简要分析。     

HIV in hiding: methods and data requirements for the estimation of the number of people living with undiagnosed HIV

Many people who are HIV positive are unaware of their infection status. Estimation of the number of people with undiagnosed HIV within a country or region is vital for understanding future need for treatment and for motivating testing programs. We review the available estimation approaches which are in current use. They can be broadly classified into those based on prevalence surveys and those based on reported HIV and AIDS cases. Estimation based on prevalence data requires data from regular prevalence surveys in different population groups together with estimates of the size of these groups. The recommended minimal case reporting data needed to estimate the number of patients with undiagnosed HIV are HIV diagnoses, including CD4 count at diagnosis and whether there has been an AIDS diagnosis in the 3 months before or after HIV diagnosis, and data on deaths in people with HIV. We would encourage all countries to implement several methods that will help develop our understanding of strengths and weaknesses of the various methods.     

Prevalence and correlates of psychosocial conditions among people living with HIV in southern India

Psychosocial conditions such as depression, intimate partner violence (IPV), and history of childhood sexual abuse (CSA) have been associated with poor HIV-related outcomes. In India, which has the third largest HIV epidemic in the world, little is understood about the impact of psychosocial conditions on people living with HIV (PLHIV). We aimed to understand the prevalence and correlates of psychosocial conditions among PLHIV entering into HIV care at the Y.R. Gaitonde Centre for AIDS Research and Education in Chennai, India. Thirteen questions were added to the standard voluntary counseling and testing questionnaire, including the Patient Health Questionnaire-9 (a depression scale) and questions assessing for CSA and IPV. We fitted logistic regression models, stratified by gender, with psychosocial condition as the outcome of interest and substance use variables and socio-demographic variables as the correlates of interest. Three hundred and eighty-three persons were enrolled into the study; of these, 253 (66%) tested positive for HIV, including 149 men and 104 women, and were included in the models. More than one-quarter (28%) of the men and 19% of the women reported at least one psychosocial condition (probable depression, CSA, or IPV). In adjusted analysis, current alcohol use was associated with greater than two times higher odds of a psychosocial condition (Adjusted Odds Ratio?=?2.24, 95% CI, 1.04–4.85) among men. In conclusion, we estimated the prevalence of probable depression, CSA, and IPV among PLHIV presenting for HIV care in southern India and found that, among male PLHIV, alcohol use was associated with a markedly higher odds of reporting a psychosocial condition. Further study is needed to characterize alcohol use among male PLHIV and the possible deleterious impact of psychosocial conditions and alcohol use on HIV-related outcomes in India.     

山东省HIV感染者中流动人口感染现况调查

目的 了解山东省自1992年～2001年9月HIV感染者中流动人口的感染情况及其对传播流行HIV/AIDS的影响,为以后如何更好地管理这一特定人群制定相关政策提供科学依据。方法 对全省HIV感染者进行个案流行病学调查,采取在严格保密下,入户面对面询问调查,并填写统一调查表。结果 在 110例HIV感染者中78例属流动人口,占70.91％（78/110）。其中省间流动者69例,占88.46％（69/78）,涉及全国10个省份,省内跨市流动者9例,占11.54％（9/78）,分布在全省9个市、16个县区。流动人口的HIV感染者以青壮年为主,年龄在20～39岁有60例,占76.92％（60/78）。男女之比为5.9:1。虽对48例流动人口已进行流调,但能每年定期进行追踪和管理的只有26例,占54.16％（26/48）。结论HIV感染者中流动人口感染者是目前山东省传播HIV/AIDS的最危险因素,相关部门应尽快制定有效措施,加强管理,以防HIV/AIDS在山东省传播蔓延。     

Undiagnosed HIV among people who inject drugs in Manipur,India

Manipur is a geographically isolated state of India characterised by a high HIV prevalence among people who inject drugs (PWID). A low-to-moderate lifetime rate of HIV testing has been documented amongst PWID in Manipur. Little is known about the extent of undiagnosed HIV in this setting and whether uptake of HIV testing (and knowledge of a positive diagnosis) leads HIV-positive PWID to change their risk behaviours. The cross-sectional data (n = 821) analysed for this paper were collected in 2009 for the Integrated Behavioural and Biological Assessment (IBBA) using interviewer-administered questionnaires and the collection of de-linked blood and urine samples. Almost one-third (30.7%) of the participants tested HIV positive. The majority knew where to obtain a confidential HIV test (80.7%), however, half of the HIV-positive participants had either never had an HIV test (37.7%), or had undertaken a test without collecting the result (12.7%). Almost one-quarter (23.4%) of the HIV-positive participants and 17.4% of the HIV-negative participants had shared a needle/syringe with at least one other injector during the preceding month. Encouragingly, HIV-positive participants were significantly more likely than HIV-negative participants to use condoms with their regular sexual partners, however, there was still a high proportion of HIV-positive participants who did not use a condom at last sex with their regular (47.2%) or casual (48.0%) partners. Having taken an HIV test and collected the result was associated with a reduction in HIV-risk behaviours among HIV-positive participants, but not among HIV-negative participants. In conclusion, we found that a substantial proportion of the HIV-positive PWID in Manipur were not aware of their positive status, and risky injecting and sexual practices were commonplace. However, HIV-positive PWID appear to reduce their high-risk behaviours when they become aware of their HIV status highlighting the importance of taking HIV testing coverage to scale.     

Living with HIV in West Bengal,India: perceptions of infected children and their caregivers

Children living with HIV (CLH) face several physical and psychological challenges. The impact of the disease is not limited to the affected CLH, but also affects their caregivers and family members. We qualitatively explored the experiences, knowledge, concerns, and perceptions of primary caregivers and triangulated those aspects with those expressed by their CLH. We conducted 34 in-depth interviews (IDI) with primary caregivers of 8- to 15-year-old CLH residing in West Bengal, India. Four focus group discussions (FGD) with CLH were held, two each with children aged 8–12 and 13–15 years. Participants were recruited with the help of a community-based organization providing need-based services to adults and CLH. Five major themes shared by caregivers and children were identified, including concerns about HIV, medications, discriminatory behaviors, having a “healthy mind”, and the advantages and limitations of available HIV-related health services. Two primary themes exclusively from IDI with caregivers were caregiving challenges and concerns about the future of their CLH. Indian CLH and their caregivers face many daily challenges, and there are many unmet but relevant expectations. Caregiving goes beyond the child-caregiver dynamic, and is intertwined with the local community and the healthcare and support system structures. The current study underscores the need for comprehensive care programs focusing on improving support to both CLH and caregivers.     

Prevalence of Campylobacter jejuni and enteric bacterial pathogens among hospitalized HIV infected versus non-HIV infected patients with diarrhoea in southern India

A prevalence study on Campylobacter jejuni and other enteric bacterial pathogens was carried out in 200 HIV infected and 200 non-HIV infected subjects with diarrhoeal symptoms at an AIDS Hospital in southern India. Diarrhoeal specimens were inoculated onto standard culture media as well as onto Columbia and Campylobacter blood agar media for C. jejuni isolation. All the C. jejuni isolates were tested for antimicrobial susceptibility using Kirby-Bauer's method. A significant difference in recovery rates was observed between the 2 groups in relation to C. jejuni (p < or = 0.02; 95% CI 5.5 (1-10) and Shigella spp. (p < or = 0.02; 95% CI 6.5 (1-12). 21 isolates of Shigella spp., 16 C. jejuni, 5 Salmonella typhi, 3 Arcobacter spp., 3 Yersinia enterocolitica, and 2 Aeromonas hydrophila were recovered from the HIV infected cases. All the C. jejuni isolates were sensitive to ciprofloxacin whereas 1 strain was resistant to nalidixic acid. Interestingly, all the 29 Shigella spp. (21 from HIV and 8 from non-HIV cases) were resistant to erythromycin and most were resistant to many other antibiotics used. Our observations underline the need for epidemiological investigations to screen C. jejuni and Shigella spp. in HIV infected subjects with diarrhoea and analyse their antibiograms periodically to minimize disease burden in HIV/AIDS.     

Oncogenic HPV among HIV infected female population in West Bengal,India

Background  

Prevalence of both cervical cancer and Human Immunodeficiency Virus (HIV) infection are very high in India. Natural history of Human Papilloma Virus (HPV) infection is known to be altered in HIV positive women and there is an increased possibility of persistence of HPV infections in this population. Therefore, this study was conducted to understand the epidemiology and circulating genotypes of oncogenic HPV among HIV positive and negative female population in West Bengal, India.     

Survival pattern of reported HIV infected individuals in the city of Delhi (India)

There is very little data on the survival period of HIV in India. In this paper survival experience of 836 HIV infected patients was studied whose illness was diagnosed upto Dec. 2003. On analysis, it was observed that the mortality was maximum in the age-group of 41-50 years (25%), 24.4% in males and 24.2% in females. For patients with tuberculosis morality was 23% and was higher among those with unsafe sex (24.5%) as a risk factor. Mortality of AIDS patients in Delhi decreased from 63.2% in 1994 to 24.2% in the year 2003. Also tuberculosis was found to be the major opportunistic infection affecting 83.2% of the patients. An increasing trend was observed with tuberculosis from 84.2% in 1994 to 89.1% in 1997 (p<0.05), but overall tendency was around 84% during the period 1994 to 2003. In AIDS related symptoms chronic diarrheoa accounted for only 5.2%. The median length of survival of HIV infected patients with all subjects was 75 months. The hazard rate showed an increasing trend and reached its peak at 102 months. The survival of HIV infected patients in Delhi was found to be shorter than that of patients in developed countries and developing African countries.     

Mental health needs of people living with HIV/AIDS in India: a literature review

We describe the global conditions associated with the AIDS pandemic and its socioeconomic and psychological impacts. A systematic review was performed to investigate the literature on the mental health needs of people living with HIV/AIDS (PLHA) in India. The focus is on the prevalence, nature, and sociocultural factors of the epidemic in India. A conceptual framework is offered and the findings of this study are presented across three major domains: (a) prevalence of mental health disorders among the HIV-infected population; (b) mental health needs of PLHA; and (c) gaps in policies and programs addressing these issues. Experiences of HIV stigma and discrimination are also noted in this population. We conclude with implications for future research, interventions, and public policy.     

HIV感染者检出粪类圆线虫幼虫1例

2006年4～12月,作者等北京军区总医院共43人组成中国维和医疗分队赴利比里亚执行维和任务.在利比里亚第四战区维和二级医院诊治期间,发现1例HIV感染者合并粪类圆线虫感染,报告如下.     

How stigmatizing is stigma in the life of people living with HIV: a study on HIV positive individuals from Chennai, South India

The nature and intensity of AIDS stigma are shaped by the social construction of the epidemic in different locales. Stigma therefore needs to be discussed in its cultural context. This clinic-based study aims at understanding stigma among 203 HIV positive individuals from Chennai, South India. The study throws light on the impact of stigma on the quality of life among these individuals. It also discusses the gender implications of stigma. This study brings out the findings that actual stigma experienced among those infected with HIV is much less (26%) as compared to the fear of being stigmatized or perceived stigma (97%). Internalizing of stigma was found to have a highly significant negative correlation with quality of life in the psychological domain and a significant negative correlation in the environmental domain. However individuals who did experience actual stigma seemed more determined to live and experience an above moderate quality of life. The implication of this study encourages HIV infected individuals to rise above stigma, avoid internalizing their stigmatized feelings and work toward a better quality of life. Health providers need to address these issues in their care for HIV infected individuals.     

四川省艾滋病定点抗病毒治疗机构HIV感染者个案管理情况调查

目的 调查四川省21个市州艾滋病定点抗病毒治疗(ART)机构个案管理情况.方法 采取便利抽样法,于2019年5-7月调查四川省21个市州598家艾滋病定点ART机构的个案管理情况及艾滋病病毒(HIV)感染者的随访管理水平.结果 598家艾滋病定点ART机构参与艾滋病门诊随访工作的专职医生平均为0.55人,专职护士平均为...     

Racial heterogeneity of HIV antigenemia in people with HIV infection

We compared the prevalence of HIV p24 antigenemia in black and white US patients with HIV infection. The prevalence of HIV antigenemia increased with severity of HIV disease (P less than 0.001). In all clinical categories, whites were more likely to be HIV-antigenemic than blacks (overall prevalence 38 versus 18%; P less than 0.01). Anti-p24 antibodies were detected in a higher proportion of blacks (84%) than whites (65%; P = 0.02). Blacks had significantly higher total serum immunoglobulin levels than whites (median 3.8 versus 3.2 mg/dl; P less than 0.00001). Racial differences in HIV antigen expression may result from differences in humoral response to HIV infection. These differences should be considered when HIV antigen is used as a surrogate marker in clinical trials.