Therapeutic communities: AIDS/HIV risk and harm reduction

The limited survey data available suggest that therapeutic communities have increasingly organized themselves to develop HIV prevention programs and to integrate HIV-infected and AIDS clients into the treatment community while providing specialized program as necessary. Nonetheless, there remains a need for a comprehensive survey of the response of therapeutic communities to AIDS and the risk of HIV infection. There is need as well for studies that can build on findings linking retention in the therapeutic community to strategies that focus on clients' motivation or readiness for treatment. In addition, therapeutic community programs can ally with outreach programs both to provide priority admission to seropositive clients, women with children, adolescents, and criminal justice clients, and to provide harm reduction services to those unwilling to enter treatment while also taking incremental steps to engage those clients in ever increasing behavior change initiatives.     

Therapeutic drug monitoring in children with HIV/AIDS

In this paper we present an overview on the use of TDM in the treatment of HIV-1-infected children. The processes of growth and development have a significant impact on drug metabolism. The use of TDM makes it possible to optimize plasma drug concentrations of antiretroviral drugs. This is important when one considers that the levels of viral suppression and drug toxicity in adults and children are associated with the plasma concentration of PIs and NNRTIs. Indeed, in clinical practice the use of TDM in the treatment of HIV-1-infected children has favorable results. However, there is a serious shortage of population reference values of antiretroviral medication in children. Targeting plasma drug levels in children to adult reference values may be insufficient because of the unique features of HIV infection in children. Apart from its primary function for dose optimization, TDM can also be used as a tool to assess adherence to antiviral medication. One should, however, be cautious to base assumptions on plasma levels alone because aberrant plasma levels may also be the result of other factors such as changes in nutritional habits, drug-drug interactions, or changing gastric motility. We conclude that TDM is a useful tool in the treatment of HIV-1-infected children. Additional data are needed to establish child-specific reference values and to assess the optimal method of TDM.     

Fever or unknown origin in HIV/AIDS patients

Fevers of unknown origin (FUO) in HIV/AIDS patients are due to the same infectious causes that are common in this subset of compromised hosts but manifest clinically as prolonged fevers. In North America, the most common etiologies of FUO in HIV/AIDS are due to intracellular pathogens, i.e., disseminated Mycobacterium avium-intracellulare, Pneumocystis carinii pneumonia (PCP), fungi or cytomegalovirus. Worldwide, leishmaniasis and Mycobacterium tuberculosis are the most important. Infections presenting as FUOs in the HIV population occur only in the late stages of illness when the CD4 count is < 100.     

HIV/AIDS患者T淋巴细胞变化情况及其临床意义

目的探讨HIV/AIDS免疫病理的改变特点,为AIDS防治工作提供科学依据。方法以71例HIV感染者和54例AIDS患者为研究对象,并选取140例健康体检者为对照组,检测分析3组外周血CD4＋、CD8＋T淋巴细胞的变化及其临床意义。结果 CD4＋细胞计数正常对照组[（670±361）个/μL]〉HIV组[（378±235）个/μL]〉AIDS组[（154±104）个/μL]（P〈0.01）;CD8＋细胞计数HIV组[（918±823）个/μL]明显高于正常成人组[（489±250）个/μL]与AIDS组[（512±319）个/μL]（P〈0.05）;CD4＋/CD8＋的比值正常成人组（1.48±0.89）明显高于HIV组（0.41±0.37）和AIDS组（0.18±0.16）（P〈0.05）。结论本地区HIV/AIDS患者T淋巴细胞亚群的变化过程与疾病进展有良好的相关性。     

康力欣胶囊对HIV/AIDS患者临床疗效的初步评价

目的探讨复方中药康力欣对HIV、AIDS患者的临床疗效,并进行初步疗效评估。方法通过康力欣胶囊对HIV/AIDS患者的临床试验,在用药前30天后分别测定30例HIV、AIDS患者外周血T细胞绝对计数（CD4、CD8细胞）及血常规,肝肾功能,相关临床症状指标（乏力、食欲下降、腹泻、功能分级）并进行卡氏评分,分析用药前后各指标的变化情况。结果康力欣胶囊可提高患者体内CD4T淋巴细胞,并有效改善患者贫血及低白蛋白水平;改善临床症状,卡氏评分基础值治疗前后有明显变化。结论试验证明康力欣胶囊对提高HIV/AIDS患者的免疫水平有一定作用,对改善患者的生活质量有明显帮助。     

心理干预对HIV/AIDS患者心理卫生状况的影响

目的：探讨心理干预对HIV/AIDS患者心理卫生状况的影响。方法：采用90项症状清单（SCL-90）对74例HIV/AIDS患者进行问卷调查分析、心理干预,比较干预前后心理卫生状况的改变。结果：74例HIV/AIDS患者中,62例（86.11%）存在程度不同的心理卫生问题,心理干预前后SCL-90各因子分比较有显著差异。结论：对HIV/AIDS患者进行心理干预可以改善他们的心理卫生状况。建议对HIV/AIDS人群进行心理干预,以改善心理健康状况,配合临床治疗,提高疗效。     

HIV/AIDS患者中弓形虫感染情况的调查

目的 了解HIV/AIDS患者中弓形虫的感染情况.方法 采用ELISA法检测HIV/AIDS患者、静脉吸毒者及正常对照组中的弓形虫特异性抗体IgG、IgM.流式细胞仪计数HIV/AIDS患者的CIM4+T淋巴细胞,依据CD4+T淋巴细胞数值分为免疫功能正常、损伤、严重损伤和AIDS晚期4组.结果 静脉吸毒者及正常对照组的弓形虫特异性抗体IgG、IgM阳性率分别为2.2%、0和4.7%、1.2%;HIV/AIDS患者中弓形虫特异性抗体IgG、IgM阳性分别为9.7%和1.2%,IgG阳性率以免疫功能损伤组的13.2%为最高,AIDS晚期组为0,且80.7%的患者出现不同程度的免疫功能损伤.结论 在HIV/AIDS患者中存在着较高的弓形虫机会性感染,可结合CD4+T淋巴细胞计数对患者进行预防性服药.     

103例艾滋病患者抗病毒治疗后药物不良反应观察

目的了解珠海市斗门区艾滋病患者经抗病毒治疗3个月内的药物不良反应的情况。方法回顾性探讨2005年6月～2012年1月于遵义医学院第五附属（珠海）医院感染科门诊或住院103例HIV/AIDS患者开始抗病毒治疗后3个月内不良反应进行统计分析。结果本研究中主要治疗方案为拉米夫定（3TC）＋齐多夫定（AZT）＋奈韦拉平（NVP）（16.50%）、3TC＋AZT＋依非韦伦（EFV）（54.37%）、司他夫定（d4T）＋3TC＋NVP（12.62%）、d4T＋3TC＋EFV（16.50%）。其中含NVP组中肝功能损害及皮疹的发生率较其他组别明显增高;含AZT组中骨髓抑制的发生率较其他组别明显增高。药物不良反应以肝功能损害（39.81%）、消化系统症状（33.98%）、骨髓抑制（25.24%）和皮疹（5.83%）为主。结论艾滋病患者经抗病毒治疗后3个月内不良反应发生率较高,故临床上应根据患者基本情况选择合适抗病毒药物组合,同时密切关注抗病毒治疗3个月以内的不良反应。     

社会歧视下艾滋病患者的心理困境及迫切需求

目的分析在社会歧视下艾滋病患者的心理困境和需求,提出构建艾滋病患者社会支持系统的建议。方法采用深度访谈、小组讨论、现场观察等研究方法。结果在社会歧视下,艾滋病患者的心理面临巨大挑战,主要存在的问题有悲观、绝望、自杀意念、退缩、逃避、被动等。艾滋病患者提出最为迫切的需求为直接的经济救助,消除社会歧视位居第二。结论艾滋病患者提出的迫切需求与心理状态之间具有联系,在社会支持的构建中心理关怀工作急需开展,真正激发艾滋病患者主动寻求帮助、解决自己困境的愿望和行为,并提高这种能力才是最重要的。     

艾滋病和结核病双重感染的临床分析

目的：探讨艾滋病、结核病双重感染患者的临床特点与治疗方法。方法选取本院2011年11月~2013年10月收治的艾滋病合并结核病患者68例作为研究对象,回顾性分析样本的临床资料,总结临床特点与治疗方式。结果68例患者临床表现为咳痰、发热、咳嗽、气短、消瘦、贫血等,其中,以咳痰为最主要的表现症状;胸部X线检测的表现不明显,多存在弥漫性侵润和粟粒性阴影;临床开展的治疗方式较为复杂,治疗后死亡率为13.2%。结论艾滋病与结核病双重感染患者的临床表现不明显,开展相关检查对结核病的诊断效果也缺乏特异性,治疗方法趋于复杂,主要是通过抗结核治疗后再进一步行抗病毒治疗,起到延长患者生存时间的效果。     

一线ART治疗方案对HIV合并HBV感染患者的临床疗效观察

目的：探讨一线ART治疗方案对HIV合并HBV感染患者的临床疗效。方法选择2012年4月至2014年5月首诊治疗的46例HIV合并HBV感染患者,入组46例患者均采取一线ART治疗方案,分别于治疗前、治疗3个月、6个月、12个月检测患者CD4+T细胞计数变化、病毒转阴率以及肝功能变化情况,并记录患者治疗期间不良反应发生情况。结果治疗3、6、12个月,患者 CD4+T 细胞计数水平显著高于治疗前,差异有统计学意义( P <0.05),且随着治疗时间的延长,患者CD4+T细胞计数显著增加( P <0.05);治疗后患者丙氨酸氨基转移酶水平较治疗前显著降低( P <0.05),患者血肌酐水平较治疗前显著升高( P <0.05);随着治疗时间的延长,患者HIV RNA与HBV DNA病毒转阴率均显著增高( P <0.05),且治疗12个月,患者 HIV RNA 与 HBV DNA 病毒转阴率均达到100%。结论一线ART治疗方案能够有效提高HIV/HBV合并感染患者免疫功能、改善患者肝功能水平,对HIV、HBV病毒均能有效控制,且患者耐受性较好,安全可靠。     

Prevalent infectious diseases in patients with HIV/AIDS in Ethiopia

Infectious diseases are a significant cause of morbidity and mortality among HIV-infected persons in Ethiopia. Though no systematic studies have been performed, anecdotal reports are available mostly from cross-sectional studies on the associations between the most prevalent infectious diseases and HIV/AIDS. In this review, we present the most frequently reported infectious diseases among people living with HIV/AIDS in the country, with the need for strengthening diagnostic laboratories being urgent in order to support surveillance as well as control measures.