男男性行为人群艾滋病防治策略研究进展

近年来,我国男男性行为人群(MSM)中艾滋病感染率迅猛增加。作者针对国内外MSM人群艾滋病防治策略和措施进行了评述,并指出了我国MSM人群艾滋病防治中存在的不足,以期为我国的艾滋病防治工作提供新的视角。     

艾滋病482例临床分析

目的：了解我国艾滋病(AIDS)患者的临床流行病学特点,自然病程及临床转归。方法：汇集国内6个地区的482例AIDS患者的流行病学和临床资料,加以归纳总结。结果：482例AIDS男女间的比例为4：1;其传播途径在云南、新疆主要为静脉注射毒品,河南为不洁献血和输血,而北京、上海、广州则主要为性途径传播;其性传播者的自然病程约为8年,静脉注射毒品和经血感染者为6年左右。临床症状以发热、消瘦、口腔和肺部感染等表现为主。常见的合并感染与文献报道类似。结论：自1985年发现第一例AIDS,相当一部分人类免疫缺陷病毒(HIV)感染者已进入AIDS期,本资料提示经血液途径感染者自然病程较经性途径感染者为短,我国HIV感染者中70．6％是静脉注射毒品者,提示及时预防感染、早期诊断,是我国HIV／AIDS综合防治的重要环节。     

大理市娱乐场所性服务人员性病艾滋病防治综合干预效果评价

目的评价大理市娱乐场所性服务人员AIDS综合干预效果,为AIDS综合干预工作提供参考。方法对项目覆盖区女性性服务人员进行一对一问卷调查,调查结果与基线结果进行比较。结果目标人群AIDS预防知识知晓率由2003年的75.50%上升到2005年的88.30%;传播知识的知晓率由5.90%上升到41.40%,干预前后差异有统计学意义。与商业性伴"最近一次"、"最近一月"使用安全套的比例分别由89.40%提高到97.22%、从71.27%提高到81.48%;与固定性伴安全套使用率仍不高,最近一月与固定性伴每次用安全套的频率仅为25.33%。结论通过综合干预的开展,有效地提高了干预点所在地目标人群的AIDS知识知晓率和安全行为率,但行为的改变需要长期持续的干预才能产生明显效果。     

合并AIDS的手术患者围术期心理护理

目的探讨合并AIDS的手术患者围术期心理护理方法。方法采用抑郁自评量表（self depression seale,SDS）及焦虑自评量表（self-rating anxiety scale,SAS）评估2010年1月至2011年12月成都市传染病医院收治的72例合并AIDS行手术治疗患者的心理状态,根据评估结果进行针对性的心理护理。结果经过围术期的心理护理,本组患者均顺利完成手术治疗,无一例发生围术期不良事件,患者术后的SAS、SDS评分较术前降低,差异均有统计学意义（均P％0．05）。结论耐心、细致、有针对性的围术期心理护理有助于减轻合并AIDS手术患者的焦虑、抑郁情绪,改善围术期心理状况,提高患者的生活质量。     

南京地区HIV耐药基因型与艾滋病患者临床治疗效果分析

摘要:目的 分析HIN耐药基因型对艾滋病(AIDS)患者抗病毒治疗效果的影响。方法以499例AIDS患者为研究对象,检测其耐药基因型并与数据库比对,同时检测样本病毒载量与CD4*淋巴细胞绝对计数,对耐药基因型及临床治疗效果进行分析。结果在499例研究病例中,成功扩增测序409例,发生耐药181例。发生耐药患者的年龄显著大于未耐药患者,且CD4*绝对细胞计数显著低于未耐药患者。核苷酸逆转录酶抑制剂(NRII)和非核苷酸逆转录酶抑制剂(NNRII)相比蛋白酶抑制剂(PI)更易发生高度耐药。同时,耐药患者具有更高的病毒载量。结论南京地区AIDS患者的总体耐药发生率较低,但耐药患者中多重耐药及高度耐药比例较高。在诊疗过程中,应监测临床指标,及时调整抗病毒治疗方案,优先选择高耐药屏障的抗病毒药物。     

HIV/AIDS pathogenesis and treatment options focusing on the viral entry inhibitors

The advent of highly active antiretroviral therapy (HAART) has revolutionized the treatment of HIV. A wide variety of antiretroviral agents are now available, allowing patients and physicians a choice of effective therapy. However, drug resistance and toxicities are emerging as major treatment challenges in the HAART era. The development of agents within existing and novel antiretroviral classes remains paramount in order to preserve the reduced morbidity and mortality we have come to expect from HAART use. This article details the development of the HIV epidemic, reviewing current and future treatment strategies, and concentrating upon the viral entry inhibitors.     

艾滋病母婴阻断用药研究进展

艾滋病(acquired immunodeficiencysydrome,AIDS)主要是由(HIV)病毒破坏机体免疫系统而引起的以感染或肿瘤为特征的致死性疾病。艾滋病的主要传播方式有血液传播、性传播和母婴垂直传播。其中母婴传播是内传播的主要方式。在一般情况下妇女感染HIV的机会是同龄男性的2.5倍[1]。有研究报道在感染HIV的儿童中,由母婴传播的达90%以上[2],由此专家认为进行母婴阻断是防止儿童艾滋病感染的必要手段。目前艾滋病母婴阻断预防用药主要以抗病毒药为主,已经获得美国FDA批准的抗病毒药物共六大类,分别为核苷(酸)类逆转录酶抑制剂(NRTI)、非核苷(酸)类逆转录酶抑制剂(NNRTI)、蛋白酶抑制剂(PI)、整合酶抑制剂、融合抑制剂和辅助受体拮抗剂。我国国家免费艾滋病抗病毒药物治疗手册第四版,亦推荐使用美国FDA批准的以上六大类抗病毒药物。用药方案则有所不同。各地还自创了很多母婴阻断用药使用方案,并已取得可喜的效果。随着科学技术的发展,艾滋病母婴阻断用药的研究,新的药物、新的治疗方法将不断涌现。本文作者主要针对近年艾滋病母婴阻断用药的筛选及用法用量进行综述。     

Trizivir^TM治疗80例HIV／AIDS患者临床研究

目的1．评估Trizivir^TM（AZT＋3TC＋ABC，TZV）治疗中国HIV／AIDS患者的疗效和安全性；2．HIV／AIDS患者的依从性；3．考察中国社区内HIV／AIDS患者服用固定剂量三联片治疗的可行性。方法80例HIV／AIDS患者进入治疗组。是一项单中心、开放式、无对照的临床试验。患者接受36个月的治疗，在治疗1，2，3，4，5，6，9，12，18，24，30和36个月按时到门诊随访。结果57例（71．3％）患者完成36个月治疗随访，23例（28．7％）在治疗过程中因药物不良反应、机会性感染复发、依从性不好或治疗失败而退出。57例治疗36个月后，CD4＋ T淋巴细胞计数平均增加252／μL，93．0％的患者显示病毒载量〈400拷贝／mL。在36个月的治疗期间，有4例患者出现耐药。结论TZV抗病毒效果显著，对于病毒载量〉500000拷贝／mL的患者也有很好的效果，CD4＋T淋巴细胞计数均显示明显增加。TZV不良反应较少，与其他药物的相互作用较少，服用方便，患者服药依从性好，对某些患者尤其有毒瘾者不失为一种可以选用的治疗方案。     

河南省204例HIV/AIDS患者的临床和治疗概况

目的：报道河南省204例人类免疫缺陷病毒－1（HIV－1）感染和艾滋病（AIDS）患的临床表现和治疗概况，为进一步计划HIV／AIDS的综合防治措施提供依据。方法：分析自1998年2月至2001年7月收治的204例HIV／AIDS患的一般情况、流行病学资料、临床表现、治疗情况。结果：感染多为青壮年，感染途径以经血液感染为主，但性接触传播和母婴传播亦相继出现。有症状、无症状组中的平均病毒载量和CD4、CD8 T细胞计数及CD4／CD8比例呈现明显差别。结论：HIV感染的传播途径非常明确，因而其传播是完全可以预防的。早期预防，早期诊断，加强治疗，实行综合防治措施，有助于控制HIV感染的流行。     

Utility of the AIDS risk assessment for crack cocaine and sex risk behaviours among homeless persons addicted to crack undergoing behavioural day treatment

The primary aim of this study was to assess the impact of an HIV and drug addiction intervention on reported sexual transmission HIV risk and drug use among homeless persons in two treatments for cocaine addiction. The ARA‐C study (n=104) included 74 (71.2%) men and 30 (28.8%) women with an average age of 37.8 (SD=6.9) years. Most participants were African American (90, 86.5%) and the remainder were Caucasian (14, 13.5%). All participants met criteria for homelessness, nonpsychotic mental distress, and admitted to smoking crack cocaine within the 2 weeks prior to treatment. It appears that, overall, behavioural day treatment for cocaine disorders among homeless persons can have a short‐ and long‐term impact on the reduction of sexual transmission HIV risk among this population with a minimal sexual transmission HIV risk intervention. The causal factors of this outcome still remain unclear. Treatment group differences did not sufficiently explain sexual transmission risk reductions and the impact of the HIV risk education programme was impossible to explain because it was provided to all participants and was only a small part of the overall programme. There did seem to be a small contribution of drug abstinence in the reduction of sexually transmitted risk, but this was at one time point for the Sex and Crack subscale only. This study demonstrates that there may be promise in providing drug addiction treatment combined with sexual transmission HIV risk reduction prevention programming for this extremely vulnerable group, and that future interventions should be better designed and tested using more robust research.     

HIV/AIDS肺部感染的影像学表现

目的 探讨HIV／AIDS合并肺部感染的X线及CT表现。方法 收集临床确证的HIV／AIDS病人中有胸部影像异常者10例,所有病例均有胸部X线及CT照片。结果 肺结核表现为肺内斑片、大片影,纵隔淋巴结肿大及肺外淋巴结肿大。军团菌肺炎为大片状影像,卡氏囊虫肺炎为弥漫性浸润及间质异常影像。结论 肺结核、卡氏肺囊虫及革兰阴性杆菌肺炎是HIV／AIDS的较常见的机会感染。HIV／AIDS病人肺内出现斑片、大片和弥漫病变,或有关淋巴结肿大时应考虑到这些疾病的可能。     

社区艾滋病防治的重要作用与相关策略

充分发掘和利用社区资源优势及功能,利用社区文化和环境影响进行艾滋病健康教育、行为干预可增强干预的深度、广度及持续性和实效性。社区卫生服务急需将不同人群艾滋病教育和行为干预纳入日常工作计划。开展社区艾滋病防治的重要策略包括:发挥政府主导和协调作用,建立社区艾滋病防治网络;开展广泛社区动员,共同参与艾滋病防治活动;加强医护人员自身队伍建设,发挥社区卫生服务功能;从伦理角度探讨艾滋病防治,形成良好的社区人文环境。     

Abdominal ultrasound findings of disseminated tuberculosis in AIDS

The sonographic findings of 76 patients with tuberculosis and HIV infection are described. These findings were compared with a control group of 76 HIV-positive patients without associated pathology. Those patients with tuberculosis and positive HIV titers commonly (p = 0.05) showed retroperitoneal and mesenteric adenopathies with node diameters greater than 1.5 cm (n = 27), and multiple, splenic, hypoechoic nodules between 0.5 cm and 1 cm (n = 11). Additional findings include hepatic hyperechoic nodules (n = 1) and retroperitoneal abscess (n = 1). The combination of ultrasound features can help in the diagnosis of abdominal tuberculosis in HIV-positive patients with non-specific clinical infections. © 1997 John Wiley & Sons, Inc.     

Correlates of fatigue in HIV infection prior to AIDS: a pilot study

Fatigue is widely recognized as a significant source of morbidity in persons with human immunodeficiency virus (HIV) infection, yet there are few data examining fatigue in this population. We present pilot data assessing the relationship between fatigue and various physical and psychosocial measures in 20 men with HIV infection prior to the clinical development of acquired immunodeficiency syndrome (AIDS). Fatigue was measured by a visual analogue scale (VAS) and the Fatigue Assessment Inventory (FAI). No statistically significant associations were found between fatigue measures and physical parameters including haemoglobin, haematocrit, albumin, total protein, and physical dimension score of the Sickness Impact Profile (SIP). The FAI correlated well with Beck's Depression Inventory and SIP — Psychosocial Dimension (r = 0·72 and 0·81, respectively; p < 0·001.) Both the FAI and VAS held moderate associations with the total SIP score. The SIP profile was similar to that observed in a sample of persons with chronic fatigue but without HIV infection, reported previously. Although the sample size is small, our data suggest a stronger association with psychosocial, rather than physical, parameters among persons with HIV infection and fatigue. The implications for clinical management and further research are discussed.     

临床致病菌整合子检测及耐药基因盒序列分析

目的对临床菌株中的第一类整合子分布及其耐药基因盒的结构特征进行分析。方法应用PCR方法检测33株临床菌株中的第一类整合酶基因intI，并对intI阳性菌株整合的耐药基因进行测序及序列分析。结果33株临床菌株（100％）均为第一类整合酶基因阳性。耐药基因盒特异PCR扩增发现，29株菌得到1913bp的扩增产物，2株得到1664bp的产物，1株得到1009bp的产物，1株得到1913bp和1009bp两种不同产物。序列分析结果表明，1913bp的扩增产物携带基因盒dhfr、orfF和aadA2，1664bp的扩增产物携带基因盒aadA5和dfr17，1009bp的扩增产物携带基因盒aadA2，aadA2和aadA5均为编码对氨基糖苷类抗生素产生耐药的基因盒，dhfr和dfr17均为编码对磺胺类药物甲氧苄氨嘧啶产生耐药的基因盒；orfF为未知功能的开放阅读框。结论第一类整合子介导的耐药基因广泛存在于临床致病细菌中，提示要加强对耐药基因在细菌种属间水平转移的监测工作。     

Collaborative Community-Based Care for South African Children Orphaned by HIV/AIDS

Colonel John S. Murray
Ask the Expert provides research-based answers to practice questions submitted by JSPN readers .     

Further validation of the AIDS Attitude Scale

The AIDS Attitude Scale (AAS) is a self-report measure of attitude toward persons with AIDS. Since its introduction in 1992, the AAS has been used in over 30 research studies. Initial psychometric estimates of reliability and validity for the scale were supportive. This report summarizes emerging psychometric data from a broad range of samples. These data offer additional support for the internal consistency and stability of the two dimensions underlying the scale, as well as documenting the factorial and construct validity of the AAS. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 161–167, 1997