53例HIV/AIDS免费抗病毒治疗效果及影响因素分析

目的探讨安吉县HIV/AIDS免费抗病毒治疗效果及影响因素。方法从"中国疾病预防控制信息系统""艾滋病抗病毒治疗数据管理系统"导出安吉县高效抗逆转录病毒治疗(HAART)的HIV/AIDS 53例病例资料,比较治疗前后CD4+T淋巴细胞数,并分析影响治疗效果的因素。结果抗病毒治疗前、治疗6个月和治疗12个月后HIV/AIDS的CD4+T淋巴细胞数分别为(239.4±138.4)、(348.2±168.6)和(372.9±184.1)个/μL,差异有统计学意义(P0.01)。Logistic回归分析显示,HIV/AIDS年龄≥40岁治疗效果是40岁的4.88倍,基线CD4+T淋巴细胞计数≥200个/μL组是200个/μL组的6.10倍。结论经免费抗病毒治疗后,HIV/AIDS免疫重建效果明显;抗病毒治疗时年龄≥40岁和基线CD4+T淋巴细胞计数≥200个/μL者治疗效果较好。     

CD4 T淋巴细胞低水平状态下的艾滋病合并肺部真菌感染的影像学特征分析

目的探讨CD4 T淋巴细胞低水平状态下的AIDS患者合并肺部真菌感染的影像学表现的特征。方法对确诊的33例CD4T淋巴细胞计数≤100个/mm3的AIDS合并肺部真菌感染的患者的发病部位、范围及影像特征进行分析。结果 AIDS合并真菌感染的患者中以念珠菌感染最常见,与其他真菌的发生率的差异具有统计学意义(P=0.000)。两肺病灶呈弥漫分布;发生率在各叶间的差异无统计学意义(P=0.221);影像特征以斑片或大片实变影多见,与结节影、空洞影、胸腔积液、纵隔内淋巴结肿大、真菌球的发生率之间差异具有统计学意义(P=0.000)。结论艾滋病合并肺部真菌感染时病变范围广,具有不典型性;因此对肺部感染进行常规抗菌治疗效果不理想时应及时进行HIV检查及真菌检查。     

泰州市新发现HIV/AIDS患者首次CD_4~+T淋巴细胞检测情况

目的了解泰州市新发现艾滋病病毒感染者/艾滋病患者(HIV/AIDS)患者首次CD4+T淋巴细胞水平,为艾滋病防治工作提供科学依据。方法对2014—2015年新发现HIV-1抗体确证阳性的HIV/AIDS病例进行随访;采集抗凝全血标本,以流式细胞术进行CD4+T淋巴细胞计数。结果共检测252例新发现HIV/AIDS病例,以男性(占84.52%)、35岁(占41.27%)、已婚(占58.73%)、本地户籍(占67.86%)为主,感染途径主要为同性传播(占50.00%)和异性传播(占49.20%),样品主要来自其他就诊者(占36.11%)。首次CD4+T淋巴细胞计数均值为(387.67±266.97)/μL,其中≤500/μL的占70.63%;不同年龄组、婚姻状况、样品来源的HIV/AIDS首次CD4+T淋巴细胞计数差异均有统计学意义(P值均0.05)。结论泰州市新发现HIV/AIDS首次CD4+T淋巴细胞免疫水平较低,发现较晚。应进一步扩大检测范围,做到早发现、早治疗、早控制,减少艾滋病的进一步传播、提高病例生存质量。     

湖州市艾滋病抗病毒治疗效果分析

目的分析湖州市艾滋病病毒感染者/艾滋病患者(HIV/AIDS)高效抗反转录病毒治疗(HAART)效果。方法收集中国疾病预防控制信息系统2005—2014年湖州市(HIV/AIDS)抗病毒治疗数据,根据治疗3个月CD4+T淋巴细胞计数和6个月HIV病毒载量评价治疗效果。结果截至2014年底,湖州市先后有357例HIV/AIDS接受HAART治疗。治疗前CD4+T淋巴细胞计数均值为(214±130)个/μL,治疗3个月后CD4+T淋巴细胞计数为(307±180)个/μL(中位数由225个/μL上升到291个/μL,P0.01)。治疗6个月后,218例患者进行了HIV病毒载量检测,其中72.02%(157/218)的患者HIV病毒载量低于实验室检测下限(40 copies/m L),病毒抑制有效率为84.86%。结论湖州市HIV/AIDS接受HAART治疗效果明显,建议对符合治疗标准的HIV/AIDS尽早进行抗病毒治疗。     

艾滋病患者肺孢子菌肺炎相关危险因素分析

目的探讨艾滋病患者发生肺孢子菌肺炎(PCP)的危险因素,以期早期识别PCP的发生。方法选择2013年10月-2014年11月117例艾滋病患者为研究对象,采用回顾性研究的方法,分析艾滋病发生与未发生PCP患者年龄、性别、发现HIV感染至入院间隔时间、抗病毒治疗、口腔真菌病、淋巴细胞、CD3+T细胞、CD4+T细胞、CD8+T细胞、NK细胞计数等指标,应用SPSS 19.0软件进行统计分析。结果单因素分析结果为发现HIV感染至入院间隔时间、抗病毒、口腔真菌病以及淋巴细胞、CD3+T细胞、CD4+T细胞表达水平在发生与未发生PCP患者中差异有统计学意义(P<0.05);多因素分析,CD4+T细胞以及发现HIV感染至入院间隔时间与PCP发生有关(P<0.05);抗病毒、口腔真菌病以及淋巴细胞、CD3+T细胞计数为混杂因素(P>0.05)。结论在HIV感染进入艾滋病期患者中,CD4+T细胞≤31.7个/μl、发现HIV感染至入院间隔平均时间≤3.5个月是预测PCP发生的较好指标。     

淮安市HIV/AIDS首次CD4~+T淋巴细胞检测分析

目的对淮安市新发现的HIV/AIDS首次CD4+T淋巴细胞计数进行分析,了解其免疫水平及疾病进展情况。方法收集淮安市2000-2014年报告的HIV/AIDS首次CD4+T淋巴细胞计数资料,分析其免疫水平,预测其疾病进程。结果 422例HIV/AIDS的首次CD4+T淋巴细胞均值为(322.81±245.81)个/μl,其中≤200个/μl占34.83%。年龄越大,首次CD4+T淋巴细胞计数均值越低(F=17.024,P0.001),未婚、离异或丧偶者首次CD4+T淋巴细胞计数均值比已婚有配偶者高(F=12.091,P0.001)。其他就诊者首次CD4+T淋巴细胞计数低于其他来源的HIV∕AIDS(χ2=83.076,P0.001)。结论新发现的感染者中有1/3已经进入艾滋病期,应加强宣传干预,扩大检测,早期发现感染者,加强感染者随访监测,及时提供抗病毒治疗,提高其生存质量。     

衢州市艾滋病抗病毒治疗效果分析

目的了解衢州市HIV/AIDS抗病毒治疗效果。方法利用"国家艾滋病网络直报系统"收集2005—2014年243例HIV/AIDS抗病毒治疗随访记录和检测信息,并对人口学特征、CD4+T淋巴细胞计数和病毒载量等进行分析。结果经抗病毒治疗1年后,HIV/AIDS CD4~+T淋巴细胞计数明显增长(P0.01);同时有90.91%(110/121)的HIV/AIDS艾滋病病毒载量降至400拷贝/m L以下。此外,8.23%的HIV/AIDS由于不良反应、死亡和依从困难等原因退出治疗。结论衢州市艾滋病抗病毒治疗效果明显,在抗病毒治疗中要提高患者用药后不良反应处理能力,营造良好关怀氛围并提高患者纳入治疗及时性。     

艾滋病合并感染现况及对CD4的影响研究

目的:研究艾滋病感染者和艾滋病人(HIV/AIDS)合并感染乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒(TP)的流行现况及对艾滋病抗病毒治疗的影响。方法:选取HIV/AIDS的病例采用ELISA法,分别对标本进行乙肝表面抗原、丙肝抗体、梅毒抗体检测,艾滋病抗病毒治疗后患者的CD4+T淋巴细胞的观察。结果:719例HIV/AIDS合并感染乙肝的有80例(11.13%),丙肝46例(6.40%),梅毒114例(15.86%)。接受艾滋病抗病毒治疗的326例患者中,单纯HIV感染的有232例,其中T淋巴细胞CD4<300/mm3者110例,占47.41%;合并多重感染的HIV患者有94例,其中T淋巴细胞CD4<300/mm3的有49例,占52.13%;两组比较差别无统计学意义(P>0.05)。结论:HIV合并感染TP、HCV和HBV率较高,易对T淋巴细胞CD4产生不同程度的影响。     

2015～2017年沈阳市新发现HIV/AIDS 患者首次检测T淋巴细胞亚群分析

目的了解沈阳市新发现的艾滋病病毒感染者/艾滋病患者(HIV/AIDS)首次外周血T淋巴细胞亚群的检测情况,为艾滋病的防治工作提供依据。方法采集沈阳市2015～2017年新发现的923例HIV/AIDS患者全血样本,用流式细胞仪检测患者T淋巴细胞各亚群的绝对值。结果首次检测CD4+细胞计数平均值为(399.83±224.33)个/μl,44.42%的病例CD4+细胞≤350个/μl,其中CD4+细胞≤200个/μl占18.63%,已经进入艾滋病期。CD4+/CD8+比值为(0.31±0.18)。不同年份间的CD4+T淋巴细胞均值差异有统计学意义(P0.01)。CD4+T淋巴细胞均值随年龄增加逐步降低。不同性别和传播途径HIV抗体阳性者的CD4+T淋巴细胞均值和CD4+/CD8+比值,差异无统计学意义(P0.05)。结论沈阳市新发现的HIV抗体阳性者中有大量的长期感染者,建议重点关注高年龄组的检测与管理,扩大HIV监测范围,并及时完成首次CD4+T淋巴细胞检测。     

HIV携带10年者T淋巴细胞亚群检测分析

目的了解HIV携带10年者T淋巴细胞亚群现状,制订救治方案,指导高效抗逆转录病毒治疗。方法采用美国FACSCount流行细胞仪,检测HIV感染者外周血中CD4、CD8T细胞绝对值数。结果检测HIV感染者836例,CD4淋巴细胞<200/mm3者180例,占21·53%;CD4T淋巴细胞>200/mm3者656例,占78·7%。CD4/CD8<1者779例,CD4/CD8>1者57例。结论长期存活的HIV感染者CD4T淋巴细胞计数10年内保持在正常范围之内;部分感染者已进入AIDS期。在无症状的HIV感染者中存在免疫力极度低下者,由高水平的T淋巴细胞的抗病毒作用而使其处于无症状期。     

Opportunistic infections in HIV-positive patients hospitalized in the Clinic of Infectious Diseases AMG

Opportunistic infections are one of the major problem among HIV infected patients still connected with high mortality. The aim of the investigation is to evaluate the incidence and mortality from opportunistic infections in HIV infected population in Pomeranian region of Poland. The paper presents analysis of incidence of opportunistic infections among 141 AIDS patients hospitalised in Clinic for Infectious Diseases in Gdańsk from 1988 to 2001/June/. In examined group 179 opportunistic infections were diagnosed. Most frequent was oesophageal candidiasis 58%, tuberculosis 29%, pneumocystis carinii pneumonia 21% and central nervous system toxoplasmosis 13%. The occurrence of opportunistic infections depends on CD4 count and rises with CD4 decline. Opportunistic infections were the reason of death in 33 from 74 cases/45%/. CONCLUSIONS: In examined group 28% of patients did not know about HIV infection when first opportunistic infection was diagnosed. Most frequent opportunistic infections in AIDS patients were oesophageal candidiasis, tuberculosis, pneumocystis carinii pneumonia and toxoplasmosis. In 98% of cases opportunistic infection developed when no HAART nor infection prophylaxis was administered. Opportunistic infection was the reason of death in 45% of cases, the most frequent were PCP and CNS toxoplasmosis.     

怀化市艾滋病患者抗病毒治疗效果及耐药影响因素分析

目的 了解怀化市艾滋病患者接受抗病毒治疗的效果及耐药状况,分析影响耐药产生的相关因素。 方法 对就诊于怀化市第一人民医院艾滋病门诊及病房的抗病毒治疗时间超过1年,且年龄为18岁以上的367例HIV感染者及AIDS患者,检测CD4⁺T淋巴细胞和病毒载量,对病毒载量大于1 000 copies/ml的标本进行HIV耐药基因型检测分析,并分组对治疗前CD4⁺T淋巴细胞水平、治疗依从性等级及抗病毒治疗期间合并应用抗结核药物的比例进一步统计分析。 结果 86.65%的治疗者采用一线治疗方案,92.37%的治疗者达到病毒学抑制,7.63%的治疗者出现病毒学失败,13.89%的治疗者CD4⁺T淋巴细胞低于200个/μl,18例治疗者发生耐药,耐药发生率4.90%。耐药组与非耐药对照组在治疗前CD4⁺T淋巴细胞水平、治疗依从性等级及抗病毒治疗期间合并应用抗结核药物的比例经统计学分析,差异有统计学意义。 结论 怀化市接受艾滋病抗病毒治疗患者总体疗效显著,少数患者出现耐药,其耐药与治疗前CD4⁺T淋巴细胞水平、治疗依从性及抗病毒治疗期间合并应用抗结核药物存在相关性。     

Late HIV presentation among AIDS cases in Australia, 1992-2001

OBJECTIVE: To describe time trends and demographic, exposure and clinical factors associated with late HIV presentation among notified AIDS cases diagnosed in Australia in 1992-2001. METHODS: AIDS cases, diagnosed in Australia and notified to the National AIDS Registry, were included in the analysis. AIDS cases newly diagnosed with HIV infection within three months of AIDS diagnosis were defined as cases of late HIV presentation. RESULTS: The percentage of AIDS cases with late HIV presentation increased significantly from 18% in 1992-96 to 33.1% in 1997 (adjusted odds ratio (AOR)=1.79, p<0.005) and to 49.6% in 2001 (AOR=3.01, p<0.005). Older age, having been born in Asia, a HIV exposure history of heterosexual contact or an 'other/undetermined' exposure and a diagnosis of PCP only or of multiple AIDS illnesses, were associated with late HIV presentation among AIDS cases diagnosed in 1992-96 and in 1997-2001, and among overseas-born cases diagnosed in 1992-2001. In 1997-2001, a low CD4+ cell count was also associated with late HIV presentation. Among homosexually active men diagnosed with AIDS in 1997-2001, older age, a diagnosis of PCP or multiple AIDS illnesses and a low CD4+ cell count were associated with late HIV presentation. CONCLUSION: Predictors of late HIV presentation have remained substantially unchanged over time and among population subgroups, suggesting a need for innovation in HIV/AIDS testing and counselling strategies.     

湖南省HIV/AIDS人群结核发病影响因素的巢式病例对照研究

目的 探讨HIV/AIDS人群发生结核病的危险因素.方法 采用1:2匹配的巢式病例对照研究方法分析HIV/AIDS人群发生结核的危险因素.结果 对1018例未患结核的HIV/AIDS人群随访观察1年,累计观察736.75人年,共检查出结核病患者62例,HIV/AIDS人群结核病发病密度为8.42人/100人年(62人/736.75人年).文化程度(OR=0.483)、卡介苗接种史(OR=0.561)、CD_4~+T淋巴细胞数(OR=0.356)、无业(OR=1.976)、单身(OR=2.646)和吸烟(OR=2.215)等因素与HIV/AIDS人群发生结核病有关.结论 文化程度高、有卡介苗接种史和CD_4~+T淋巴细胞数高是HIV/AIDS人群患结核病的保护因素;无业、单身和吸烟是HIV/AIDS人群患结核病的危险因素.     

CD4细胞计数,IL-6/IL-10比值联合对艾滋病合并肺孢子菌肺炎的诊断价值

目的探讨CD4细胞计数,IL-6/IL-10比值联合对艾滋病合并肺孢子菌肺炎的诊断价值。方法纳入2018年1月至2019年5月南充市中心医院收治的100例艾滋病合并肺孢子菌肺炎患者为艾滋肺炎组、100例艾滋病患者为艾滋组、100例健康体检者为对照组;通过流式细胞仪检测血清中CD4+T细胞的数量;酶联免疫吸附试验检测血清中IL-6,IL-10的表达水平。用受试者工作特征曲线(receiver operating characteristic curve,ROC)的AUC分析CD4细胞计数,IL-6/IL-10检测在艾滋病合并肺孢子菌肺炎中的诊断意义。结果艾滋病合并肺孢子菌肺炎患者血清中CD4细胞数量均<艾滋病患者与健康体检者(t=28.31,P<0.0001;t=36.90,P<0.0001),但是,IL-6/IL-10比值均高于艾滋病患者与健康体检者(t=7.184,P<0.0001;t=19.03,P<0.0001)。CD4细胞计数,IL-6/IL-10比值联合对艾滋病合并肺孢子菌肺炎的诊断的的灵敏度为92.00%,特异度为88.00%,准确度为89.33%。结论CD4细胞计数,IL-6/IL-10比值的检测可作为诊断艾滋病合并肺孢子菌肺炎的潜在标志。     

Increasing rate of pneumonia hospitalizations in the Bronx: a sentinel indicator for human immunodeficiency virus

To describe secular trends in pneumonia hospitalizations in the Bronx, New York City from 1982-1986, we analysed all cases with a discharge diagnosis of pneumonia, excluding Pneumocystis carinii pneumonia (PCP), for Bronx residents by age, sex, neighbourhood, and length of stay (N = 21,822). Hospital deaths from PCP and immune disorders were analysed separately as a non-recurrent indicator of human immunodeficiency virus (HIV) related disease prevalence by age, sex and geographical areas. From 1982 to 1986, pneumonia hospitalizations increased 132% among males and 100% among females aged 25-54, an age group accounting for 90% of adult AIDS cases in the Bronx, as compared to a 21% rise among males and 38% among females in all other age groups (p less than 0.001). Pneumonia rates increased most in those population groups with the highest rates of PCP and immune disorders. An ecological correlation of pneumonia hospitalization with this measure of AIDS prevalence for residents of a small geographical area is evident (r2 = 0.92). The observed increase in pneumonia hospitalizations, believed to be related to underlying prevalence patterns of HIV in this population, accounts for a significant and previously unrecognized burden on the local health care system. From 1983-1986, these 'excess' pneumonias in the Bronx accounted for 14,707 days of hospitalization--equal to 42% of the total days attributed to all hospital admissions for AIDS per se.     

Current epidemiology of Pneumocystis pneumonia

Pneumocystis pneumonia (PCP) has historically been one of the leading causes of disease among persons with AIDS. The introduction of highly active antiretroviral therapy in industrialized nations has brought about dramatic declines in the incidence of AIDS-associated complications, including PCP. In the adult population, the incidence of PCP has significantly decreased, but it remains among the most common AIDS-defining infections. Similar declines have been documented in the pediatric population. In much of the developing world, PCP remains a significant health problem, although its incidence among adults in sub-Saharan Africa has been debated. This review discusses the epidemiology of PCP during the current era of the AIDS epidemic. Although fewer cases of PCP occur in industrialized countries, increasing drug-resistant HIV infections, possible drug-resistant PCP, and the tremendous number of AIDS cases in developing countries make this disease of continued public health importance.     

Individual variation in CD4 cell count trajectory among human immunodeficiency virus-infected men and women on long-term highly active antiretroviral therapy: an application using a Bayesian random change-point model

The authors evaluated population- and individual-level CD4-positive T-lymphocyte (CD4 cell) count trajectories over a 7-year period (July 1995-March 2004) following initiation of highly active antiretroviral therapy (HAART) in the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study. The study population included 404 human immunodeficiency virus (HIV)-infected men and 609 HIV-infected women who 1) had a CD4 cell count measurement available from their last pre-HAART study visit, 2) provided at least four post-HAART CD4 cell count measurements, and 3) reported HAART usage for at least 80% of the post-HAART visits. The CD4 cell count trajectory was analyzed by means of a Bayesian random change-point model. The results indicated that CD4 cell count trajectories for long-term frequent HAART users can be well modeled with change points at both the population and individual levels. At the population level, regardless of CD4 cell count before HAART initiation, the gains in CD4 cell count ended approximately 2 years after HAART initiation in both men and women. At the individual level, 35% of men in the Multicenter AIDS Cohort Study versus 25% of women in the Women's Interagency HIV Study had a statistically significant change in CD4 cell count trajectory within 7 years after HAART initiation.