13例感染了HIV的FSW抗病毒治疗效果观察

目的了解感染了艾滋病病毒（HIV）的女性性服务人员（rsw）抗病毒治疗效果。方法对13例感染了HIV的Fsw进行及早抗病毒治疗,并跟踪随访,分别于治疗前和治疗后不同时间检测其CD4＋T细胞和HIV病毒载量。结果13例FSw经过3个月多的抗病毒治疗后,病例的CD4＋T细胞计数不同程度增长,差异无统计学意义（P〉0．05）,HIV病毒载量明显下降,与治疗前比较,差异有统计学意义（R0．05）,患者生活状况良好。结论及早抗病毒治疗感染了HIV的FSw,给感染者带来好的预后结果,降低了传播艾滋病的风险。     

艾滋病抗病毒治疗的流行病学研究

目的 探讨艾滋病（AIDS）患者抗病毒治疗时的流行病学特征.方法 选择2008 ～ 2012年间我院收治的AIDS抗病毒治疗患者78例,对其基本资料进行分析.结果 男性多于女性,平均年龄（42.5±7.5）岁,同居或已婚患者占51.28％.资料来源主要以医院就诊患者检测为主.异性性行为传播是艾滋病病毒（HIV）感染的主要途径,其次为男男性行为传播,两者共计83.33％.治疗时本组患者CD4＋T细胞平均为109.1个/μL;确诊时间与开始治疗时间的平均间隔天数为115 d.结论 早发现、早诊断HIV感染对于AIDS患者抗病毒治疗效果起到了决定性的作用.     

艾滋病母婴传播和母婴阻断

母婴传播(MTCT)是15岁以下儿童感染艾滋病病毒(HIV)最主要途径,婴儿和儿童HIV感染约有90%是通过母婴传播而获得的。艾滋病母婴传播可以发生在妊娠、分娩和哺乳过程中,通过HIV咨询检测、抗病毒治疗、安全分娩、人工喂养等系列措施可阻断HIV母婴传播。随着艾滋病母婴阻断技术的成熟和完善,艾滋病母婴传播率可降至2%。     

阻断HIV/AIDS母婴传播28例临床分析

目的探讨阻断艾滋病（AIDS）/人类免疫缺陷病毒（HIV）感染母婴垂直传播的具体措施。方法回顾性分析2005年1月～2009年6月我院收治的28例足月妊娠合并AIDS/HIV感染患者,对孕产期阻断母婴传播措施方面进行临床分析。结果 28例孕妇分娩的29例婴儿,随访9～12月龄婴儿29例,随访率100%,检测HIV抗体阴性27例;随访≥18月龄的婴儿2例,检测HIV抗体阳性1例,（婴儿HIV感染者）,垂直传播率3.45%（1/29）。结论对于HIV感染的孕妇,应做好围产期保健,采取在孕产期前接受抗病毒治疗等母婴阻断措施,使母血病毒载量显著降低,最大限度降低HIV母婴垂直传播的发生率。     

综合干预对HIV／AIDS孕妇母婴传播阻断的效果分析

目的 探讨阻断艾滋病病毒（HIV）/艾滋病（AIDS）孕妇母婴传播的有效方法. 方法 对54例要求生育的HIV/AIDS孕妇采取于孕期三联抗病毒治疗,结合选择性剖腹产及人工喂养,新生儿12 h内服用齐多夫定口服液等措施,监测孕妇的病毒载量（HIV-RNA）、CD4^＋ T淋巴细胞数（CD4^＋）以及婴儿1、4月龄的HIV-DNA,1岁6月的HIV抗体. 结果 54例孕妇HIV-RNA均显著下降,53例婴儿HIV-DNA为阴性. 结论 采取综合干预措施进行HIV母婴传播阻断是有效的.     

农村预防艾滋病母婴传播关键技术研究

目的探索预防艾滋病母婴传播关键技术,降低艾滋病母婴传播率．方法采用流行病学现场干预试验,探索提高孕妇艾滋病自愿咨询检测率的措施．采用临床研究方法开展艾滋病母婴传播干预实验研究,将艾滋病病毒（HIV）感染孕产妇随机分为两组,分别给予HIV感染孕产妇及其所生新生儿两种抗反转录病毒药物方案（齐多夫定（AZT）与耐韦拉平（NVP）联合方案和单一NVP方案）阻断治疗,并实施住院分娩、人工喂养等措施．结果获得了促进农村妇女孕早、中期HIV抗体自愿咨询检测综合策略．通过干预,研究点妇女孕28周前HIV抗体检测率、孕28周前自愿咨询检测率分别上升了50．4％和60．9％;研究点研究期间接受HIV母婴阻断系列服务122例,完成112例婴儿追踪随访,阻断成功107例,阻断成功率达到95．5％,AZT＋NVP联合方案母婴传播率降至1．8％,单一NVP方案母婴传播率降至7．0％．结论促进农村妇女孕早、中期HIV抗体自愿咨询检测综合措施与抗病毒治疗,结合住院分娩和婴儿人工喂养能显著地降低艾滋病母婴传播率．     

艾滋病病毒（HIV）感染产妇的新生儿护理

艾滋病病毒（HIV）感染产妇的新生儿护理是母婴阻断的一项重要内容,母婴传播是新生AL（胎儿）感染人类免疫缺陷病毒（HIV）的主要途径,即感染了艾滋病病毒的妇女,有可能在妊娠、分娩和哺乳期,把艾滋病病毒传染给孩子。HIV检测阳性的妇女及孕妇,将艾滋病传给新生儿（胎儿）主要通过3种方式：第1种是血液中的艾滋病病毒可以通过胎盘直接到达胎儿体内,使胎儿感染艾滋病病毒;第2种是怀孕的母亲在分娩过程中,当新生儿经过母亲产道时,     

深圳市龙华新区2005～2012年HIV/AIDS患者流行病学特征

目的了解深圳龙华新区HIV感染者和艾滋病患者的流行病学特点,探讨艾滋病抗病毒治疗对患者生存时间的影响。方法采用2005-2012年全国疾病监测信息报告管理系统报告的数据进行趋势及描述性分析,运用Ka-plan-Meier曲线分析艾滋病患者接受抗病毒治疗后对其生存时间的影响。结果 2005-2012年累计报告艾滋病453例,其中艾滋病病人112例,HIV感染者341例,2005-2012年间,艾滋病发病（含HIV感染）率呈上升趋势（χ^2=94.33,P=0.000）,艾滋病（含HIV感染）在新区传染病中的比例也呈上升趋势（χ2=81.46,P=0.000）。所有患者中,HIV感染者男女性别比为6.1：1,AIDS患者男女性别比为2.6：1,85.43%患者感染途径为性接触感染。运用Kaplan-Meier曲线分析艾滋病患者接受抗病毒治疗后对其生存时间的影响,发现经抗病毒治疗后,艾滋病患者的1、6、12个月累积生存率分别为99.3%、98.2%、98.2%,明显高于未治疗组的88.0%、77.7%、69.9%（χ^2=35.256,P〈0.001）。结论深圳龙华新区艾滋病发病呈上升趋势,抗病毒治疗能有效提高艾滋病患者生存率。     

52例感染艾滋病病毒孕产妇母婴阻断效果分析

目的观察探讨感染艾滋病病毒孕产妇母婴阻断效果,总结其临床意义。方法选取我院2009年1月至2010年6月52例感染艾滋病病毒孕产妇,随机分为观察组和对照组各26例,观察组采取综合性的母婴阻断措施,对照组不采取任何母婴阻断措施,观察对比2组分娩方式、分娩结局、婴儿HIV感染情况及婴儿喂养方式,进行统计学分析。结果 2组分娩方式、分娩结局、婴儿HIV感染情况及婴儿喂养方式对比差异显著（P〈0.05）,具有统计学意义。结论及时发现并及早对感染艾滋病病毒孕产妇采取选择性剖宫产、母婴抗病毒药物综合性治疗和人工喂养等干预措施,能有效预防HIV母婴传播,降低新生儿死亡率,具有重要的临床意义。     

HIV母婴传播及母婴阻断的临床研究

随着艾滋病在全球迅速蔓延,孕妇感染人类免疫缺陷病毒(HIV)的人数越来越多。在儿童HIV感染中,90%以上来自母婴传播,因此母婴阻断是预防儿童艾滋病的主要措施。母婴传播的方式有宫内感染、分娩时经产道感染、经母乳感染。针对母婴传播的方式,母婴阻断的措施有抗病毒治疗、选择性剖宫产、人工喂养。随着母婴阻断的研究进展,母婴传播率可降至2%~4%。     

HIV/AIDS患者抗逆转录病毒治疗退出影响因素研究进展

艾滋病是由人类免疫缺陷病毒(H1V)引起的一种危害性极大的传染病,需要HIV/AIDS患者每日按时按量服药才能有效抑制体内HIV复制.中国实施抗逆转录病毒疗法(ART)和扩大治疗策略将所有符合条件的HIV感染者纳人治疗范围,越来越多的HIV感染者接受ART,同时退出(停药和失访)ART的HIV/AIDS患者人数也在逐年...     

人类免疫缺陷病毒感染早期启动抗逆转录病毒治疗的意义

人类免疫缺陷病毒（HIV）感染者如在感染早期未及时诊断和治疗,HIV将在体内持续复制,损害免疫系统。目前,越来越多的指南建议HIV感染者应尽早启动抗逆转录病毒治疗（ART）,尤其是急性HIV感染者。早发现并在感染早期开始ART可以限制病毒储存库的规模,改善免疫细胞功能。从社会层面而言,感染早期的患者通过启动ART达到病毒抑制状态,可以减少HIV的传播机会,降低获得性免疫缺陷综合征（AIDS）的发病率,进而减少与AIDS相关的卫生支出。但HIV感染早期诊断及治疗存在个人因素和社会因素等方面的问题,阻碍了早期治疗的实施和开展。尽早启动ART,联合其他治疗策略,有可能真正实现功能性治愈。     

HIV Testing and Antiretroviral Therapy in Government and Mission Hospitals in Malawi: 2002 – 2007

HIV testing and antiretroviral therapy (ART) has scaled up tremendously in Malawi in the last 5 years. We analyzed trends of HIV testing uptake in the course of ART scale-up in 25 government and mission hospitals, which were selected because they do not receive support from non-governmental organizations. Data on numbers of clients HIV tested and on cumulative ART registrations were collected from annual country-wide situational analyses and from quarterly ART supervisory visits from 2002 to 2007. In the period before ART scale up, the quarterly number of clients HIV tested increased from 2609 in 2002 to 8197 in 2004, equivalent to an average quarterly increase of 559 tests. During ART scale up, the quarterly number of clients HIV tested increased from 17977 in early 2005 to 35344 in the second quarter of 2007, equivalent to an average quarterly increase of 2171 tests. During this time, the cumulative number of patients started on ART increased from 2441 to 29756. There has been a rapid acceleration of HIV testing uptake and ART in government and mission hospitals. ART may facilitate the decision of clients to have an HIV test and therefore contribute in this way to HIV prevention efforts.     

Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study

Background and objective

There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on appropriate placement on ART among eligible patients.

Methods

We conducted a retrospective, pre-post EMR study among patients enrolled in HIV care and eligible for ART at 17 rural Kenyan clinics and compared the: (1) proportion of patients eligible for ART based on CD4 count or WHO staging who initiate therapy; (2) time from eligibility for ART to ART initiation; (3) time from ART initiation to first CD4 test.

Results

7298 patients were eligible for ART; 54.8% (n=3998) were enrolled in HIV care using a paper-based system while 45.2% (n=3300) were enrolled after the implementation of the EMR. EMR was independently associated with a 22% increase in the odds of initiating ART among eligible patients (adjusted OR (aOR) 1.22, 95% CI 1.12 to 1.33). The proportion of ART-eligible patients not receiving ART was 20.3% and 15.1% for paper and EMR, respectively (χ²=33.5, p<0.01). Median time from ART eligibility to ART initiation was 29.1 days (IQR: 14.1–62.1) for paper compared to 27 days (IQR: 12.9–50.1) for EMR.

Conclusions

EMRs can improve quality of HIV care through appropriate placement of ART-eligible patients on treatment in resource limited settings. However, other non-EMR factors influence timely initiation of ART.     

Effects of Antiretroviral Therapy and HIV Exposure in Utero on Adverse Pregnancy and Infant Outcomes:A Prospective Cohort Study in Guangzhou,China

Objective This study aimed to evaluate the effects of in-utero exposure to HIV and ART on pregnancy outcome and early growth of children.Methods This cohort study enrolled 802 HIV-infected pregnant women between October 2009 and May 2018 in Guangzhou, China. The women were assigned to receive combination ART(c ART) or mono/dual ART or no treatment. The primary outcomes were the combined endpoints of any adverse pregnancy outcome [including ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth, small for gestational age(SGA)] and adverse early growth outcome(including infant death, HIV infection of mother-to-child transmission, and underweight, wasting and stunting of infants at 4 weeks of age).Results Adverse pregnancy outcomes occurred in 202(35.1%) of all enrolled HIV-infected women, and121(31.3%) of all infants exhibited adverse effects on early growth at 4 weeks of age. The rates of adverse pregnancy outcomes, spontaneous abortion, ectopic pregnancy, stillbirth, infant death and perinatal HIV infection were higher among women not receiving ART, compared to those treated with c ART or mono/dual ART(P 0.05). However, women treated with c ART had a higher rate of SGA,compared to untreated women(P 0.05). No differences in early infant growth were observed among the different treatment regimens.Conclusion Our findings underscore the essentiality of prioritizing HIV-positive pregnant women for ART, as even mono/dual ART available in resource-limited countries could improve pregnancy outcomes and infant survival.     

Antiretroviral therapy: Shifting sands

HIV/AIDS has been an extremely difficult pandemic to control. However, with the advent of antiretroviral therapy (ART), HIV has now been transformed into a chronic illness in patients who have continued treatment access and excellent long-term adherence. Existing indications for ART initiation in asymptomatic patients were based on CD4 levels; however, recent evidence has broken the shackles of CD4 levels. Early initiation of ART in HIV patients irrespective of CD4 counts can have profound positive impact on morbidity and mortality. Early initiation of ART has been found not only beneficial for patients but also to community as it reduces the risk of transmission. There have been few financial concerns about providing ART to all HIV-positive people but various studies have proven that early initiation of ART not only proves to be cost-effective but also contributes to economic and social growth of community. A novel multidisciplinary approach with early initiation and availability of ART at its heart can turn the tide in our favor in future. Effective preexposure prophylaxis and postexposure prophylaxis can also lower transmission risk of HIV in community. New understanding of HIV pathogenesis is opening new vistas to cure and prevention. Various promising candidate vaccines and drugs are undergoing aggressive clinical trials, raising optimism for an ever-elusive cure for HIV. This review describes various facets of tectonic shift in management of HIV.     

Should HIV discordant couples have access to assisted reproductive technologies?

In this paper we identify and evaluate arguments for and against offering assisted reproductive technologies (ART), specifically IVF, to HIV discordant couples (male partner HIV positive, female partner HIV negative). The idea of offering ART to HIV discordant couples generates concerns about safety and public health and raises questions such as: what is an acceptable level of risk to offspring and should couples who want this assistance be subject to selection criteria; should they undergo scrutiny about their suitability as parents when those who are able to conceive naturally face no such scrutiny and people with other illnesses are given access to ART? We conclude that offering ART to HIV discordant couples is likely to produce more benefit than harm and violates no ethical principles. Nevertheless, a decision to deny treatment need not constitute unjustified discrimination.     

Acceptance of Voluntary Counselling, Testing and Treatment for HIV Among Pregnant Women in Kumasi, Ghana

Summary BACKGROUND: Voluntary counselling and testing (VCT) for human immunodeficiency virus (HIV) and treatment of positive pregnant women can reduce mother to child transmission (MTCT) of HIV. OBJECTIVE: This study was conducted to assess acceptance of HIV VCT and antiretroviral therapy (ART) by pregnant women in Kumasi, Ghana, before and after VCT and ART were available. METHODS: Two cross-sectional studies were conducted among women in antenatal clinics. The first, in 2003 among 501 women, before VCT and ART were available in Kumasi. Women who were willing were counselled and tested for HIV. In 2005, after the introduction of VCT and ART by the Ghana Health Service, 675 pregnant women were surveyed regarding HIV/VCT acceptance and uptake. RESULTS: In 2003, 98% of women accepted counselling and 97% accepted testing; 3.3% tested HIV positive. Multivariate analysis showed that women with secondary education were 88% less likely than those with no/primary education to accept testing (OR=0.12, CI=0.03-0.54,p=0.006). Women who had prior HIV testing were 95% less likely to accept testing (OR=0.05, CI=0.01-0.19, p=0.0001). Women who reported two sexual partners in the past year were 6 times as likely to be HIV positive than those reporting one sexual partner (OR=5.76. CI=1.53 - 21.69, p=>0.05). In 2005, 76% of women reported no prior HIV counselling and 78% no testing. CONCLUSIONS: In 2003, there was wide uptake of VCT by prenatal women. However, in 2005 the majority of pregnant women were not accessing the available VCT services.     

云南省某地艾滋病抗病毒治疗脱失患者的调查

目的 调查云南省某地某地接受免费艾滋病抗病毒治疗患者脱失原因及其影响因素.方法 整理云南省某地2004年7月至2015年5月的艾滋病抗病毒治疗患者资料, 采用χ2检验, Logistic回归分析患者治疗过程中出现脱失的可能影响因素.结果 6 614例接受抗病毒治疗的艾滋病患者中, 540例患者由于各种原因在抗病毒治疗过程中脱失, 脱失率8.2%.艾滋病抗病毒治疗过程中脱失的主要类型为失访 (402例, 74.4%) , 停药 (138例, 25.6%) .婚姻状况为已婚或同居、通过静脉吸毒感染、入组治疗基线CD4细胞计数>500个/μL、接受治疗时间小于6个月等均增加患者治疗过程中脱失概率.结论 在艾滋病抗病毒治疗过程中应加强对吸毒人群、未婚/离异、CD4细胞计数>500个/μL和治疗时间在6月内人群应给予重视, 加强患者依从性教育和关怀, 减少脱失.     

Effects of Cotrimoxazole Prophylaxis Initiation and Discontinuation on Mortality and Attrition Rates among HIV Patients Who Initiate ART in Southwest China: An Observational Cohort Study

Combination antiretroviral therapy (ART) reduced AIDS-related mortality and increased survival among patients living with HIV by interrupting HIV replication, enhancing immune recovery, and preventing the onset of opportunistic infections[1].?In?China,?ART?has?rapidly?been?scaled?up since the beginning of the National Free Antiretroviral?Treatment?Program?(NFATP)?in?2003[2]. By the end of 2016, 489,411 individuals diagnosed with?HIV?were?receiving?free?antiretroviral?treatment in China. China is firmly committed to reducing overall AIDS-related mortality and HIV incidence within the country. However, similar to other low-and middle-income countries, the NFATP is challenged by high mortality and attrition shortly after?patients?initiate?ART[3].