艾滋病患者及人类免疫缺陷病毒感染者心理健康状况及其影响因素

目的了解艾滋病患者及人类免疫缺陷病毒（HIV）感染者心理健康状况,并探讨其影响因素。方法确诊艾滋病患者及HIV检测阳性者共94例为研究组,38名健康人作为对照组,对二者进行症状自评量表（SCL-90）、社会支持量表、应付方式问卷（CSQ）及艾森克人格问卷（EPQ）测评。结果研究组SCL-90的强迫、抑郁、焦虑及精神病因子分显著高于对照组（P〈0．05或0．01）,研究组内部男性抑郁因子分和偏执因子分均高于女性,其SCL-90多个因子与CSQ和EPQ多个因子之间存在显著相关关系,相关系数在0．21～0．70之间。结论艾滋病患者及HIV感染者心理健康状况不良,以情绪障碍为主,应进行心理社会支持和治疗。     

人类免疫缺陷病毒感染与艾滋病患者合并分枝杆菌菌血症的检测与分析

目的 分析人类免疫缺陷病毒(HIV)感染或艾滋病(AIDS)患者合并分枝杆菌(MYC)菌血症的播散性,为临床确诊HIV感染或AIDS患者合并MYC菌血症提供病原学诊断依据.方法 用BACTEC Myco/F Lytic(MFL)培养基配合BACTEC 9120血培养仪对278例可疑合并MYC感染的HIV或AIDS患者外周血标本进行培养,DNA微阵列芯片法对阳性标本进行菌种鉴定.结果 278例患者血培养分析显示,MFL血培养的总阳性率为5.40％,其中13例占86.67％,阳标本经菌种鉴定证实为结核分枝杆菌(MTU)生长,2例阳性标本为非结核分枝杆菌(NTM)中的鸟分枝杆菌生长,占13.33％.结论 MFL血培养法诊断MYC菌血症操作简单、安全性高,多次培养增加阳性率,能协助临床诊断MYC菌血症,同时要提高检测的特异性和敏感性,需采用多种方法对多份样本和多种类样本同时检测.     

HIV感染者/AIDS患者衰弱状况及影响因素分析

目的 了解人类免疫缺陷病毒(HIV)感染/艾滋病(AIDS)患者(PLWHA)衰弱现状及其影响因素。 方法 选取2019年6-8月长沙市某医院≥18岁的PLWHA作为研究对象, 采用自行编制的问卷以及蒂尔堡衰弱量表分别评估研究对象的基本情况以及衰弱情况。 结果 PLWHA衰弱发生率为26.4%, logistics回归分析显示, 感染年限>5年的患者发生衰弱的风险为感染年限≤5年患者的2.33倍(95%CI: 1.24~4.37, P=0.009);最高HIV载量≥10万拷贝/mL患者发生衰弱的风险为最高HIV载量 < 10万拷贝/mL患者的1.40倍(95%CI: 1.05~1.85, P=0.022);CD4⁺T淋巴细胞计数 < 200个/mm³的患者发生衰弱的风险为CD4⁺T淋巴细胞计数≥200个/mm³患者的3.60倍(95%CI: 1.96~6.62, P < 0.001)。 结论 HIV感染年限越长、当前CD4⁺T淋巴细胞计数越低、HIV载量越高的PLWHA更容易发生衰弱。     

Nutrition and immune function in human immunodeficiency virus infection

The triad of human immunodeficiency virus (HIV) infection, nutritional status and immune function are intimately related, each factor having effects on the others. The dominant effect in this three-way relationship is the effect of HIV infection on nutritional status, an effect which, until the advent of potent anti-retroviral drugs, has been manifest primarily as wasting. Recently, more complex metabolic abnormalities have become apparent, particularly fat redistribution syndromes, hyperlipidaemia and hypercholesterolaemia. For the converse effect, the effect of nutritional state on HIV disease progression, there is good evidence that clinical outcome is poorer in individuals with compromised nutrition. However, the beneficial effects of nutritional support have been more difficult to demonstrate. For macronutrients, effective macronutrient supply improves survival in severely-malnourished individuals and may have beneficial effects in less-severely-affected individuals. Micronutrient deficiencies appear to be involved in modifying clinical HIV disease and may also be associated with enhanced mother-to-child transmission of virus, particularly in developing countries. Intervention trials in this setting are currently under way. In conclusion, the interaction of HIV infection and nutrition is of great importance not just because of the major impact that HIV infection has on nutritional state, but also because strategies to improve nutritional status, both quantitatively and qualitatively, may have a beneficial effect on the clinical and immunological course of the disease.     

Intestinal infection and malnutrition initiate acquired immune deficiency syndrome (AIDS)

AIDS is a complex immunodeficiency syndrome affecting a limited target population, principally male homosexuals. The various immunologic dysfunctions in AIDS, or those persons with the AIDS prodrome, are explained in terms of multiple pathogeninduced alterations in the gastrointestinal tract which result in malabsorption and malnutrition. Malnutrition need not be severe but may be due to failure to transport one or serveral nutrients essential for immune functions. Alteration of gastrointestinal permeability results in an increased uptake of normally excluded microbial products possibly resulting in latent virus activation or enhanced replication of viruses, including the retrovirus HTLV-III. Once this has occurred, transmissible agents are present which may cause or predispose to AIDS in other susceptible populations such as hemophiliacs, persons receiving multiple blood transfusions, drug users sharing needles, populations with repeated close contact, and susceptible populations by virtue of genetic, environmental or disease state. The combination of rigorous parenteral nutrient repletion and antibiotic therapy aimed at abrogating the intestinal infections, and immunologic therapies may be effective in addressing the underlying causes of the immune defects in AIDS. A prevention strategy should be directed toward reducing repeated polymicrobial enteric infections and their attendant malabsorption (e.g., gay bowel syndrome) in addition to reducing exposure to circulating transmissible agents.     

Selenium deficiency and cardiomyopathy in acquired immunodeficiency syndrome

Selenium deficiency is common in patients with human immunodeficiency virus infection and may contribute to the development of cardiomyopathy. A 5-year-old boy with congenital human immunodeficiency virus infection developed cardiomyopathy. Evaluation for reversible causes of cardiomyopathy was notable for the diagnosis of selenium deficiency. Cardiac function improved on selenium supplementation. The role of selenium in cardiac dysfunction and the need for nutritional evaluation and supplementation of malnourished patients with acquired immunodeficiency syndrome is discussed.     

Prevention and treatment of human immunodeficiency virus/acquired immunodeficiency syndrome in resource-limited settings

Strategies for confronting the epidemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have included a range of different approaches that focus on prevention and treatment. However, debate persists over what levels of emphasis are appropriate for the different components of the global response. This paper presents an overview of this debate and briefly summarizes the evidence on a range of interventions designed to prevent the spread of HIV infection, paying particular attention to voluntary counselling and testing, treatment for sexually transmitted infections and prevention of mother-to-child transmission. We also review the experience with antiretroviral therapy to date in terms of response rates and survival rates, adherence, drug resistance, behavioural change and epidemiological impact. Although various studies have identified strategies with proven effectiveness in reducing the risks of HIV infection and AIDS mortality, considerable uncertainties remain. Successful integration of treatment and prevention of HIV/AIDS will require a balanced approach and rigorous monitoring of the impact of programmes in terms of both individual and population outcomes.     

Acquired immunodeficiency syndrome and human immunodeficiency virus infection in Bujumbura, Burundi

In the first seroepidemiological survey in Burundi in 1984, only 59 acquired immunodeficiency syndrome (AIDS) cases were recognized. We report here clinical surveillance of AIDS cases in the 4 hospitals in Bujumbura during a 4-month period in 1986. The project was combined with a seroprevalence study of pregnant women in the 6 dispensaries in Bujumbura. 258 AIDS patients were recorded. 16% of the 925 pregnant women were seropositive for human immunodeficiency virus (HIV). The clinical characteristics of 120 adult AIDS patients were similar to those reported in Kinshasa or Kigali. From demographic findings we presume that the major mode of HIV transmission in Bujumbura is by sexual contact. The results of this study formed the starting point of prevention activities against AIDS in Burundi.     

Nutritional impact of acquired immune deficiency syndrome: a unique counseling opportunity

The acquired immune deficiency syndrome (AIDS) presents a challenge for dietitians. Changes in the immune system have a potentially detrimental effect on nutritional status as a result of conditions such as anorexia, infection, diarrhea, and drug side effects. Conversely, poor nutrition status may adversely alter the immune systems. Dietary guidelines for the management of these conditions and additional obstacles are discussed. When counseling patients with AIDS, the dietitian needs to be aware of and sensitive to alternative therapies, to evaluate their effectiveness, and to assist in determining their place in the patient's treatment. Psychosocial factors that could influence nutritional status, such as dementia, unemployment, and isolation, must also be taken into consideration. A nutrition program has been established to address the needs of AIDS patients at AIDS Project Los Angeles-Necessities of Life Program (APLA-NOLP), a food distribution center. The goal of the program is to maintain or improve the client's nutritional status by providing education and counseling. The nutrition program has been enthusiastically received, and the outcome of the program on the nutritional status of the participants is currently under study. The dietitian is in a unique position to intervene by providing resource information, food preparation tips, and individualized nutrition plans. It is imperative that the dietitian become familiar with the AIDS disease process and its implications for nutritional status to be considered an expert in the nutrition management of such patients.     

艾滋病的内分泌机能障碍

HIV可以直接或间接地引起多种内分泌代谢紊乱,受累的内分泌腺体包括肾上腺、甲状腺、性腺、胰岛细胞及导致电解质代谢紊乱的相关腺体。对各种腺体功能影响是多方面的,从腺体激素的改变到临床表现,其机制也是错综复杂的。     

Intravenous drug users and the acquired immune deficiency syndrome

Acquired immune deficiency syndrome (AIDS), a new epidemic disease characterized by dysfunction of cellular immunity, is most common among homosexual and bisexual males with multiple sexual partners and users of intravenous drugs. AIDS appears to be spread by contact with blood products and body fluids. Not only is the heroin user at increased risk of contracting AIDS, but also the occasional recreational drug user who shares a needle and syringe when he or she self-administers cocaine or amphetamines at a party on a weekend. Although precise figures are not available, there may be as many as several million recreational and regular users of cocaine and heroin. Data from a national sample of drug abuse treatment programs indicates that more than 80 percent of all clients seeking treatment, whatever their primary drug of abuse at the time of admission to treatment, have administered drugs to themselves intravenously during the year before treatment. Several hundred thousand treatment episodes occur each year. Data from surveys indicate that drug users entering treatment are well aware of the increased risks associated with AIDS. It is not surprising that treatment staff, also, have expressed concerns about their own susceptibility to the disease. Special education programs for these health workers have been instituted in New York City and have met with success. These programs have provided information and reassurance to treatment providers. At present, no health worker providing direct treatment service to drug abusers with a history of intravenous drug use has contracted AIDS.     

Resting energy expenditure, caloric intake, and short-term weight change in human immunodeficiency virus infection and the acquired immunodeficiency syndrome.

To assess the causes of short-term weight loss in patients with acquired immunodeficiency syndrome (AIDS), we measured resting energy expenditure (REE), caloric intake, and the 28-d weight trend in control subjects, human immunodeficiency virus (HIV)+ subjects, AIDS patients, and AIDS patients during secondary infection (AIDS-SI). REE was increased in HIV+ (11%), AIDS (25%), and AIDS-SI (29%). Caloric intake was similar in control subjects, HIV+, and AIDS but reduced 36% in AIDS-SI, who consumed 17% fewer calories than their REE. Average short-term weight was stable for HIV+ and AIDS but decreased 5% in AIDS-SI. Weight trend correlated with caloric intake but not with REE. Thus HIV+ and AIDS are able to partially compensate for increased REE because they do not show short-term weight loss. Decreased caloric intake is critical for short-term weight loss and is seen during secondary infection. Inability of decreased caloric intake to decrease REE during infection accelerates short-term weight loss. Rapid weight loss with anorexia may be a harbinger of secondary infection in AIDS.     

Setting standards and an evaluation framework for human immunodeficiency virus/acquired immunodeficiency syndrome surveillance.

National acquired immunodeficiency syndrome surveillance commenced with the beginning of the human immunodeficiency virus (HIV) epidemic in the United States in 1981, and by 2003 all states had implemented HIV surveillance. This information, used for prevention interventions, and the allocation of resources, must be accurate to determine trends in HIV transmission and the number of persons living with HIV. Standards for data accuracy were developed through a national consensus approach and integrated into a framework for local and national program evaluation. The evaluation framework allows for continual quality improvement by providing information for training and technical assistance efforts. These tools allow comprehensive assessments of whether reported HIV case data are adequate, reliable, and sufficiently accurate for determining the resources needed for HIV prevention and care.     

Human immunodeficiency virus/acquired immunodeficiency syndrome training from a union perspective.

The authors developed a union sponsored 2-day human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) "train the trainer" program for healthcare workers in the San Francisco Bay Area. The program incorporated the "education for action" approach in an effort to respond to the inadequacies in many traditional, institutional trainings. Service Employees International Union (SEIU) and Labor Occupational Health Program (LOHP) conducted the HIV/AIDS "train the trainer" program for approximately 100 healthcare workers in county public hospitals and community health clinics. After completing the program, these workers went back to their healthcare facilities, or community organizations, and led additional classes on HIV/AIDS transmission and prevention for approximately 600 more people. The goal of the program was to empower healthcare workers to: 1) identify the occupational risks associated with exposure to blood and potentially infectious body fluids at the workplace; 2) develop strategies to reduce those risks; 3) discuss their feelings about caring for an HIV/AIDS patient; and, 4) conduct HIV/AIDS workshops at the workplace.     

The acquired immune deficiency syndrome: setting up a practical information network.

AIDS is a highly emotive subject. From the outset the problem was tackled openly, looking at it from a professional and a public point of view. Initially the programme was intended only to protect staff and manage patients effectively. It rapidly expanded to delivery an educational message, which deals with all aspects of the AIDS problem, to virtually all members of the community. This should help allay unnecessary anxiety and enhance communication. The incidence of AIDS infection in North Lincolnshire is low--there have not been any cases recorded. In these circumstances it may seem the efforts have been excessive. However, it is hoped that both staff and public have been reasonably well prepared to face the problem and help prevent its spread should the need arise.     

Impairment of nutritional,educational status and quality of life among children infected with and belonging to families affected by human immunodeficiency virus/acquired immune deficiency syndrome

The human immunodeficiency virus (HIV) epidemic has ramified impact on family members of people living with the disease, especially in vulnerable groups such as children, which has been neglected while addressing the overt burden in infected individuals. The objectives of this study were to evaluate the impact of HIV on the nutritional and educational status in HIV-infected and -affected children and to compare quality of life (QoL) in these children with controls. A cross-sectional controlled study was conducted among children aged 5–11 years. HIV-infected children and children accompanying parents seeking treatment in an antiretroviral treatment (ART) centre were sampled. Controls were obtained from the field practice area of a teaching hospital. A semi-structured questionnaire and anthropometric measures were used to evaluate the impact on the nutritional and educational status. The General Health Assessment for Children (GHAC) instrument was used to measure QoL. Thirty-eight infected children, 149 children living with family members infected with HIV and 200 controls were sampled. The mean age was 8.55 ± 1.78, with 203 male children and 184 female children. The mean nutritional Z-scores were impacted in the affected and infected groups and significant differences were obtained on the domains of educational status on a proportions test. Most QoL domains were affected and the significance was retained in multivariate regression analysis after controlling for sociodemographic factors. HIV-infected and -affected children have poorer outcome on nutritional and educational indicators with impaired QoL. Identifying and defining vulnerability in these children can help mitigate the wider impact of HIV.