农村地区艾滋病免费抗病毒治疗规范化管理模式探讨

在落实国家“四免一关怀”政策,对艾滋病病人实施免费抗病毒治疗过程中,缺少一个适合于基层工作需要便于操作的规范管理模式。根据卫生部《关于艾滋病抗病毒治疗管理工作的意见》等相关文件精神,参照《国家免费艾滋病抗病毒治疗手册》要求,通过不断探索尝试,总结出了符合基层工作需要,简捷易行的农村地区艾滋病抗病毒规范管理“三二一四”模式。这一模式简捷、凝练、易记、可操作,又涵盖了国家抗病毒管理工作的基本内容,在抗病毒治疗过程中发挥了重要的积极作用,效果良好。     

《中国艾滋病性病》开设“中国免费艾滋病抗病毒治疗启动20年”专栏

2022年是中国免费艾滋病抗病毒治疗启动20周年。《中国艾滋病性病》杂志于2022年1―6月开设"中国免费艾滋病抗病毒治疗启动20年"专栏。专栏将聚焦中国免费艾滋病抗病毒治疗启动与发展的过程及对我国和世界艾滋病防治事业的贡献。     

艾滋病抗病毒治疗政策和策略分析与思考

目的把握艾滋病抗病毒治疗政策和策略现状,分析存在的问题,为调整完善艾滋病抗病毒治疗机制提供建议。方法采用文献回顾、数据资料收集和现场调查的方法。结果中国制定落实了艾滋病病人免费抗病毒治疗的政策和策略,建立了医疗机构和疾病预防控制机构服务相结合的治疗模式,探索建立了免费抗病毒治疗的药品供应、经费保障机制,将抗病毒治疗药品纳入城镇职工基本医疗保险支付范围,推动了抗病毒治疗工作的迅速开展,明显降低了病人的病死率。当前抗病毒治疗工作面临治疗服务规模和能力有限、治疗药品供应和管理机制不能适合治疗发展需要、治疗与现行基本医疗保障体系脱节、流动人口异地治疗办法尚不完善等问题。结论需要进一步健全以定点医疗机构为依托的抗病毒治疗服务体系,结合医改重建满足治疗需求的免费抗病毒治疗药品供应保障机制,将抗病毒治疗纳入现行的医疗保障范围,加快探索异地抗病毒治疗的办法     

中国艾滋病抗病毒药物治疗信息系统的建立与现况

目的介绍中国建设艾滋病抗病毒药物治疗信息系统的运转方式、内容及系统建设的现状和存在问题,为进一步完善中国的抗病毒药物治疗信息系统提出建议。方法艾滋病抗病毒药物治疗信息系统,系统地收集所有接受抗病毒药物治疗的艾滋病病人治疗开始、随访、方案更换、终止及转诊的数据。以DataFax系统为数据收集方式,以艾滋病专报系统为平台进行数据库的反馈和共享。结果截至目前,中国已初步建立了艾滋病抗病毒药物治疗信息系统,为更好的管理、监督与评估中国艾滋病免费抗病毒药物治疗的进展和效果提供科学依据。结论通过加强人员培训、评估和检查,以及强化数据分析利用能力,将提高数据质量和数据利用效率,保证系统可持续的正常运转。     

吸毒艾滋病病人参加抗病毒治疗的影响因素及促进策略

尽管艾滋病抗病毒治疗能对吸毒艾滋病病人的健康状况产生积极作用,但目前治疗覆盖率仍较低。文章针对影响吸毒艾滋病病人参加抗病毒治疗的因素进行了综述,并总结了一些国家针对该人群实施的以成瘾治疗和社区卫生服务为基础的艾滋病治疗策略,以期为进一步促进中国吸毒艾滋病病人参加抗病毒治疗提供参考。     

近年国家艾滋病免费抗病毒治疗药品经费投入及采购问题与建议

分析近年国家艾滋病免费抗病毒治疗药品经费投入及采购问题，并提出改进建议。中央财政用于艾滋病防治的经费逐年增加，从20世纪90年代中期的1500万元增加到目前的8亿元左右。国家用于治疗和关怀领域的投入比例也逐年增加，而且所占艾滋病防治项目总资金的比例由1999年的5％左右增加到2006年的40．7％。但是，国家财政资金管理制度普遍要求提前一年制定经费预算，这与艾滋病抗病毒治疗药品需求变化快之间存在着一定矛盾。且艾滋病抗病毒治疗药品招标采购周期过长，国内外艾滋病抗病毒治疗药品生产企业数量均有限，招标采购中形成恶性价格竞争。为了避免年度中央财政预算与实际药品采购供应之间的矛盾，建议：（1）中央财政应建立一定额度的艾滋病治疗药品采购专项资金，而且在品种及数量方面不应该有限制，在实际采购时即可根据当时的情况确定采购的品种及数量；（2）应尽快确定艾滋病抗病毒治疗药品招标的采购模式；（3）现阶段在实施招标采购时，政府应制定艾滋病抗病毒治疗药品不同品目的政府采购指导价。     

2003-2012年濉溪县AIDS病人抗病毒治疗疗效分析

艾滋病病人抗病毒治疗可以有效地抑制体内的病毒复制,重建免疫功能,降低艾滋病相关疾病的发病率和死亡率。濉溪县自2003年11月开展国家免费抗病毒治疗工作以来,随着国家艾滋病综合防治示范区和第三轮中国艾滋病全球基金艾滋病项目的实施,治疗人数迅速增加,截至2012年底,累计治疗人数已达153人。为评价濉溪县艾滋病病人抗病毒治疗的效果,现对抗病毒治疗情况报告如下。1对象与方法1.1对象2003年11月至2012年12月,     

影响艾滋病抗病毒治疗效果有关因素的研究进展

目前高效抗逆转录病毒治疗（HAART）是治疗艾滋病的唯一方法,但是影响艾滋病抗病毒治疗效果的因素较复杂,该文对影响艾滋病抗病毒治疗效果的有关因素作一简要综述。     

新疆伊犁地区2014年HIV感染者抗病毒治疗效果及其影响因素分析北大核心

目的了解伊犁地区艾滋病病毒(HIV)感染者的抗病毒治疗效果及其影响因素,为提高生存质量,制定更加合理的治疗方案及控制艾滋病的传播蔓延提供科学依据。方法采用自行设计的调查问卷,对2014年1月至2015年2月开始抗病毒治疗的356例HIV感染者进行调查,同时通过艾滋病抗病毒治疗管理系统收集相关的实验结果和诊疗记录。结果 356例HIV感染者中,抗病毒治疗失败者101例(28.4%),在接受抗病毒治疗的各时间段内,治疗有效者CD4^+T淋巴细胞(简称CD4细胞)计数不断地上升,并在各时间段之间差异有统计学意义(P<0.05);治疗无效者CD4细胞计数变化情况不规律,从治疗第9个月开始不断地下降。通过单因素分析,年龄、治疗方案、最初临床分期(治疗前)、治疗时间、基线CD4细胞计数、病毒载量、漏服情况等,与抗病毒治疗失败相关,均有统计学意义(P<0.05);经过二元Logistic回归分析,接受治疗时间、漏服情况和最初临床分期,是抗病毒治疗的危险因素[比值比(OR)值分别为3.667,2.332,2.181]。结论伊犁地区HIV感染者接受抗病毒治疗前9个月治疗效果较好,随着治疗时间的延长,治疗效果不理想。应有针对性地开展预防艾滋病相关知识的宣传,加强对HIV感染者的管理和随访,可提高该地区抗病毒治疗的效果。     

第13届世界艾滋病大会抗病毒药物及其应用的研究进展

回顾抗艾滋病病毒药物和艾滋病治疗的发展历史,我们对1996年第11届世界艾滋病大会上高效抗病毒治疗的报道所引起的轰动依然记忆犹新,当时人们对艾滋病的治疗充满了信心,此后临床上开始了大规模的抗病毒治疗.然而,1998年第12届世界艾滋病大会的报道并没有向人们期待的那样——从感染者体内彻底清除病毒,治愈艾滋病,反而有大量的研究和临床事实表明高效抗病毒治疗带来了很多新的问题,如药物毒性和副作用、耐药性、治疗难以坚持、停药后病毒载量反弹等.于是人们开始分析和研究解决这些问题的方法和途径.主要集中在两个方面,一个是积极研究和发展新型抗病毒药物(第二代抗病毒药物),以取代或补充现有的抗病毒药物.另一个     

注射吸毒人群HIV/AIDS抗病毒治疗的研究进展

通过查阅相关文献了解并分析注射吸毒人群HIV感染者/AIDS患者(HIV/AIDS)抗病毒治疗的研究现状,为进一步完善我国注射吸毒人群中HIV/AIDS治疗策略提供参考依据。针对注射吸毒人群中HIV/AIDS,我国采取了针具交换、阿片类药物替代以及抗病毒治疗等措施治疗并预防新发感染,同时也广泛开展抗病毒治疗效果的评估研究,探讨了相关影响因素并不断优化药物治疗方案。今后需继续扩大检测监测覆盖面,最大限度地发现注射吸毒人群中HIV/AIDS,并尽早进行抗病毒治疗,提高依从性、降低其病死率。     

HIV感染者/AIDS病人死亡原因的研究进展

近年来,随着越来越多的艾滋病病毒（HIV）感染者进入艾滋病（AIDS）发病期,越来越多的感染者死于AIDS相关疾病。另外,随着抗病毒治疗的覆盖率不断扩大,HIV感染者/AIDS病人死于AIDS相关疾病的比例不断降低,而死于其他非AIDS相关疾病的比例却不断升高。文章就当前国内外对HIV感染者/AIDS病人死亡原因的有关研究进展进行综述,为医疗机构加强和提高对重点疾病的诊疗技术水平提供理论支持,也为中国AIDS死因监测的建立提供理论依据。     

300例艾滋病患者高效抗逆转录病毒治疗后免疫重建规律探讨

目的探讨高效抗逆转录病毒治疗（HAART）对中国南部地区艾滋病患者的免疫重建规律。方法收集近3年来300例患者的完整资料,按基线CD4^＋T细胞数分为A、B、C三组,观察基线及治疗1、3、6、12月末CD4^＋T淋巴细胞数、12月末血浆病毒载量（VL）、临床症状和毒副作用。结果抗病毒治疗12月末300例患者CD4^＋T淋巴细胞计数平均上升127个／1,以治疗3月后增长明显,3、12月末与基线CD4^＋T淋巴细胞计数比较差异有显著性（P〈0．05）;12月末273例（91％）患者血浆病毒载量（VL）〈5copies/ml,27例（9％）患者病毒载量（VL）〉50copies/ml,高病毒载量A组16例,C组4例;A组与C组比较差异有显著性（P〈0．05）;药物不良反应主要是外周神经炎（35．4％）、骨髓抑制（18．2％）、皮疹（15．2％）、肝功能损害（12．1％）、乳酸酸中毒（12．1％）和肾结石（6．1％）。结论HAART治疗对中国南部地区的艾滋病患者有效,能够实现免疫重建,但存在较多毒副作用。     

Is age a negative prognostic indicator in HIV infection or AIDS?

To better understand disease progression in older persons with human immunodeficiency virus (HIV infection or acquired immunodeficiency syndrome (AIDS), we studied patients aged 50 years and older hospitalized with a diagnosis of HIV infection or AIDS between January 1985 and October 1995. Data collected included demographics, opportunistic infections, comorbid disease, neurologic dysfunction, and antiretroviral therapy. A total of 86 patients with a mean age of 54.3 years was identified. Pneumocystis carinii pneumonia was the most frequent opportunistic infection (43%). Hypertension was the most common previous medical condition (38%). Other comorbid disease was present in less than 15% of the subjects. Fifty-seven patients (66%) had neurologic impairment, with 30 requiring treatment for delirium. In these 30, 23 (77%) had anemia, infection, or both. The median length of survival following the diagnosis of AIDS was 18.5 months, for HIV it was 48 months. The median survival following the diagnosis of AIDS in patients who received antiretroviral therapy was 22 months compared with 11 months for those who did not receive antiretroviral therapy (p < 0.0004). Multivariable analysis found that antiretroviral therapy was the only independent predictor of survival after the diagnosis of AIDS. In contrast to previous studies, the present findings suggest that older age may not necessarily be associated with more rapid disease progression and reduced survival times in persons with HIV infection or AIDS. In those patients with delirium, many may have readily treatable conditions (anemia and/or infection). The absence of significant comorbid disease and the access to antiretroviral therapy may be in part responsible for the longer survival times obtained in this cohort compared to that reported previously.     

Intensive care of patients with HIV infection

Despite the improvements in the prognosis associated with the development of highly active antiretroviral therapy (HAART), more than 410,000 people in the United States were reported to have died from acquired immune deficiency syndrome (AIDS) by the end of 1998. The number of people living with human immunodeficiency virus (HIV) infection and AIDS in the United States continues to increase, estimated at more than 370,000 in 1998, and there is good reason for optimism that HIV infection may be a controllable disease in many people. Nevertheless, an estimated 27,000 persons still died of AIDS in the United States in 1997, and AIDS is still a leading cause of death in the age group 25 to 44 years. Despite the dramatic treatment advances for HIV infection and improving survival following an AIDS diagnosis, many patients still present with life-threatening complications of HIV infection for three major reasons. Highly active antiretroviral therapy and prophylaxis against Pneumocystis carinii and other infections are not effective in all patients, despite rigorous adherence to treatment. Others adhere to these therapies poorly. Finally, many patients present with advanced disease, unaware that they have HIV infection until they develop a serious opportunistic infection. Therefore, the AIDS epidemic and its burden of illness will continue, and decisions regarding the appropriateness of intensive care for individual patients will be inevitable. The impact of AIDS in Africa and Asia is far more devastating than in the United States and Europe, and most HIV-infected persons in the world live in the underdeveloped nations where intensive care is often unavailable. This article will deal with intensive care in patients with HIV in developed nations.     

Association between risk of acquiring HIV and beliefs and perceptions about the lived experience of HIV/AIDS among HIV-negative or untested men who have sex with men

The study aim was to assess whether the sexual behaviour of HIV-negative or untested men who have sex with men (MSM) was related to their perceptions of what it is like to live with HIV/AIDS, their beliefs or their attitudes to highly active antiretroviral treatments. Any unprotected anal intercourse (UAI) with casual partners was used as the sexual-risk indicator. The study enrolled 261 MSM. There were no significant differences between beliefs, attitudes and perceptions about HIV/AIDS, knowledge of post-exposure prophylaxis (PEP) or exposure to the HIV/AIDS epidemic among those who had had UAI with casual partners and those that had not (P>0.12). Those who considered that low levels of viral load and withdrawing before ejaculation reduced the risk of HIV transmission were significantly more likely to have had UAI with a casual partner (P=0.03). Only a minority of MSM engaging in UAI were optimistic about antiretroviral therapy. The study participants were in general pessimistic about life with HIV/AIDS despite their risk-taking sexual behaviour.     

Factors Associated with Treatment Satisfaction Among People Living with HIV in Japan and Other Selected Countries: Examination of the Intertwined Roles of Medication,Patient, and Provider Characteristics

AIDS and Behavior - We examined satisfaction and perceived challenges with antiretroviral therapy (ART) among people living with HIV (PLHIV) in Japan vs three other Asian countries (China, Taiwan,...     

Treatment of HIV-related tuberculosis—unresolved issues

Abstract:   Tuberculosis (TB) is one of the most common opportunistic infections among persons with HIV infection. However, there are uncertainties about both TB and HIV treatment regimens among patients with advanced immunodeficiency. On the TB treatment side, there are lingering concerns about whether patients with advanced immunodeficiency should have a more intensive regimen for TB treatment (longer duration, more frequent [daily] dosing and/or post-treatment isoniazid). The use of antiretroviral therapy among patients with TB and AIDS dramatically decreases the risk of death and other opportunistic infections. However, use of antiretroviral therapy during TB treatment is complicated by the need to coordinate the activities of the TB control program and the HIV care clinic, overlapping side-effect profiles of anti-TB and antiretroviral drugs, drug–drug interactions between the rifamycins and many antiretroviral drugs, and the occurrence of immune reconstitution inflammatory syndrome events. The combination of rifampin-based TB treatment and efavirenz-based antiretroviral therapy is clearly the best option for cotreatment of these two infections. However, there are a number of uncertainties about the optimal antiretroviral therapy if efavirenz cannot be used (because of intolerance, drug resistance, pregnancy or lack of an appropriate formulation in children). The competing risks of AIDS events and severe immune reconstitution inflammatory syndrome events raise uncertainties about the optimal timing of antiretroviral therapy during TB treatment. Despite all of these complexities, the treatment of HIV-related TB can be remarkably successful. I review these unresolved questions in the treatment of HIV-related TB and suggest studies to help resolve them.     

AIDS抗病毒治疗的历史、现状与未来

高效抗逆转录病毒治疗（highly active antiretroviral therapy,HAART）显著降低了HIV相关疾病的病死率,使HIV／AIDS的临床治疗取得了突破性进展,但HAART不能彻底清除患者体内的病毒。长期服药带来的不良反应、病毒耐药性、患者服药依从性与经济负担等问题已成为抗病毒治疗失败的主要原因。本文就国内外AIDS抗病毒治疗的历史和现状进行回顾,并对抗病毒治疗的未来进行展望。     

The influence of disclosure of HIV diagnosis on time to disease progression in a cohort of Romanian children and teens

The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that in 2004, there were 39.4 million people living with HIV/AIDS worldwide (UNAIDS/WHO Report on the global HIV/AIDS epidemic, 2004). Children less than 15 years of age comprise 2.2 million of these individuals. As more children globally gain access to highly active antiretroviral therapy (HAART), more children are growing to the age when disclosure of their HIV status is inevitable. This information may affect a child's disease trajectory, and in the context of HAART, may have wide-ranging impact in the management of paediatric HIV infection. This study is an investigation of the effect of disclosure of a child's own HIV infection status on death and CD4 decline in a cohort of 325 HIV-infected Romanian children receiving highly active antiretroviral therapy (HAART). A retrospective database analysis was conducted. Data from a nearly three-year period were examined. Children who were aware of their HIV diagnosis were compared with those who were not aware. We found significant associations between not knowing the HIV diagnosis and death, and not knowing the HIV diagnosis and disease progression defined as either death or CD4 decline. Our results imply that in the context of HAART, knowledge of one's own HIV infection status is associated with delayed HIV disease progression.