HIV revisited: the global impact of the HIV/AIDS epidemic

This review is intended as an update on modern trends in the global impact and epidemiology of human immunodeficiency virus infection for physicians who are not acquired immunodeficiency syndrome experts. Africa has been the most affected, but epidemics are spreading in Asia and Russia. Therefore, physicians should be informed about seroconversion disease and human immunodeficiency virus diagnosis as well as the impact of sexually transmitted infections on many stages of human immunodeficiency virus. International treatment guidelines are available. Highly active antiretroviral therapy has been the mainstream therapy since 1996, but all drugs--regardless of class used--have potent side effects, many of which are dermatologic. Others affect the neurologic, hematopoietic, cerebral, and abdominal systems, and drug interactions are common. Lipodystrophy is a common, long-term side effect that is still not well understood. Broader use of highly active antiretroviral therapy has highlighted viral resistance. This is reviewed, and a simple explanation of therapeutic monitoring is provided.     

Treatment of urinary incontinence in epispadias at the beginning of the third millenium

The treatment of urinary incontinence in epispadias is delicate. Urinary continence is generally obtained after onerous and repetitive surgery. Different publications show a variable results. After the study of the results of our series (nine cases) and the results published in the literature, we propose a clarification on the therapeutic modalities of urinary incontinence associated to this malformation.     

Clinical features of surgical diseases at the patients with HIV/AIDS

Results of treatment of HIV-infected patients with surgical diseases are analyzed. These results are compared with ones at non-infected patients. The standards of surgical operations at HIV-infected patients are that permits to optimize surgical tactics at HIV/AIDS patients and to improve treatment results.     

The unveiling of traumatic brain injury in an HIV/AIDS population

This study examines the frequency of traumatic brain injury (TBI) in an HIV/AIDS population and its associated symptomatology. A panel of 173 individuals with HIV were split into two groups - those who have experienced a blow to the head within their lifetime (n = 128) and those who have not (n = 45). Self-reported symptoms from the TIRR Symptom Checklist were compared across both HIV panels, individuals who identified as traumatically brain injured (n = 416), and individuals with no disability (n = 282). Six clusters of symptoms (total, cognitive, physical, affective/behavioural, five symptoms sensitive and specific to TBI in general and 25 symptoms sensitive and specific to mild TBI) were analysed in a MANOVA, controlling for the demographic variables that were correlated with total symptoms, including panel membership, education, annual household income and substance use history. Significant main effects were found for panel membership. Individuals with HIV and a history of blow to the head reported a higher number of total symptoms and the 25 symptoms specific to mild TBI. The significance of these findings acknowledges the need to recognize the frequency of TBI in an HIV population and the subsequent need to provide the appropriate interventions that will lead to an enhanced overall quality of life.     

Current clinical aspects of HIV/AIDS

OF NEW CLINICAL DEMONSTRATIONS: Since the use of HAART, morbidity and mortality in HIV-infected patients have decreased dramatically. But increased survival in these patients is associated with other diseases (malignant diseases, inflammatory reactions after initiation of HAART) and with drug toxicity (lipodystrophy, mitochondrial toxicity). TRANSMISSION AND REVELATION: Despite widespread information on HIV, new HIV-infected patients with an AIDS-defining illness are still detected. At present, heterosexuality is the most frequent risk factor for HIV-infection (51%). Pneumocystis pneumonia remains the most common opportunistic illness in HIV-infected patients (28%).     

HIV/AIDS患者配偶心理体验的质性研究

目的 了解HIV/AIDS患者配偶在患者患病过程中的真实心理感受.方法 采用现象学研究法对30例HIV/AIDS患者的配偶进行深入访谈,将获得的资料分析整理,提炼出主题.结果 HIV/AIDS患者配偶在患者患病过程中情绪变化和应对方式有性别差异.他们的心理体验主要有3个方面:①确诊初期有否认、愤怒、恐惧、不知所措和获得信息的强烈愿望,经短期的适应后痛苦地接受事实;②在患者治疗过程中他们感到巨大的压力,包括经济压力、精力和体力不支、被周围人群歧视等;③社会适应能力改变.结论 HIV/AIDS患者配偶存在疾病事实、经济、精力及社会适应压力的心理体验,需对其提供医疗性、信息性、情感性支持和经济援助.     

Pathology of the breast associated with HIV/AIDS

Breast pathology that is characteristic of patients infected with human immunodeficiency virus (HIV) has not been addressed in the literature. HIV may directly and indirectly affect the glandular, mesenchymal, and intramammary lymphoid tissue in seropositive patients. Likely infections in this setting include tuberculous mastitis and pyogenic abscesses that may lead to fatal septicemia. Benign stromal changes include gynecomastia, adipose tissue deposition as part of the fat maldistribution syndrome, and pseudoangiomatous stromal hyperplasia. Breast carcinoma in HIV-infected patients occurs at a relatively early age, with increased bilateral disease, unusual histology, and early metastatic spread with a poor outcome. However, the link between breast cancer and HIV remains controversial. Kaposi's sarcoma and non-Hodgkin's lymphoma may also be localized to the breast in patients with acquired immunodeficiency syndrome (AIDS). This article reviews benign and malignant breast diseases that are likely to be encountered in patients with HIV/AIDS.     

HIV感染者/AIDS患者自我管理量表的编制

目的编制测评HIV感染者/AIDS患者自我管理能力的工具。方法通过文献回顾、患者访谈、专家咨询和预调查形成试测量表,选取360例接受抗病毒治疗的HIV感染者/AIDS患者进行正式调查,检验量表信度和效度。结果量表共7个维度49个条目。条目水平的内容效度指数(I-CVI)为0.786~1.000;探索性因子分析提取14个特征值大于1的公因子,累积方差贡献率为61.694%,经合并公因子组合成维度后,5个条目所属维度发生迁移,4个条目在2个维度的载荷均大于0.3。总量表Cronbach′sα系数0.853,重测信度0.879。结论 HIV感染者/AIDS患者自我管理量表的信度和效度尚可接受,仍需完善相关鉴别力不够的条目。     

Vascular disease in HIV/AIDS patients.

OBJECTIVES: An ongoing prospective clinical survey to determine the spectrum of vascular disease in HIV/AIDS patients and the risk factors affecting clinical outcome in order to formulate a management protocol for future use. METHODS: Comprehensive screening for risk factors for vascular disease as well as HIV/AIDS-related conditions. Disease pattern and presentation are noted and patients treated accordingly. Vascular emergencies are managed regardless of HIV status because this information is usually not available at the time of presentation. Elective management is based on immune status and risk stratification. RESULTS: 42 patients tested positive for HIV. The majority of patients presented with occlusive disease (57%), followed by aneurysms (21%) and vascular trauma (19%). A variety of vascular surgical procedures were performed on 36 patients. There was no surgical mortality and 10 patients developed complications, including 2 amputations and 7 cases of minor wound sepsis. The 3 patients who received preoperative antiretroviral therapy showed a marked reduction in viral count and a significant improvement in CD4 T-cell count. CONCLUSION: Surgery can be safe and effective in HIV-positive patients provided the necessary precautions are taken to reduce surgical morbidity.