HIV／AIDS病人ART相关性高乳酸血症的预测因素分析

目的探讨艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人进行抗反转录病毒治疗（ART）中,发生高乳酸血症（LAHL）的预测因素分析。方法回顾性分析2005年1月-2012年5月,门诊进行ART的随访AIDS病人出现LAHL的临床资料,对相关性数据进行统计学分析。结果在191例门诊进行ART随访的AIDS病人中,有71例发生LAHL,其中女性34例（χ2=6.147,P〈0.01）,服用D4T的42例（χ2=7.784,P〈0.01）,服用核苷类反转录酶抑制剂（NRTIs）药物超过1年以上59例（χ2=18.100,P〈0.01）。发生LAHL病人相比未发生LAHL病人更容易出现丙氨酸转氨酶（ALT）、天冬氨酸转氨酶、乳酸脱氢酶（LDH）、γ-谷酰转肽酶（GGT）升高,差异有统计学意义（P〈0.01）。在多因素非条件Logistic回归分析中,女性[比值比（OR）10.923,95%可信区间（CI）：1.067～111.836]、ALT升高（OR1.09,95%CI：1.017～1.168）、LDH升高（OR1.025,95%CI：1.007～1.043）,均为发生LHAL的预测因素。在ART中CD4T淋巴细胞计数升高病人中LAHL发生率低（OR0.991,95%CI：0.983～0.999）。结论 AIDS病人服用NRTIs药物,尤其是服用D4T、女性、服药时间超过1年以上,是发生LAHL的预测因素。在ART过程中出现ALT、GGT、LDH升高,要高度警惕是否存在LAHL风险,避免进一步发展成致死性的乳酸酸中毒。     

HIV/AIDS病人HAART相关的高乳酸血症/乳酸酸中毒研究进展

在发展中国家,由于高效抗反转录病毒治疗(HAART)的引进和广泛地应用,使得艾滋病(HIV/AIDS)病人的患病率和病死率大大下降。中国自从2003年开始,在政府的倡导下,广泛开展艾滋病的免费抗病毒治疗,其主要的方案是以核苷类药物(NRTIs)司他夫定(d4T)、齐多夫定(AZT)或去羟肌苷(DDI)为骨干的,而核苷类药物的主要不良反应是线粒体毒性。在线粒体毒性中最严重的甚至是威胁生命的高乳酸血症和乳酸酸中毒。文章就高乳酸血症的发生率、发生机制、临床表现、诊断、治疗和预后进行综述。     

HAART伴乳酸酸中毒1例报告

某女,51岁,已发现艾滋病病毒(HIV)抗体阳性10个月,伴乏力、纳差、恶心、胸闷1月余,于2007年6月11日入院.患者于2006年8月因不明原因发热及腹泻而入住唐都医院传染科.     

艾滋病抗病毒治疗乳酸酸中毒及高乳酸血症32例临床分析

乳酸酸中毒和高乳酸血症被认为是核苷类反转录酶抑制剂（NRTI）引起的严重甚或致命的远期副作用。广西壮族自治区疾病预防控制中心（CDC）门诊收治32例艾滋病（AIDS）抗病毒治疗乳酸酸中毒及高乳酸血症病人,现将其临床表现、诊疗经过及预后总结报告如下。     

HIV/AIDS合并血小板减少患者HAART后血小板复常的特征及影响因素分析

目的分析HIV/AIDS合并血小板减少患者在高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)后血小板的复常特征,探讨影响复常的相关因素。方法采用回顾性分析,以2003年6月—2015年12月在北京地坛医院进行抗病毒治疗的132例HIV/AIDS合并血小板减少的患者为研究对象,分析患者HAART 4周和24周后血小板的复常率及基本特征。结果 1 132例患者中血小板轻度减少99例(75.00%),中度减少19例(14.39%),重度减少14例(10.61%)。患者HAART 4周、24周后血小板的复常率分别为63.9%、80.8%,差异具有统计学意义(P=0.003)。2单因素Logistic分析提示通过血液传播(OR=4.632,P=0.024),合并HBs Ag阳性(OR=3.829,P=0.024)及合并抗HCV阳性(OR=6.476,P=0.020)是影响血小板复常的因素,多因素Logistic分析提示合并HBs Ag阳性(OR=4.345,P=0.027)是影响血小板复常的因素。结论 HAART为HIV/AIDS合并血小板减少最有效的方法,尽早HAART可避免血小板持续降低。HBs Ag阳性是影响血小板复常的主要因素。对于存在危险因素的患者应该给予重视,尽早做出干预措施。     

23例HIV/AIDS病人HAART致乳酸酸中毒临床分析

目的探讨艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人在高效抗反转录病毒治疗(HAART)过程中,出现乳酸酸中毒的情况,其临床表现、诊断、治疗和预后,以进一步采取预防措施,降低其发生率和致死率。方法采用回顾性分析的方法,分析HAART时间及不同方案发生乳酸酸中毒的情况。结果 2010年1月-2011年8月收治的住院病人中,已经进行HAART的共1 115例,出现高乳酸血症者74例,占6.64%;发生乳酸酸中毒的病人23例,发生率2.06%。所有发生乳酸酸中毒的病人都采用含司他夫定(D4T)的方案。经过综合治疗的18例治愈,死亡5例,总死亡率21.74%(5/23)。HAART 6个月以上及应用含D4T方案的病人发生率最高,为4.41%(23/521)。结论乳酸酸中毒的发生率虽低,致死率高,且临床表现多不典型,易被误诊、漏诊;危险因素包括肥胖、女性、合并HCV应用干扰素利巴韦林治疗的病人、以及同时合并其他机会性感染病人等。     

32例HIV/AIDS患者HAART治疗效果

目的为了了解高效抗逆转录病毒治疗(HAART)有效组合,减轻药物的毒副作用,增强疗效,改善艾滋病(AIDS)患者和艾滋病病毒(HIV)感染者生存质量。方法对32例AIDS/HIV患者,采用国产HAART:奈韦拉平(NVP) 司它夫丁(D4T) 去羟肌苷散(DDI)常规服药,治疗观察时间6个月。结果30例CD4计数平均增加130±130.38个/μl;CD4/CD8比值平均增加0.207±0.104,2例(57岁、62岁各1例)治疗1~2个月后因肺部感染而死亡。提示HAART能够有效促进免疫重建,减轻症状,延长生命;但治疗开始时间与HIV感染的时间、年龄、CD4细胞和CD4/CD8比值有明显的相关性。结论治疗要抓住有利时机,尽可能早治疗,促进和加快免疫重建。尤其对儿童与老年人更应选择有利时机早治疗。     

13例AIDS病人在HAART治疗过程中机会性感染的诊治分析

机会性感染（Opportunistic infections,OI）是条件性病原体在人体免疫功能损伤、防御功能降低情况下所发生的炎症性疾病。文献报道,几乎80％的艾滋病（AIDS）患者因机会性感染而死亡。收集青春医院13例AIDS病人在高效抗逆转录病毒治疗（HAART）过程中发生的机会性感染情况,作一回顾性分析。     

HAART在儿童中应用的特殊问题

与成人相比,儿童艾滋病抗病毒治疗有其特殊性.药物代谢更快,剂量要根据体表面积或体重来计算.不良反应与成人类似,肝毒性的发生率还要低一些.疗效良好,显著降低了儿童艾滋病相关的发病率和死亡率.对儿童患者来说,治疗依从性问题更为突出,其父母/监护人是关键,药物口味也是一个影响因素.由于儿童艾滋病患者进展更快,抗病毒治疗要更积极.     

Risk factors for and clinical characteristics of severe hyperlactataemia in patients receiving antiretroviral therapy: a case–control study

Background

Symptomatic hyperlactataemia and lactic acidosis (SHLA) are potentially life‐threatening complications associated with stavudine (d4T), an antiretroviral therapy (ART) drug widely used in developing countries.

Methods

Cases comprised all symptomatic patients with measured lactates ≥5 mmol/L referred to a South African hospital between August 2003 and November 2005. Matched controls were selected according to facility and duration on ART.

Results

Seventy‐one cases and 142 controls were included in the study. The majority of cases presented between 6 and 18 months on ART. Female sex [adjusted odds ratio (AOR) 23.4; 95% confidence interval (CI) 4.0–136.6], a baseline weight between 60 and 75 kg (AOR 4.5; 95% CI 1.4–14.1) or, in particular, ≥75 kg (AOR 19.4; 95% CI 4.1–82.5) at ART initiation and gaining ≥6 kg in the first 3 months on therapy (AOR 3.5; 95% CI 1.3–9.5) were independent risk factors identifying patients who may subsequently develop SHLA. Weight loss of ≥2 kg (AOR 6.1; 95% CI 2.0–18.3), a rise in alanine aminotransferase (ALT) ≥10 U/L (AOR 3.1; 95% CI 1.1–8.9), the presence of at least one of three major symptoms (vomiting, nausea and abdominal pains) of SHLA (AOR 12.6; 95% CI 3.3–47.2) and peripheral neuropathy (AOR 3.4; 95% CI 1.1–9.8) were the clinical parameters that were most able to identify patients with early manifestations of SHLA.

Conclusions

This is the first case–control study for SHLA in Southern Africa. Given these findings, we advise that stavudine is avoided in overweight women. Weight loss, a rise in ALT, peripheral neuropathy and/or gastrointestinal symptoms should prompt healthcare workers to assess for SHLA, especially at between 6 and 18 months on ART.     

河南省2007-2012年首次接受抗病毒治疗的AIDS病人入组时的流行病学特征

目的了解河南省2007-2012年首次加入国家免费抗病毒治疗项目的艾滋病（AIDS）病人,入组时的流行病学特征。方法收集河南省2007-2012年开始接受抗病毒治疗的艾滋病病人的基本信息,分析其流行病学特征和变化趋势。数据采用Excel 2010进行了整理,使用SPSS 17.0软件进行统计学分析。结果 19 909例AIDS病人平均年龄为（43.96±10.95）岁,56.73%为男性,已婚或者同居者占73.98%。经血液途径感染13 393例（67.27%）,经异性性途径感染4645例（23.33%）,经同性性途径感染419例（2.10%）。基线CD＋4T淋巴细胞计数的平均值是（198.72±168.38）个/μL,HIV确认阳性时间与开始治疗时间的间隔天数的中位数为280（P25=29,P75=1418）天。64.46%的病人首次接受抗病毒治时,采用D4T/AZT/TDF＋3TC＋NVP方案。结论河南省艾滋病抗病毒治疗时机的选择较之以前有所提前,应进一步采取措施早发现和积极治疗艾滋病病人,同时重视复方新诺明预防治疗工作。     

A literature review on cardiovascular risk in human immunodeficiency virus-infected patients: implications for clinical management

IntroductionIn recent years, there has been growing concern about an increasing rate of cardiovascular diseases in human immunodeficiency virus-infected patients, which could be associated with side effects of highly active antiretroviral therapy. It is likely that the metabolic disorders related to anti-human immunodeficiency virus treatment will eventually translate into a increased cardiovascular risk in patients submitted to such regimens.ObjectiveTo evaluate if human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy are at higher risk of cardiovascular diseases than human immunodeficiency virus infected patients not receiving highly active antiretroviral therapy, or the general population.Research design and methodsWe conducted a computer-based search in representative databases, and also performed manual tracking of citations in selected articles.ResultThe available evidence suggests an excess risk of cardiovascular events in human immunodeficiency virus-infected persons compared to non-human immunodeficiency virus infected individuals. The use of highly active antiretroviral therapy is associated with increased levels of total cholesterol, triglycerides, low-density lipoprotein and morphological signs of cardiovascular diseases. Some evidence suggested that human immunodeficiency virus-infected individuals on highly active antiretroviral therapy regimens are at increased risk of dyslipidemia, ischemic heart disease, and myocardial infarction, particularly if the highly active antiretroviral therapy regimen contains a protease inhibitor.ConclusionPhysicians must weigh the cardiovascular risk against potential benefits when prescribing highly active antiretroviral therapy. Careful cardiac screening is warranted for patients who are being evaluated for, or who are receiving highly active antiretroviral therapy regimens, particularly for those with known underlying cardiovascular risk factors. A better understanding of the molecular mechanisms responsible for increased risk of cardiovascular diseases in human immunodeficiency virus-infected patients will lead to the discovery of new drugs that will reduce cardiovascular risk in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy.     

艾滋病高效抗反转录病毒治疗并发高脂血症的研究进展

高效抗反转录病毒疗法（HAART）使艾滋病病毒（HIV）感染者的病死率明显下降,极大地提高了艾滋病（AIDS）病人的生存率。随着治疗时间的延长,病人长期服用抗病毒药物引起的代谢异常日益受到重视,其中HAART相关的高脂血症因可能使心血管病风险升高而备受关注。该文就HAART治疗并发的高脂血症的流行病学、发病机制及干预治疗策略的相关进展进行了阐述。     

Outcome of HIV-infected patients with invasive squamous-cell carcinoma of the anal canal in the era of highly active antiretroviral therapy

PURPOSE: Before the development of highly active antiretroviral therapy for the treatment of HIV infection, HIV patients diagnosed with invasive squamous-cell carcinoma of the anal canal carried a very poor prognosis. This study was designed to determine the outcome in a similar group of patients in the era of highly active antiretroviral therapy.METHODS: HIV-positive patients treated for invasive squamous-cell carcinoma of the anal canal at the University of Texas Medical Center affiliated hospitals from 1980 to 2001 were identified from operative data and cancer registries. We reviewed these records and collected data regarding age, CD4 count, highly active antiretroviral therapy, cancer treatment, complications, and survival. The patients were divided into two groups based on the presence or absence of highly active antiretroviral therapy and compared using a Kaplan-Meier approach.RESULTS: Fourteen patients with HIV and invasive squamous-cell carcinoma of the anal canal were identified. Six were in the prehighly active antiretroviral therapy group and eight in the highly active antiretroviral therapy group. All were considered for treatment with chemotherapy and radiation. In the prehighly active antiretroviral therapy group, one patient refused therapy and three were unable to complete the squamous-cell carcinoma therapy as planned because of complications. Four of eight highly active antiretroviral therapy patients were unable to complete the squamous-cell carcinoma therapy as planned. The prehighly active antiretroviral therapy patients had a mean age of 40 years and a mean CD4 count of 190 at the time of diagnosis. The highly active antiretroviral therapy patients had a mean age of 44 years and a mean CD4 count of 255 at the time of diagnosis. The 24-month survival was 17 percent in the prehighly active antiretroviral therapy group and 67 percent in the highly active antiretroviral therapy group (P = 0.0524). All six patients in the prehighly active antiretroviral therapy group died with active squamous-cell carcinoma vs. two in the highly active antiretroviral therapy group. Four of the remaining six patients had no evidence of active squamous-cell carcinoma at the last follow-up visit.CONCLUSIONS: A review of patients with HIV and invasive squamous-cell carcinoma of the anal canal suggests a trend toward a higher CD4 count at the time of diagnosis and improved survival in patients receiving highly active antiretroviral therapy. In this new era, HIV-positive patients should be on highly active antiretroviral therapy. If not, highly active antiretroviral therapy should be initiated, and standard multimodality therapies for invasive squamous-cell carcinoma of the anal canal are recommended.Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

Heart and HAART: Two sides of the coin for HIV-associated cardiology issues

The introduction of highly active antiretroviral therapy (HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome. In developed countries, we have observed an approximately 30% reduction in the prevalence of human immunodeficiency virus (HIV)-associated cardiomyopathy, possibly related to a reduction of opportunistic infections and myocarditis. In developing countries, however, where the availablity of HAART is limited and the pathogenic impact of nutritional factors is significant, we have observed an approximately 32% increase in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure. Also, some HAART regimens in developed countries, especially those including protease inhibitors, have been shown to cause, in a high proportion of HIV-infected patients, an iatrogenic metabolic syndrome (HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis, even in young HIV-infected people. Careful cardiac screening is warranted for patients who are being evaluated for, or who are receiving, HAART regimens, particularly for those with known underlying cardiovascular risk factors. A close collaboration between cardiologists and infectious disease specialists is needed for decisions regarding the use of antiretrovirals, for a careful stratification of cardiovascular risk factors, and for cardiovascular monitoring of HIV-infected patients receiving HAART, according the most recent clinical guidelines.     

无国界医生及广西壮族自治区疾病预防控制中心艾滋病项目三年抗病毒治疗结果分析

目的 分析无国界医生及广西壮族自治区疾病预防控制中心AIDS免费综合治疗关怀项目(以下简称项目)3年治疗结果及面临的挑战.方法 回顾性分析2003年12月-2006年12月随访的432例接受高效抗逆转录病毒治疗(HAART)患者的治疗结果.结果 成年患者病死率为6.5%,失访率为2.8%.接受治疗9～15个月和21～27个月的患者,CD+4T细胞计数增长分别为147个/μl和246个/μl.2006年3月-12月进行的治疗依从性评估显示,95.9%的患者依从性≥95%.在接受HAART的30例儿童中,4例(13.3%)死亡,抗病毒治疗后9～15个月CD+4T细胞计数平均增长值为673个/μl;治疗后21～27个月CD+4 T细胞计数平均增长值为658个/μl.148例静脉注射吸毒者(IDU)或既往IDU接受了HARRT,其病死率和失访率与非IDU人群的差异无统计学意义(Logrank test,P=0.91).结论 联合抗病毒治疗取得了很好的中期治疗结果.完全免费的关怀和治疗、对患者强有力的咨询和支持是项目成功的关键因素.     

高效抗逆转录病毒治疗对人类免疫缺陷病毒感染患者骨密度的影响

目的 评价高效抗逆转录病毒治疗(HAART)对HIV感染患者骨密度(BMD)的影响及其相关因素.方法 收集2007-2008年间50例接受HAART的HIV/MDS患者(治疗组)、12例未用HAART的HIV/AIDS患者(未治疗组)、20例健康对照者(对照组)的临床资料,采用双能X线BMD吸收仪(DEXA)测定BMD以及T值,分别对其数据进行统计分析.结果 治疗组中19例(38.0%)患者发生骨量减少,1例(2.0%)患者发生骨质疏松.对照组中5例(25.0%)发生骨量减少,无骨质疏松者.未治疗组中6例(50.0%)患者发生骨量减少,2例(16.7%)患者发生骨质疏松.未治疗组骨量减少/骨质疏松发生率较对照组显著增高(P=0.02).HIV/AIDS组(包括未治疗组和治疗组)的股骨、股骨颈、大粗隆的BMD[(0.97±0.14)、(0.91±0.13)、(0.76 4-0.12)g/cm2]明显低于对照组[(1.04±0.12)、(0.98±0.14)、(0.84±0.11)g/cm2,P<0.05];而未治疗组和治疗组的BMD差异无统计学意义.治疗组中,骨量减少/骨质疏松与体重<60 kg(r=0.074,P=0.004)、使用HAART前血浆病毒载量(r=5.103,P=0.021)呈正相关.结论 未接受HAART的HIV/AIDS患者较健康人骨量减少/骨质疏松发生率高.HIV/MDS患者BMD较健康人低,接受HAART和未接受HAART治疗的HIV/AIDS患者BMD相当.接受HAART患者中,体重<60 kg、治疗前HIV RNA是发生骨量减少/骨质疏松的危险因素.     

糖皮质激素在艾滋病免疫重建炎性综合征中的应用分析

目的探讨分析糖皮质激素在艾滋病（AIDS）免疫重建炎性综合征（IRIS）中的应用价值。方法回顾性分析AIDS高效抗逆转录病毒治疗（HAART）过程中发生IRIS而使用糖皮质激素治疗的19例患者的临床资料。结果 IRIS并发肺结核10例、结核性胸膜炎4例、颈淋巴结结核2例、结核性脑膜炎1例、隐球菌脑膜炎2例。表现为持续发热19例（100%）,头痛呕吐3例（15.8%）。使用激素治疗前均给予非甾体类抗炎药物对症处理无效,经糖皮质激素治疗后好转。结论糖皮质激素可改善IRIS并发结核病、隐球菌脑膜炎的临床症状,提高患者治疗的依从性。