Evaluation of bone mineral density in Iranian HIV/AIDS patients

Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy (na?ve patients) and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects (77.3% in HIV positive na?ve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002). Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group (P=0.003). Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection (P<0.0001) and antiretroviral treatment (P=0.012). Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment.     

Impact of HIV/aids epidemic on human capital development in West Africa

West Africa occupies the third position with respect to the burden of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) globally, after Southern and East Africa. About 5 million adults and children are infected with the disease in the subregion, while HIV prevalence in the general population hovers around 2% and 5%. This paper attempts to investigate the impact of HIV/AIDS epidemic on human capital development in 11 West African countries over the period 1990 to 2011. The study used a dynamic panel data modeling approach, using first difference, difference generalized methods of moment, and system generalized methods of moment estimating techniques. Four measures of HIV/AIDS and 2 human capital measures were used in the study. The findings revealed that HIV/AIDS pandemic had negative and significant impact on human capital in West Africa. However, the statistical significance was more pronounced on life expectancy (a measure of human capital), while the negative impact on school enrolment (another human capital measure) was not significant. It is therefore recommended that the spread of HIV/AIDS disease in West Africa should be effectively controlled, while the number of infected persons undergoing antiretroviral therapy in the subregion should be increased to a near 100% coverage.     

The 14th International Aids Conference: 'Knowledge,commitment and action'

During the world AIDS conference in Barcelona it became clear that the worst-case scenario of 10 years ago has become a reality: the HIV epidemic is continuing to spread. Also in industrialised countries the incidence of HIV infections among homosexual men is once again increasing. An HIV vaccine is still not available. Although the development of antiretroviral therapy continues, HIV inhibitors do not result in an eradication of HIV. It is still not clear as to when therapy can best be started and what the consequences are of temporarily withdrawing therapy. In countries where HIV inhibitors are widely available, the life expectancy of HIV-infected persons is increasing. The life expectancy of HIV patients will possibly decrease again due to an increased resistance towards the currently available antiretroviral drugs.     

The Médicins sans Frontières HIV/AIDS programme in Ukraine

In 1999, Médicins sans Frontières started an HIV/AIDS programme in Ukraine, a country with an estimated 410,000 people with HIV (1.4% prevalence), including 53,000 in urgent need of antiretroviral therapy. Between 1999 and 2004, a comprehensive HIV/AIDS programme was implemented in close collaboration with the Ministry of Health in AIDS centres in Odessa, Mikolaev and Simferopol. Initial activities included prevention and treatment advocacy campaigns, which were later followed by prevention of mother-to-child transmission, treatment of opportunistic infections, antiretroviral therapy for infants and adults and palliative care. This programme has served as a model and has led to meaningful improvements in HIV/AIDS care in Ukraine. It demonstrates that adequate care for patients with HIV or AIDS is possible in countries like Ukraine.     

台州市2017-2018年新报告HIV/AIDS巨细胞病毒血症现患率及影响因素研究

目的:了解2017-2018年台州市新报告且未接受抗病毒治疗（ART）的HIV/AIDS血浆巨细胞病毒血症现患率及其影响因素。方法:收集台州市新报告且未接受ART的成年HIV/AIDS血浆样本,提取核酸后采用荧光定量PCR检测巨细胞病毒DNA水平,采用单因素与多因素logistic回归分析其影响因素。结果:研究对象61...     

某市高新区 HIV 感染者/AIDS 病人失访影响因素分析

目的：分析流动人口较多的高新区 HIV 感染者/AIDS 病人失访影响因素,旨在降低其失访率。方法某市高新区全部 HIV 感染者/AIDS 病人作为研究对象,用 Logistic 回归分析确定失访的影响因素。结果该市高新区 HIV 感染者/AIDS 病人共367例,其中,失访62例,失访率为16.89%。经 Logistic 回归分析发现,疾病名称、有无性病史、确认感染 HIV 时间、CD4检测结果、是否接受抗病毒治疗、户籍地是否高新区6项因素是 HIV 感染者/AIDS 病人失访的影响因素(P <0.05)。结论高新区 HIV 感染者/AIDS 病人失访情况较严重,针对发现的失访影响因素提出了 HIV 感染者/AIDS 病人管理工作建议,以减少失联。     

Accès aux traitements antirétroviraux dans les pays en développement : quelles stratégies de financement ?

BackgroundIn low- and middle-income countries, access to combination antiretroviral therapy for all people living with Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) in need of treatment is a major public health challenge. The objective of this paper was to provide an overview of the different financing modalities of HIV/AIDS care at the microeconomic level and analysis their advantages and limitations.MethodsA review of the published literature using mainly Medline and Science Direct databases in English and French for the period 1990 to 2008 made it possible to explore different financing strategies for access to combination antiretroviral therapy using as case studies specific countries from different regions: Ivory Coast, Uganda, Senegal and Rwanda for sub-Saharan Africa, Brazil and Haiti in the Latin America/Caribbean region and Thailand for Asia.ResultsIn these settings, direct payment through user fees is the most frequent financing mechanism in place for HIV/AIDS care and treatment, including combination antiretroviral therapy. Nevertheless, other mechanisms are being implemented to improve access to treatment such as community-based health insurance schemes with free care for poor and vulnerable households and public-private partnerships.ConclusionThe type of financing strategy for HIV/AIDS care and treatment depends on the context. As direct payment through user fees limits access to care and does not enable programme sustainability, national and donor agencies are introducing alternative strategies such as community financing system (mutual health organizations, microinsurance, community health funds) and public-private partnership. Finally, access to combination antiretroviral therapy has improved in resource-limited settings; however, there is a need to introduce alternative financial mechanisms to assure long-term universal and equitable access to treatment and care, including combination antiretroviral therapy.     

HIV/AIDS and economic growth: Evidence from West Africa

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is one of the leading causes of morbidity and mortality in West Africa. Prevalence among the most productive age group in West and Central Africa stood at 1.5%, 3.4.0%, 2.5%, and 2.1% in 1990, 2000, 2010, and 2015 respectively. This study examined the effect of HIV/AIDS on economic growth in West Africa with focus on 11 countries. The augmented Solow model, rooted in the neoclassical growth theory, was used, which was operationalized using dynamic panel data modeling approach. Incidence, prevalence, number of people living with HIV/AIDS (PLWHA), and AIDS‐related deaths were used to measure HIV/AIDS. Estimations using system GMM returned statistically significant results while those of first difference and difference GMM were not. From the outcome of system GMM analysis, a percentage increase in incidence, prevalence, PLWHA, and AIDS deaths correspondingly reduced growth significantly through their effects on life expectancy by 0.15%, 0.02%, 0.004%, and 0.03%. Acquired immune deficiency syndrome deaths and PLWHA lowered economic growth through enrolment but not significantly. The import of the findings is that HIV/AIDS threatens growth through life expectancy in West Africa. Therefore, its spread in the subregion should be effectively contained while proper treatment should be provided for all infected persons.     

Access to antiretroviral treatment in developing countries: Which financing strategies are possible?

BackgroundIn low- and middle-income countries, access to combination antiretroviral therapy for all people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in need of treatment is a major public health challenge. The objective of this paper was to provide an overview of the different financing modalities of HIV/AIDS care at the microeconomic level and an analysis of their advantages and limitations.MethodsA review of the published literature using mainly the Medline and Science Direct databases for the 1990–2008 period in English and French made it possible to explore different financing strategies for the access to combination antiretroviral therapy using as case studies specific countries from different regions: Ivory Coast, Uganda, Senegal, and Rwanda for sub-Saharan Africa, Brazil and Haiti in the Latin America/Caribbean region, and Thailand for Asia.ResultsIn these settings, direct payment through user fees is the most frequent financing mechanism in place for HIV/AIDS care and treatment, including combination antiretroviral therapy. Nevertheless, other mechanisms are being implemented to improve access to treatment such as community-based health insurance schemes with free care for the poor and vulnerable households and public–private partnerships.ConclusionThe type of financing strategy for HIV/AIDS care and treatment depends on the context. As direct payment through user fees limits access to care and does not enable program sustainability, national and donor agencies are introducing alternative strategies such as community financing systems (mutual health organizations, micro insurance, community health funds) and public–private partnerships. Finally, access to combination antiretroviral therapy has improved in resource-limited settings; however, there is a need to introduce alternative financial mechanisms to ensure long-term universal and equitable access to treatment and care, including combination antiretroviral therapy.     

Inequalities in health: access to treatment for HIV/AIDS

The HIV infection represents a very clear example of the inequalities in access to health care between rich and poor countries: AIDS is a disease that the Western world can treat and the resource-limited countries cannot. In the world scenario a total of 5 million patients with HIV/AIDS who need treatment have no access to therapy: the estimated treatment coverage is 28% in Sub-Saharan Africa, 19% in Asia and only 14% in low and middle-income countries of Eastern Europe and Central Asia. A broad, multisectorial response at national and international levels is required to guarantee access to antiretroviral drugs for all people with HIV/AIDS who need them.     

艾滋病感染者抗病毒治疗的服药依从性及其相关因素的研究

目的 了解河南省艾滋病病毒感染者／艾滋病患者(HIV／AIDS）高效联合抗病毒疗法(HAART)的服药依从性及其相关因素。方法 抽取了2个AIDS综合防治示范区、1个AIDS高发县。未服药和服药在2—12个月的HIV感染者作为被调查对象，分别对服药依从性、不良反应及临床表现，治疗前后临床症状改善状况及治疗保障措施等项目，通过访谈问卷调查；同时抽取静脉血，测定评价服药者CD4^ T淋巴细胞，病毒载量，用逆转录聚合酶链反应(RT-PCR)方法扩增HIV-1 POL区基因，进行基因型耐药性分析。结果 治疗组治疗时间在4—8个月的人数最多占78．24％，服药依从性达到90％～100％的占67．51％，停服和漏服药物的主要原因是不良反应占66．95％，最显著的不良反应是服药后引起的恶心、呕吐、皮疹等不适。治疗组坚持服药症状明显改善的占87．57％，停服和漏服药症状未明显改善的占11．01％。服药依从性对病情趋势变化具有显著影响(P＜0．05)。治疗组服药后CD4^ T细胞总数保持稳定或有所增加，但实际速度较缓慢。抗病毒治疗3个月和6个月时，患者的病情好转率分别是55．1％和50．8％，CD4^ T细胞数较未服药治疗的患者显著提高。耐药性毒株的流行率显著增加，由未服药人群的13．9％快速上升到服药3个月的45．4％和服药6个月的62．7％，其中对非核苷类逆转录酶抑制剂(NNRTI)类药物耐药性的增加最为明显，导致中高度以上耐药率的显著增加。结论 采取有效的抗病毒治疗以后，HIV／AIDS患者在接受抗病毒治疗过程中，服药依从性直接关系治疗效果以及对治疗计划的实施。避免耐药毒株的出现，必须提高服药依从性，这对今后评价治疗效果具有重要意义。     

山东省50岁及以上HIV感染者和艾滋病患者抗病毒治疗效果分析

目的 分析山东省50岁及以上首次接受艾滋病免费抗病毒治疗的HIV感染者和艾滋病患者抗病毒治疗情况。方法 收集2003-2014年底在山东省内接受艾滋病抗病毒治疗的50岁及以上HIV感染者和艾滋病患者基线和治疗后的相关资料,分析抗病毒治疗效果。结果 共纳入研究对象322例,其中男性占76.7%,女性占23.3%;平均年龄为（56.9±6.4）岁;以已婚或同居者为主,占63.4%;感染途径以异性性传播为主,占54.3%;基线时CD4+T淋巴细胞计数中位数是194.0（83.5～301.0）个/mm3,基线时仅不同感染途径者CD4+T淋巴细胞计数差异有统计学意义（H=14.200,P=0.003）。治疗后不同时间段与基线时CD4+T淋巴细胞计数进行比较,显示差异均有统计学意义（均有P<0.001）,多因素分析结果显示性别和治疗前机会性感染情况是影响治疗效果的因素（均有P<0.05）。治疗后不同时间段病毒完全抑制的比例差异无统计学意义（χ2=2.093,P=0.719）。结论 山东省50岁以上的HIV感染者和艾滋病患者接受艾滋病抗病毒治疗能有效提高机体免疫力,降低病毒载量。     

Regional differences in presentation of AIDS in Europe

Data were collected on 6578 patients diagnosed with AIDS at 52 clinical centres in 17 European countries during an 1-year period from 1979 to 1989. The centres were divided into four regions, North, Central, Southeast, and Southwest. Differences in the incidence of most AIDS-defining opportunistic infections and malignancies were found. After adjusting for known possible confounders, statistically significant differences between regions remained. Pneumocystis carinii pneumonia (PCP) was more common in Northern Europe, Kaposi's sarcoma and toxoplasmosis in Central Europe, cytomegalovirus retinitis in South-eastern Europe, and extrapulmonary tuberculosis in South-western Europe. These differences we attribute primarily to different degrees of exposure to the respective underlying pathogens. The prevalence of these and other micro-organisms will determine the clinical course of HIV infections in parts of Eastern Europe and elsewhere where the virus now is spreading.     

湖南省艾滋病患者抗病毒治疗后耐药性分析

目的了解湖南省艾滋病患者接受免费抗病毒治疗的效果以及人免疫缺陷病毒(HIV)的耐药情况,为改善该省的高效抗逆转录病毒治疗效果,指导临床医生用药提供科学的依据。方法收集湖南省衡阳市抗病毒治疗6个月以上的252例HIV感染者的血标本,进行病毒载量检测,其中32例病毒载量10~3拷贝/mL,对此32份样本进行进一步的HIV基因型耐药检测。结果测得的31个序列中,发生突变的样本18份,其中13份(5.16%,13/252)对蛋白酶抑制剂(PIs)、核苷类逆转录酶抑制剂(NRTIs)以及非核苷类逆转录酶抑制剂(NNRTIs)这3类抗逆转录病毒药物有耐药突变;对PIs、NRTIs和NNRTIs均耐药者1例(0.40%),对NRTIs和NNRTIs均耐药者9例(3.57%),对NNRTIs耐药者3例(1.19%)。同时发现M184V、K103N、Y181CG、G190A引起NRTIs和NNRTIs高水平耐药的重要突变位点。结论湖南省艾滋病治疗者中,PIs耐药发生率极低,NRTIs和NNRTIs的耐药发生率相对较高;已出现NNRTIs高水平的多药耐药。但总体耐药的发生仍处于较低水平。     

Optimal antiretroviral therapy for aging

The introduction of highly active antiretroviral therapy (HAART) has irrevocably changed the nature of the HIV epidemic in developed countries. Although the use of HAART does not completely restore health in HIV-infected individuals, it has dramatically reduced morbidity and mortality. Increases in life expectancy resulting from effective long-term treatment mean that the proportion of older people living with HIV has increased substantially in the past 15 years. Increasing age is associated with many complications including cardiovascular disease, neurological complications, kidney and liver dysfunction, and metabolic complications such as dyslipidaemia and diabetes. HIV infection and antiretroviral drugs have also been associated with similar complications to those seen with increasing age. The increase in HIV prevalence in older age groups has not been accompanied by the development of treatment guidelines or recommendations for appropriate antiretroviral therapy or clinical management in these patients.     

HIV耐药毒株在山东省艾滋病抗病毒治疗人群中的流行及演变

目的 了解HIV耐药毒株在山东省AIDS抗病毒治疗人群中的流行及演变.方法 对山东省抗病毒治疗时间满1年的324例AIDS患者,使用荧光实时定量PCR( NucliSens EasyQ系统)进行HIV病毒载量检测,对结果大于1000拷贝/ml的样本采用基因型耐药检测白建方法(in house)进行HIV耐药检测.对耐药者既往(治疗前、治疗中)样本进行耐药检测,分析耐药株的演变状况.结果 HIV抗病毒治疗满1年人群耐药率为6.2％ (20/324),有耐药突变位点但不耐药为0.6％ (5/324);核苷类与非核苷类耐药突变位点占所测突变位点的93.1％ (94/101),蛋白酶类仅占6.9％ (7/101);M184V及Y181C位点在25份样本中出现突变频率最高,分别为48.0％( 12/25)和32.0％ (8/25).演变研究发现,20.0％( 2/10)的耐药者属于原发耐药;最早在治疗6个月后检测到了耐药;病毒株存在从无耐药突变位点向有耐药突变位点、从仅有耐药突变位点而不耐药向耐药、从对少种类药物低水平耐受向对多种类药物高水平耐受的演变现象,也存在突变位点相互影响使得对某种药物耐受程度降低的演变现象.结论 HIV耐药毒株在山东省AIDS抗病毒治疗人群中处于较低流行水平,耐药株的演变现象复杂.     

Clinical research, prophylaxis, therapy, and care for HIV disease in Africa.

By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and discuss prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world.     

陕西省HIV/AIDS患者接受抗病毒治疗后病毒载量结果及其影响因素分析

目的 分析陕西省艾滋病病毒(human immunodeficiency virus,HIV)感染者/艾滋病(acquired immune deficiency syndrome,AIDS)患者(以下简称为HIV/AIDS患者)接受抗病毒治疗后病毒载量结果及相关影响因素。 方法 对接受抗病毒治疗六个月以上的1 046例HIV/AIDS患者进行病毒载量检测,结合病例流行病学资料分析病毒载量结果及其影响因素。 结果 1 046例HIV/AIDS患者中,≥1 000 copies/ml占9.6%(100/1 046),50~999 copies/ml占9.1%(95/1 046),＜50 copies/ml占25.4%(266/1 046),TND(未检出病毒)占55.9%(585/1 046)。单因素分析显示病毒载量结果＜1 000 copies/ml与≥1 000 copies/ml HIV/AIDS患者在民族(P＜0.05)、教育程度(χ²=10.901,P＜0.05)、感染途径(χ²=14.286, P＜0.05)变量上差异有统计学意义。多因素分析显示教育程度大专及以上是病毒载量≥1 000 copies/ml的保护因素(OR=0.344,95%CI:0.121~0.979),HIV感染途径中注射吸毒是病毒载量≥1 000 copies/ml的危险因素(OR=5.237,95%CI:1.272~21.556)。 结论 陕西省HIV/AIDS患者抗病毒治疗效果较好,但需要提高患者治疗依从性,减少病毒抑制失败。     

ESPEN Guidelines on Enteral Nutrition: Wasting in HIV and other chronic infectious diseases

Undernutrition (wasting) is still frequent in patients infected with the human immunodeficiency virus (HIV), despite recent decreases in the prevalence of undernutrition in western countries (as opposed to developing countries) due to the use of highly active antiretroviral treatment. Undernutrition has been shown to have a negative prognostic effect independently of immunodeficiency and viral load. These guidelines are intended to give evidence-based recommendations for the use of enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) in HIV-infected patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. Nutritional therapy is indicated when significant weight loss (>5% in 3 months) or a significant loss of body cell mass (>5% in 3 months) has occurred, and should be considered when the body mass index (BMI) is <18.5 kg/m(2). If normal food intake including nutritional counselling and optimal use of ONS cannot achieve an adequate nutrient intake, TF with standard formulae is indicated. Due to conflicting results from studies investigating the impact of immune-modulating formulae, these are not generally recommended. The results obtained in HIV patients may be extrapolated to other chronic infectious diseases, in the absence of available data.     

Current trends in the treatment of HIV infection, 2003

The HIV/AIDS epidemic appears to have stabilized in the world's developed countries while it is still worsening in many areas of the resource-poor world. HIV/AIDS patients in countries such as the United States are living longer primarily due to the availability of potent antiretroviral drug combinations and tests to monitor the risk of progression of disease. Management of HIV is very complicated. General guidelines for treatment are available. Published guidelines, however, are often too simplistic and do not reflect new or controversial information. Most patients will develop resistant virus during their treatment. Several antiretroviral medications are on the horizon that will afford better options for treatment, and studies are underway to evaluate treatment strategies that would be potent, less toxic, and convenient for patients. Because the field of HIV care continues to evolve rapidly and there is increasing diversity among infected patients, treatment and prevention are optimized when provided by a dedicated care team supervised by an HIV specialist.