Human immunodeficiency virus seroconversion illness in the emergency department: A review

Abstract Advances in the understanding of the pathogenesis of human immunodeficiency virus (HIV) infection, in diagnostic testing, and in antiretroviral therapy have refocused attention on the HIV seroconversion illness. Preliminary studies suggest that early institution of combination therapy may significantly alter the long-term outcome of infection. As a significant proportion of cases of acute HIV infection occur in populations frequenting emergency departments, the importance of recognition and appropriate management of patients with this syndrome is reviewed.     

HIV阳性育龄妇女的抗病毒治疗及HIV母婴阻断

随着艾滋病在全球范围的迅速蔓延,妇女儿童中HIV的感染流行情况以及如何控制其进一步传播扩散也受到越来越多的关注。目前,全球存活的HIV感染者中约有50%为育龄妇女,而15岁以下儿童感染HIV的90%经母婴垂直传播。鉴于HIV阳性育龄妇女的抗病毒治疗对于阻断HIV的母婴传播以及控制HIV感染进一步扩散蔓延具有极其重要的作用,本文将从育龄妇女HIV感染及母婴传播情况、HIV阳性育龄妇女的抗病毒治疗以及HIV母婴阻断等方面进行综述。     

HIV集合核酸检测在男男性行为人群中的应用评价

目的 评估集合核酸检测方法在男男性行为人群(MSM)中的应用,探索适合该人群的HIV早期感染检测策略及应用该方法估算新发感染率的可行性.方法 本研究共采集4 856份2008年4月至2009 年9月我国黑龙江省(4 156份样品)和北京市(700份样品)MSM人群的样品.分别经三代ELISA、四代ELISA和WB检测后,HIV阴性样品进行集合核酸检测.样品集合采用三级集合策略.并计算和比较"三代ELISA检测+WB"、"四代ELISA检测+WB"、"三代ELISA检测+WB+集合核酸检测"和"四代ELISA检测+WB+集合核酸检测"的HIV检测阳性率.4 156份黑龙江省MSM人群样品中符合条件的WB确认阳性样品纳入BED-捕获酶联试验 (BED-CEIA),并应用BED方法和集合核酸检测方法进行新发感染率估算.结果 4 856份样品中共有143份被判定为HIV阳性,其中经三代和四代ELISA检测为阳性的样品均为130份,窗口期感染样品13份.常规ELISA检测加核酸检测能最有效检测出MSM人群窗口期感染者;4种检测策略的HIV检测阳性率分别为:2.68%(95%CI 为2.22%～3.14%)、2.82%(95%CI 为2.35%～3.29%)、2.94%(95%CI 为2.46%～3.42%)和2.94%(95%CI 为2.46%～3.42%),差异无统计学意义(χ2=0.854 3,P=0.836 4).4 156份黑龙江省样品中有88份纳入BED检测,41份样品被判为新近感染.应用BED检测方法和集合核酸检测方法估算的HIV发病率分别为2.36%(95%CI 为1.63%～3.08%)和2.92%(95%CI 为1.01%～4.83%).结论 HIV集合核酸检测技术能有效地筛查出窗口期感染者,可用于我国MSM人群窗口期检测.

Abstract：

Objective To evaluate the application of pooling HIV nucleic acid amplification testing (NAAT) among men who had sex with men (MSM) population, and to investigate suitable HIV screening strategy and the feasibility of calculation of HIV incidence using pooling NAAT among MSM population in China.Methods Four thousand eight hundred and fifty-six samples were collected from MSM population from April 2008 to September 2009 among with 4 156 were in Heilongjiang province and 700 were in Beijing in China. After standard testing with an HIV ELISA and WB confirmation testing, HIV antibody-negative samples were pooled and screened for HIV using NAAT.A three-stage pooling strategy was adopted.The HIV positive rate estimated by the four HIV screening strategies was calculated.In addition, 4 156 HIV positive specimens from Heilongjiang province were screened with the BED capture enzyme immunoassay (BED-CEIA).The HIV-1 incidences were estimated by BED-CEIA assay and pooling NAAT individually.ResultsOne hundred and forty-three of 4 856 subjects were HIV infected.130 were 3rd and 4th generation ELISA positive; 13 were antibody-negative but acutely HIV infected.According to the evaluation of four HIV screening strategies, routine HIV screening test together with pooling NAAT was more effective than other strategies for screening out window period generation ELISA+WB+pooling NAAT' were 2.68%(95% confidence interval CI=2.22%-3.14%), 2.82%(95%CI=2.35%-3.29%), 2.94%(95%CI=2.46%-3.42%) and 2.94%(95%CI=2.46%-3.42%), respectively.The differences were not significant (χ2=0.854 3, P=0.836 4).Of the 88 HIV positive samples from Heilongjiang province, 44 participants were tested as recent HIV infections by BED-CEIA assay. The estimated HIV-1 incidence was 2.36% (95%CI=1.63%-3.08%) and 2.92% (95%CI=1.01%-4.83%) based on BED-CEIA assay and pooling NAAT,respectively.Conclusions Pooling NAAT is a effective screening test in HIV negative population to detect window period infection among MSM population in China.     

黄石地区抗-HIV筛查后输血传播HIV危险度的评估

目的评估黄石地区献血者中抗-HIV筛查阴性血液传播HIV的危险度。方法 收集了1995年至2000年每一单位血液的资料,用数学模型进行输血传播HIV危险度研究。结果 在有偿重复献血者中HIV流行率为0.0028％(1/36274),新无偿献血者中为0(0/20698),无偿重复献血者中为0(0/6015)。经评估“窗口期”输血传播HIV的危险度为1:118231。结论 虽然输血传播HIV的危险是非常低,但需进一步采取措施提高血液筛查水平。     

马里1021例HIV/AIDS患者心电图分析

目的:分析HIV/AIDS患者心电图的临床特征.方法:对1021例HIV/AIDS患者常规心电图进行对比分析.结果:(1)AIDS患者心电图异常346例(56.6%);HIV患者心电图异常105例(25.6%).(2)两组相比心电图异常差异有显著性统计学意义(P<0.001).结论:HIV病毒及高强度的抗病毒治疗对心脏、血管有明显的损害,故对HIV/AIDS患者,常规进行心电图检查对早期发现心脏并发症、尽旱采取干预措施是很有必要的.     

国产试剂测定艾滋病患者HIV病毒载量及临床应用

目的 探讨人类免疫缺陷病毒（HIV）病毒载量测定与临床的关系。方法 用国产试剂对14例艾滋病患者血浆进行连续病毒载量测定。结果 14例患者中有4例死亡，且都有HIV病毒载量较高或进行性增高，其余10例，好转或稳定。结论 国产试剂对艾滋病患者进行病毒载量测定试验操作相对简单，价格也较便宜。能够很好的反映患者的治疗效果和病情评估，有较好的实用价值。     

HIV感染者口腔念珠菌检出率及菌种分布

目的:检测人类免疫缺陷病毒(HIV)感染者口腔念珠菌的驻菌情况.方法:取82例HIV感染者口腔含漱液并以形态学、酵母菌鉴定系统及45℃生长试验等方法进行分型鉴定,计算不同念珠菌的检出率.结果:82例HIV感染者中60例可培养出念珠菌,检出率73.17%.其中白色念珠菌42例(51.22%),非白色念珠菌48例(58.54%).共分离出211株念珠菌,其中光滑念珠菌103株(48.82%),白色念珠菌95株(45.02%),热带念珠菌4株(1.90%),近平滑念珠菌4株(1.90%),菌膜念珠菌2株(0.95%),其他3株(1.42%).29例患者检出单一菌株(12例为白色念珠菌,15例为光滑念珠菌,1例为热带念珠菌,1例为近平滑念珠菌),占51.7%;31例检出多种菌株(30例为2种菌株,1例为3种菌株),占48.3%.结论:HIV感染者口腔的主要菌种是白色念珠菌和光滑念珠菌,并且白色念珠菌和光滑念珠菌共存的比例大于单一菌株的比例.     

核酸扩增检测技术在血液筛查中的应用

目的探讨核酸扩增检测技术在血液筛查中的应用价值。方法用酶联免疫吸附试验(ELISA)常规筛查血液,对免疫指标合格的血液采用美国Roche Cobas Amplicor全自动PCR诊断系统检测HBV DNA、HCV RNA和HIV-1 RNA,样本混合采用48人份×50μL汇集,采用汇集池阳性的再分拆检测。结果 70 953份无偿献血标本中,HBV DNA阳性10份(1.4/10 000),未发现HCV RNA和HIV-1 RNA阳性样本。结论血站系统采用微量标本混合方式使用核酸扩增检测技术筛查血液是可行的,能有效提高临床用血的安全。     

Universal HIV Screening in Ambulatory Care Settings

Statistics reveal that clinicians are not offering or recommending routine HIV screening in almost all health care settings, despite strongly recommended clinical guidelines published in 2006 and 2013. The Centers for Disease Control and Prevention estimates that less than half of the US population aged 18–64 years has ever been tested for HIV.^1,2 To increase HIV screening rates, it is crucial to provide education on the guidelines and a mechanism for readily available testing to increase HIV screening rates. Employing evidence-based universal screening will potentially identify new HIV diagnoses earlier. Timely identification decreases the spread of HIV, reduces the complications from living with HIV, and provides significant cost savings. Undiagnosed persons living with HIV pose a substantial epidemiologic risk. Without increased HIV screening and linkage to care, ending the HIV epidemic within the United States will be unattainable.     

HIV/HCV共感染患者肝损害影响因素的研究

目的:探讨HIV/HCV共感染患者肝损害影响因素.方法:回顾性分析92例HIV/HCV共感染患者,男51例(55.4%),女41例(44.6%).年龄9～62岁,平均(39.5±9.4)岁.分别采用单因素及Logistic回归方法分析其肝损害影响因素.结果:单因素分析发现肝损害组20例(33.9%)有抗结核治疗史,39例(66.1%)有抗逆转录病毒治疗史,37例(62.7%)CD4+T淋巴细胞计数＜200个/mm3;无肝损害组患者4例(12.1%)有抗结核治疗史,13例(39.4%)有抗逆转录病毒治疗史,14例(42.4%)CD4+T淋巴细胞计数＜200个/ mm3,统计学分析差异有显著性(P值分别等于0.023、0.013、0.031).Logistic回归分析提示抗结核治疗和抗逆转录病毒治疗是HIV/HCV共感染患者肝损害的危险因素.结论:HIV/HCV共感染患者肝损害的影响因素是多方面的,其中抗结核治疗和抗逆转录病毒治疗是其独立危险因素.     

HIV prevention outreach in black communities of three rural north Florida counties

Literature to guide HIV prevention outreach for southeastern rural blacks is limited despite the increasing prevalence of HIV infection in this population. Three men and one woman conducted HIV prevention outreach in three north Florida rural counties in teams of two. The workers received five days of training in additional homework assignments. The workers used HIV/AIDS outreach surveys to guide their 10- to 15-minute outreach visits. Five hundred seventy-four outreach contacts with blacks were made between January and June 2001 (329 in County 1, 176 in County 2, and 69 in County 3) with 347 women and 227 men. Eighty-four percent of the persons contacted accepted literature, 47.5% accepted male condoms, and 31.9% accepted female condoms. More women (99.4%) were knowledgeable about HIV/AIDS than men (92.5%), and they reported taking precautions against infection more often than men (98% vs. 90.3%). Many blacks in rural north Florida were receptive to an HIV prevention outreach program that provided information, literature, and condoms on the street and in homes. These findings suggest that HIV prevention outreach should be expanded to reach more rural blacks, who are increasingly at risk for HIV infection.     

3649例孕妇HBV、HCV、HIV和TPPA感染血清流行病学的分析

目的了解孕妇乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、艾滋病毒（HIV）和梅毒感染情况,为建立有效的防治母婴传播措施提供依据。方法对来本院做围生保健3649例孕妇,采用ELISA法检测血清5项乙肝标志物（HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc）、抗-HCV、抗-HIV和梅毒血清学检测（TPPA）。结果3649例孕妇中,HBsAg阳性率为11．13％,抗-HCV和TPPA阳性率分别为0．11％和0．36％,未检测出抗-HIV阳性孕妇。结论揭示了本市孕妇HBV、HCV、HIV和TPPA感染血清流行病学特征,建议青年男女婚前、孕前、孕期、产前应进行HBV、HCV、HIV和TPPA血清学检查,才能及早发现、及早治疗,有效阻断母婴传播,有利于优生优育。     

怒江州无偿献血者HIV感染情况调查

怒江州地处西南边陲,地理环境恶劣,经济文化较落后,改革开放进程较缓慢。1999年发现首例HIV感染,为杜绝HIV经输血传播,本站自2003年7月建站起,即开始对无偿献血者做HIV筛查。1材料与方法1.1调查对象2003年7月~2004年12月来本站的无偿献血者1564名(表1),取其初、复检血液为检测标本。1.2方法与试剂初、复检分别为上海科华和英科新创的抗-HIV ELISA试剂,均为批批检产品,并在有效期内使用。凡初、复检抗-HIV单边或双边阳性者,若复查后结果仍相同,则送血清标本至省艾滋病防治检测中心进一步确认。2结果(表1)表1 2003年7月~2004年12月献…     

北京市主动戒毒人群人类免疫缺陷病毒、丙型肝炎病毒和梅毒螺旋体感染状况调查

目的调查主动戒毒人群人类免疫缺陷病毒(HIV)、丙型肝炎病毒(HCV)和梅毒螺旋体(梅毒)感染状况,为其行为干预提供科学依据。方法 对北京市1136名主动戒毒人员进行HIV、HCV和梅毒抗体检测,并调查不同吸毒方式与上述各病毒感染的关系。结果 1136例中HIV、HCV、梅毒感染率分别为1.50%、36.18%及6.87%。静脉注射吸毒者HIV、HCV感染率明显高于非静脉注射吸毒者,差异有统计学意义(P<0.01)。静脉吸毒者中共用针具者HIV感染率高于不共用针具者,差异有统计学意义(P<0.05)。HIV、HCV重叠感染率1.41%,HCV、梅毒重叠感染率2.55%,HIV、梅毒重叠感染率0.26%,HIV、HCV、梅毒重叠感染率0.26%。结论主动戒毒人群存在血源性传染病传播和流行的高风险,应加强对此类人群的监测及干预,以减少HIV、HCV和梅毒播散。     

浙江省景宁县“外来媳”人群艾滋病病毒感染状况及艾滋病相关知识调查

目的　了解浙江省景宁县外来媳人群艾滋病病毒（HIV）感染状况及艾滋病知识知晓情况。方法　对1990年以后由外省嫁到景宁县的外来媳 （包括法定婚姻、事实婚姻）采血检测抗-HIV并进行问卷调查。结果　检测930名外来媳，抗 HIV阳性2例,感染率为0.22%，参加问卷调查的880名外来媳大部分来自艾滋病流行相对严重的云南和贵州省，小学及以下文化程度占78.86%，艾滋病知识总知晓率仅为54.56%。 结论　景宁县外来媳人群存在着一定的HIV感染流行，是景宁县艾滋病防治的重点人群之一。     

Decision making in HIV testing among a group with low HIV risk

Relatively little is known about how individuals (apart from gay and bisexual men) decide to have an HIV test and how, once they have presented for testing, they make decisions about proceeding through the testing trajectory. This paper reports on a qualitative study in which 55 mainly heterosexual respondents with low HIV risk were interviewed about their experiences of decision making around HIV testing. Reasons for deciding to be tested centred on a desire for reassurance and the circumstances of the respondents' current relationship. The most common relationship reason focused on a desire to confirm HIV status before beginning sexual relations or engaging in unprotected sex with a partner. Although some respondents recognized that other individuals had influenced their decision to be tested, few said that pretest counselling had been influential in this respect. Instead, it was said to have promoted feelings of 'ownership' of a decision which had already been taken prior to counselling. The potential effects of HIV testing on HIV risk behaviour were also examined and a non-significant increase in unprotected sex was reported between the month before the test and the month after. The implications of these findings for the provision of HIV testing services are explored.     

Beyond the end of exceptionalism: integrating HIV testing into routine medical care and HIV prevention

In September 2006, the US CDC issued new guidelines for HIV testing. These guidelines were designed not only to simplify and expand HIV testing but also to integrate testing into routine medical care in the USA. The nationwide implementation of these guidelines is currently facing several political and legal barriers. In this article, we examine the origins of current patient-driven and risk-based HIV testing in the USA and highlight shortcomings of this strategy. We then demonstrate how the changing HIV epidemic in the USA requires routine HIV screening at all points of contact in the medical system in order to control the HIV epidemic and how novel testing strategies could increase the yield of testing in these settings.     

Non-targeted HIV testing in the emergency department: not just how but where

ABSTRACT

Introduction: The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate.

Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among ≥5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient’s journey from registration, via triage and the waiting room, to the bedside. Barriers to the testing offer, acceptance and performance were examined at each location.

While testing offer rates were higher at registration and triage, compared to the waiting room and bedside, this was sometimes at the expense of testing acceptance and performance. Variables affecting testing rates included type of consent, employment of external staff and type of testing: fourth generation serological testing versus rapid testing.

Expert commentary: These large studies shed light on the importance of where as well as how HIV testing is performed, and the ways in which the ‘where’ can influence non-targeted screening yields. This perspective enables testing approaches to be tailored to specific ED settings in order to maximize testing rates.     

江门市桑拿沐足场所从业人员的HIV/STD感染情况调查分析

桑拿、沐足场所已逐步成为性病、艾滋病潜在的传播场所,江门市涉及此类场所的人群中梅毒、淋病、衣原体、支原体的感染率分别是1.12％、3.02％、5.83％、32.09％,还未发现有HIV感染病例,其感染率仅略低于性病门诊的感染率。感染者中,中学学历者占90％以上,且多来自农村,流动性大,性病艾滋病知识水平低,是性病艾滋病传播的重点人群,应针对性采取宣传、防治和干预等综合措施,控制性病艾滋病在此类人群中的传播。