1990—2019年中国人类免疫缺陷病毒/获得性免疫缺陷综合征流行趋势及疾病负担

目的 分析1990—2019年中国人类免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)疾病流行现状、负担及危险因素变化趋势,预测2020—2030年HIV/AIDS发病和死亡情况。方法 探讨1990—2019年中国HIV/AIDS疾病的流行现状,通过Joinpoint回归拟合其发病率和疾病负担变化趋势。采用集成嵌套拉普拉斯近似(INLA)的贝叶斯年龄-时期-队列分析(BAPC)方法预测2020—2030年HIV/AIDS发病和死亡趋势。结果 1990—2019年中国男性HIV/AIDS标化发病率、标化死亡率高于女性,15～19岁、20～24岁标化发病率总体呈增长趋势,75～79岁标化发病率变化幅度最大。1990—2019年中国HIV/AIDS标化发病率、标化伤残调整寿命年(DALYs)率均呈上升趋势,差异具有统计学意义(P均<0.001);归因于危险性行为的标化DALYs率最高。BAPC预测结果显示,2020—2030年中国男性HIV/AIDS标化死亡率呈上升趋势。结论 中国青少年HIV/AIDS发病风险持续增加,老年群体死亡风险也不容忽视;HIV/AIDS疾病负担呈上升趋...     

获得性免疫缺陷综合征的眼部并发症

获得性免疫缺陷综合征(AIDS)是由人免疫缺陷病毒(HIV)感染引起,导致被感染者免疫功能部分或完全丧失,CD4+细胞数目减少,继而发生机会性感染、肿瘤等各种表现的慢性进行性疾病。其眼部并发症多发生在眼后段,包括HIV/AIDS视网膜炎、机会性感染、罕见肿瘤和神经眼科疾病。目前广泛应用高效抗逆转录病毒疗法(HAART)及更昔洛韦治疗AIDS及其眼部并发症取得了很大进展。现本文对4种眼部主要并发症进行综述。     

获得性免疫缺陷综合征研究进展

获得性免疫缺陷综合征是一种由人免疫缺陷病毒引起的、严重损害人体免疫系统的疾病。该病有明显的地域聚集性;以30～39岁的男性占绝大多数;主要通过精液和血液传播。临床上主要表现为机会性感染和恶性肿瘤,病情的轻重取决于细胞免疫功能的丧失程度。AIDS的诊断主要依据监测标准和临床病毒学检测。目前对该病尚无特效的治疗方法,重点在于加强宣传教育,增进人们对其传播途径及一般预防措施的认识。     

人类免疫缺陷病毒/获得性免疫缺陷综合征性疼痛的精神病学(中)--精神心理干预

HIV相关疼痛的精神病学治疗涉及心理疗法、行为认知性及心理药物学的技术.     

血友病合并人类免疫缺陷病毒感染患者的手术安全与护理研究

目的探讨血友病合并人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)患者的围术期治疗和护理措施。方法对14例血友病合并HIV感染者(均为男性,年龄20～54岁)进行手术,术前检测免疫功能,规范手术操作程序,精细操作减少手术损伤,术中持续输注凝血因子Ⅷ,常规应用抗生素预防感染。重视患者的心理护理,用专业性的沟通技巧对患者进行心理疏导,帮助其面对现实,对疾病树立正确的态度,增加生活的信心。结果 6例术后发生脓毒症,经抗生素控制感染和支持治疗后治愈,无手术死亡。脓毒症组术前血清清蛋白(Alb)水平明显低于非脓毒症组,差异有统计学意义(P<0.05)。术后2周复查各项指标,脓毒症组血红蛋白(Hb)明显减少(P=0.047),其他指标差异均无统计学意义(P>0.05)。术前CD4与CD4/CD8,术前CD4与Alb,术前CD4与术后CD4/CD8,术前白细胞计数(WBC)与术后血小板计数(PLT),术后CD4与术前Alb呈正相关(P<0.05)。术前Hb与PLT呈负相关(P<0.05)。术后随访3～35个月,患者均恢复正常生活,心理状态良好,对抗病毒治疗依从性良好。结论对血友病合并HIV感染者采用适当围术期治疗和护理措施可以取得较好的疗效。     

治疗获得性免疫缺陷综合征的中药研究

总结了近年来抗人类免疫缺陷病毒 (HIV)的中药活性成分及复方制剂的研究进展情况 ,说明中药在治疗获得性免疫缺陷综合征 (AIDS)方面有着非常广阔的前景     

淋巴结结构及其结构改变与获得性免疫缺陷综合征发病机制的关系

免疫器官是免疫细胞再生、分化的重要场所,淋巴结（lymph nodes,LNs）作为外周免疫器官,其正常结构对于维持自身内环境稳定和免疫细胞的生存、发育、增生是非常重要的.近来,国外有研究发现胶原纤维在淋巴组织中T细胞区域（T cell zone,TZ）的沉积可能是导致HIV感染者外周血和淋巴组织中CD4^＋ T细胞减少的又一重要机制.该文拟根据近年研究进展,阐述LNs正常组织结构对CD4^＋ T细胞存活、发育和运输的影响及其结构改变与获得性免疫缺陷综合征（AIDS）发病机制的关系,以期对目前AIDS发病机制和临床治疗的研究有所裨益.     

30例获得性免疫缺陷综合征合并非结核分枝杆菌肺病患者临床特征分析

目的：分析获得性免疫缺陷综合征(AIDS)合并非结核分枝杆菌肺病患者的临床特征,为临床诊断提供科学的参考依据。方法：回顾性分析2019年8月—2021年1月贵阳市公共卫生救治中心感染科收治的30例AIDS合并非结核分枝杆菌肺病患者的临床资料。结果：AIDS合并非结核分枝杆菌肺病患者主要临床症状包括以咳嗽为主的呼吸道症状、以发热为主的中毒症状、以细菌感染为主的合并症;男性患者较多;感染途径主要为性传播;农民工、学历较低者发病率较高;B超检查结果异常情况以肝大为主,其次是颈部淋巴结肿大;胸部影像学表现常见的类型为双肺中下叶、胸膜病变。结论：AIDS合并非结核分枝杆菌肺病患者和肺结核具有高度的相似性,鉴别难度非常高,可以通过影像学检查、痰涂片、痰培养等方式综合诊断。     

人类免疫缺陷病毒/获得性免疫缺陷综合征性疼痛的精神病学(下)--治疗和药物滥用

在过去8年多的时间,注射毒品的人在AIDS患者群体中的增加率是最高的,特别是在大都市的中心[1].担心成瘾和对有关药物滥用过分关注影响病人的依从性.被"求药"患者所操纵的内科医生经常不愿意使用大剂量的麻醉性镇痛剂来控制疼痛.大多数临床医生推荐社区全科医生建立明确的制度,并且指导限制剂量.临床医生企图尽可能地通过直接处理好阿片类戒断的困扰和药物的治疗,来减少药物滥用.临床医生片面地相信病人主诉疼痛,就有可能犯错,应该利用特异性HIV-相关疼痛综合征的知识来辨认所觉察到的不可信的病人的诉说.     

人类免疫缺陷病毒原发感染的实验室检测

人类免疫缺陷病毒(human immunodeficiency virus,HIV)的原发感染期(primary infection)指从病毒进入人体到抗体产生后的3～12个月,根据其临床表现及机体免疫应答的出现又可进一步分为急性感染期(acute infection)和之后的新近感染期(re-cent infecti...     

Physicians and acquired immunodeficiency syndrome. What patients think about human immunodeficiency virus in medical practice

Are patients concerned about going to a physician who is infected with human immunodeficiency virus (HIV) or one who is treating HIV-infected patients? To answer these questions, we surveyed a nationwide sample of 2000 interviews (response rate, 75%). Forty-five percent of all respondents believed that physicians who were HIV infected should not be allowed to continue to practice. More than half of those who had seen a physician in the past 5 years said they would change physicians if they knew their physician were HIV infected, while one fourth said they would seek care elsewhere if their physician were treating people with HIV disease. These data suggest that patients are concerned about HIV in their physicians' offices. The American Medical Association recommends that HIV-infected physicians continue to practice as long as there is no risk to their patients. Physicians and the public need to be educated about this policy and its appropriateness.     

The costs of hospital-based medical care for patients with the acquired immunodeficiency syndrome

The costs which were incurred by patients for hospital-based care during the time from the diagnosis of the acquired immunodeficiency syndrome (AIDS) to death, range from pounds 6838 in London, England, to US$147,000 in Atlanta, USA. In 1986, a study was undertaken in Sydney to calculate the costs of the hospital-based treatment of patients with AIDS. The medical records of 39 patients who had received all their treatment at one institution were analysed retrospectively, and data were collected on their survival, hospitalizations, investigations and treatments. The mean survival time of the 39 patients was 7.2 months; during this time they had a mean of 4.0 hospital admissions that accounted for an average total stay of 34.6 days. In addition, they made, on average, 9.4 outpatient visits. There was a significant difference in the duration of hospitalization between those who presented with an opportunistic infection and those who presented with a malignancy (38.3 days and 22.4 days, respectively; P = 0.01). The mean cost for hospital-based care was $A22,332 (range, $A4229-$A58,398), of which 95% of costs were incurred for inpatient care. The mean cost of care of those who presented with an opportunistic infection was significantly higher than that of those who presented with a malignancy, but there was no difference according to the age at the time of diagnosis. If the predictions of 3000 cases of AIDS in Australia by 1991 are realized, such cases will represent--conservatively--an additional cost to the community of $A58.5 million. This study emphasizes the need for health authorities to plan for the future financial impact of the hospital-based treatment of patients with AIDS.     

Premature atherosclerosis in patients with acquired immunodeficiency syndrome

Background Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus （HIV）infection since highly active antiretroviral therapy （HAART） has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients.Methods One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients （41HAART-treated and 41 antiretroviral therapy （ART） naive patients） and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity （PWV） was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage.Results A higher PWV （（1358.3±117.8） cm/s vs. （1270.2±189.2） cm/s, P=0.010） was found in ART na（i）ve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART na（i）ve patients （（1283.8±181.4） cm/s vs. （1358.0±117.8） cm/s, P=0.033）. Multiple regression analysis revealed that age （B=5.218, 95% confidence interval （CI） 1.420-9.016, P=0.008）, current smoking （B=-74.671, 95% CI -147.003 to -2.339, P=0.043） and HAART （92.7% patients on a protease inhibitor-free regimen） （B=-169.169, 95% CI-272.508 to -65.831, P=0.010） were associated with reduced PWV in HIV-infected patients.Conclusions Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.     

获得性免疫缺陷综合征患者的肺部感染

目的: 提高对获得性免疫缺陷综合征(AIDS)肺部机会性感染的认识。方法: 对18例AIDS患者进行临床分析。结果: 18例患者肺部感染临床症状有发热、消瘦、乏力、咳嗽、咳痰等。卡氏肺囊虫肺炎(PCP)9例;细菌性肺炎7例;霉菌性肺炎6例;肺结核5例;伴有其他多系统感染8例。结论: 肺部感染是AIDS患者晚期的主要机会性感染,其中PCP和细菌性肺炎最多,其次为霉菌性肺炎和肺结核,同时常伴有多系统损害。     

Premature atherosclerosis in patients with acquired immunodeficiency syndrome

Background Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus (HIV)infection since highly active antiretroviral therapy (HAART) has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients.Methods One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients (41HAART-treated and 41 antiretroviral therapy (ART) naive patients) and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity (PWV) was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage.Results A higher PWV ((1358.3±117.8) cm/s vs. (1270.2±189.2) cm/s, P=0.010) was found in ART na(i)ve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART na(i)ve patients ((1283.8±181.4) cm/s vs. (1358.0±117.8) cm/s, P=0.033). Multiple regression analysis revealed that age (B=5.218, 95% confidence interval (CI) 1.420-9.016, P=0.008), current smoking (B=-74.671, 95% CI -147.003 to -2.339, P=0.043) and HAART (92.7% patients on a protease inhibitor-free regimen) (B=-169.169, 95% CI-272.508 to -65.831, P=0.010) were associated with reduced PWV in HIV-infected patients.Conclusions Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.     

Ocular manifestations in 321 male consecutive cases of human immunodeficiency virus infection/acquired immunodeficiency syndrome at an HIV-referral centre

Background

Most studies on the ocular manifestations of human immunodeficiency virus (HIV) infection are on cases of acquired immunodeficiency syndrome (AIDS), not including asymptomatic carriers of HIV. With this background, we proceeded to study all the HIV-infected individuals attending our centre, with the aim:a. To study the ocular manifestations of HIV.b. To correlate those manifestations with the CD4+ T-lymphocyte counts.c. To compare our findings with other studies.

Method

A cross-sectional study involving a detailed ocular examination of 321 cases of HIV/AIDS was done. Automated perimetry, digital fundus photography and fundus fluorescein angiography were done for relevant cases. The last 125 cases were subjected to Schirmer''s test and tear film break-up time.

Results

We studied 321 male HIV cases (642 eyes), with a mean age of 36.78 years, mean CD4+ count of 276.54 cells/μL, 78.82% of them being on anti-retroviral therapy. Ocular manifestations were seen in 87 out of 321 cases, 72.41% of them being asymptomatic carriers of HIV. The ocular findings seen were conjunctival microvasculopathy, molluscum contagio-sum, dry eye, neuro-ophthalmic manifestations, anterior uveitis, posterior uveitis, and HIV retinopathy, only the last three of which had a significant association with CD4+ counts. The overall prevalence of ocular lesions also had a significant association with CD4+ counts.

Conclusion

Ocular manifestations are common in asymptomatic carriers of HIV. Anterior uveitis, posterior uveitis and HIV retinopathy have a significant association with CD4+ counts and are reliable indicators of low CD4+ count.