Access to antiretroviral therapy among HIV/AIDS patients in Khon Kaen Province, Thailand

This study attempted to identify the factors associated with the access to antiretroviral therapy (ARV) among HIV/AIDS patients in Khon Kaen Province, Thailand. We collected medical and sociodemographic data from the medical charts of adult patients living in the province who received medical services at two public hospitals in the province. The study period was from December 1, 2001 to February 28, 2002. Total 593 outpatients were included in the analysis. One hundred and forty-six patients (24.6%) received ARV. A logistic regression analysis was conducted to identify the factors associated with the use of ARV. Patients who were covered by the Civil Servant Medical Benefit Scheme were significantly more likely to receive ARV than those who were covered by the Universal Coverage Scheme (UC), a publicly-funded medical insurance (OR = 12.43; 95% CI = 6.03-25.62). The results of this study indicated that there were inequalities in access to and use of ARV among HIV/AIDS patients by health insurance status. The current government announced that they would include ARV in the benefits package of UC. It would be important to monitor how this policy will improve the access to ARV among HIV/AIDS patients.     

HIV传播动力学模型的研究

目的 用数学模型来预测中国近几年艾滋病病毒感染伎滋病(HIV／AIDS)的流行情况。方法 用离散型HIV传播动力学的基本模型和分阶段模型进行了分析。结果 给出了基本模型和对HIV感染者进行分阶段的模型，确定了一些有关参数，并用：Matlab软件对未来几年HIV感染者和AIDS患者人数进行了预测。结论 未来几年内中国的HIV感染者和AIDS患者人数将会继续增加。从两种模型可以看出：如果对AIDS不加有力的控制，到2010年中国的HIV感染者人数将达到1000万人左右，AIDS患者人数约达到65万人左右。因此，预防和控制AIDS的发生及对其流行动态的研究已是一件非常紧迫的任务。     

The prevalence and predictors of stigma amongst people living with HIV/AIDS in the Western Province

The aim of the present study was determine the extent to which internalized and enacted stigma is experienced by people living with HIV/AIDS and to establish correlates of such experiences. A convenience sample of 400 HIV-positive participants was selected from three health clinics in the Cape Town area. Respondents' experiences of internalized and enacted stigma were investigated using the HIV/AIDS Stigma Instrument - PLWA (HASI-P). Overall, 28% of respondents endorsed more than one item addressing internalized stigma and 8% endorsed more than one item on any of the four subscales measuring enacted stigma. Male respondents (OR = 0.52, CI = 0.92-0.99), younger respondents (OR = 0.52, CI = 0.29-0.94), and those respondents who had been living with HIV longer were less likely to experience internalized stigma. More educated respondents (OR = 1.19, CI = 1.02-1.39) experienced more internalized stigma than those with less education No demographic characteristics predicted enacted stigma in this particular population. There are a number of possible reasons for low reports of HIV-related stigma, including having access to treatment and not disclosing HIV status.     

北京地区干扰素联合利巴韦林经治与未经治慢性丙型肝炎患者直接抗病毒药物的天然耐药突变分析

目的探索我国北京地区慢性丙型肝炎(CHC)患者直接抗病毒药物(DAA)的天然耐药突变发生情况,比较干扰素(IFN)联合利巴韦林(RBV)经治与未经治患者DAA的天然耐药突变。方法收集2009年7月~(-2)013年11月于北京大学第一医院就诊的101例基因1b型CHC患者,其中IFN联合RBV经治患者40例,未经治患者61例。提取患者的HCV RNA,PCR法扩增并测序HCV NS3、NS5A、NS5B区基因,进行序列比对和耐药分析,并比较天然耐药发生率。符合正态分布的计量资料组间比较采用t检验,非正态分布的计量资料组间差异比较采用Mann-Whitney U检验。计数资料组间比较采用χ~2检验或Fisher精确概率法。结果共获得84例(83.17%)NS3区、92例(91.09%)NS5A区和97例(96.04%)NS5B区基因序列信息。NS3区7例(8.33%)存在DAA天然耐药突变(T54S,n=1,1.19%;R117H,n=5,5.95%;N174F,n=1,1.19%)。NS5A区19例(20.65%)存在天然耐药突变(L28M,n=7,7.61%;L31M,n=1,1.09%;P58S,n=4,4.35%;Y93H,n=7,7.61%)。NS5B区95例(97.94%)存在天然耐药突变(L159F,n=1,1.03%;C316N,n=92,94.85%;A421V,n=6,6.18%;R422K,n=1,1.03%;M426L,n=3,3.09%;V499A,n=38,39.18%)。NS3、NS5A和NS5B区天然DAA耐药突变发生率在IFN联合RBV经治与未经治患者之间差异均无统计学意义(P值均0.05)。结论未接受过DAA治疗的我国北京地区基因1b型CHC患者中存在DAA天然耐药突变,这些突变大多为低度耐药突变,其对DAA临床疗效的影响仍需进一步研究。未观察到既往IFN联合RBV治疗对CHC患者DAA天然耐药突变率的影响。     

To take or not to take: decision-making about antiretroviral treatment in people living with HIV/AIDS

Knowledge is limited regarding decision-making about antiretroviral treatment (ART) from the patient's perspective. This substudy of a longitudinal study of psychobiologic aspects of long-term survival, conducted in 2003, compares the rationales of HIV-positive individuals (n = 79) deciding to take or not to take ART. Inclusion criteria were HIV/AIDS symptoms, or CD4 nadir less than 350, or viral load greater than 55,000. Those not meeting any criteria for receiving ART (2/2003 U.S. DHHS treatment guidelines) were excluded. Diagnosis was on average 11 years ago; 36% were female, 42% African American, 28% Latino, 24% white, and 6% other. Qualitative content analysis of semistructured interviews identified 10 criteria for the decision to take or not to take ART: CD4/viral load counts (87%), quality of life (85%), knowledge/ beliefs about resistance (66%), mind-body beliefs (65%), adverse effects of ART (59%), easy-to-take regimen (58%), spirituality/worldview (58%), drug resistance (41%), experience of HIV/AIDS symptoms (39%), and preference for complementary/alternative medicine (17%). Participants choosing not to take ART (27%) preferred complementary/alternative medicine (r = 0.43, p = 0.001)1, perceived a better quality of life without ART (r = 0.32, p < 0.004), and weighted avoidance of adverse effects of ART more heavily (r = 0.24, p < 0.030) than participants taking ART (73%). Demographic characteristics related to taking ART were having a partner (r = 0.31, p < 0.008) and having health insurance (r = 0.26, p< 0.040). Decisions to take or not to take ART depend not only on patient medical characteristics, but also on individual beliefs about ART, complementary/alternative medicine, spirituality, and mind-body connection. HIV-positive individuals declining treatment place more weight on alternative medicine, avoiding adverse effects and perceiving a better quality of life through not taking ART.     

HIV/AIDS病人高效抗逆转录病毒治疗效果的临床评价

目的 评价目前高效抗逆转录病毒治疗(HAART)方案的疗效. 方法 应用国家免费提供的抗病毒治疗药品,对符合治疗条件的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人进行规范的抗病毒治疗,并检测病人的病毒载量及CD 4T淋巴细胞. 结果 对接受HAART 12个月后的98例病人测定病毒载量,平均病毒载量为(2.03±0.17)log10拷贝/ml,其中53人(58.24%)治疗24个月后血浆中检测不到HIV.98例病人的CD 4T淋巴细胞均不同程度升高,平均增高(197.27±51.71)个/μl(19～506个/μl);治疗2年以上者CD 4T淋巴细胞平均升高(235.92±77.45)个/μl.病人机会性感染得到明显控制,能从事中重度体力劳动的比例,由治疗前的15.31%上升到治疗后的32.65%. 结论 抗病毒治疗效果显著,HIV/AIDS病人生活质量得到明显改善.符合治疗条件的病人应及早进行规范的抗病毒治疗.     

Hepatitis B virus mutations potentially conferring adefovir/ tenofovir resistance in treatment-naive patients

Anti-hepatitis B virus （HBV） therapy leads to the emergence of mutant viral strains during the treatment of chronic hepatitis B with nucleos（t）ides analogues. The existence of HBV variants with primary antiviral resistance may be important for treatment choice. We studied two patients with chronic HBV infection by sequencing the HBV polymerase gene. They had adefovir- and tenofovir-related mutations in the viral polymerase, although they had never been treated. These mutations were rtV214A/rtN238T in one patient and rtA194T in the other. Thus, mutations in untreated patients deserve cautious surveillance. These data indicate that mutations that can theoretically confer adefovir or tenofovir resistance may emerge in treatmentnaive patients.     

Internet health information seeking behavior and antiretroviral adherence in persons living with HIV/AIDS

Abstract While the Internet has the potential to educate persons living with HIV/AIDS (PLWHA), websites may contain inaccurate information and increase the risk of nonadherence with antiretroviral therapy (ART). The objectives of our study were to determine the extent to which PLWHA engage in Internet health information seeking behavior (IHISB) and to determine whether IHISB is associated with ART adherence. We conducted a survey of adult, English-speaking HIV-infected patients at four HIV outpatient clinic sites in the United States (Baltimore, Maryland; Detroit, Michigan; New York, and Portland, Oregon) between December 2004 and January 2006. We assessed IHISB by asking participants how much information they had received from the Internet since acquiring HIV. The main outcome was patient-reported ART adherence over the past three days. Data were available on IHISB for 433 patients, 334 of whom were on ART therapy. Patients had a mean age of 45 (standard error [SE] 0.45) years and were mostly male (66%), African American (58%), and had attained a high school degree (73%). Most (55%) reported no IHISB, 18% reported some, and 27% reported "a fair amount" or "a great deal." Patients who reported higher versus lower levels of IHISB were significantly younger, had achieved a higher level of education, and had higher medication self-efficacy. In unadjusted analyses, higher IHISB was associated with ART adherence (odds ratio [OR], 2.96, 95% confidence interval [CI] 1.27-6.94). This association persisted after adjustment for age, gender, race, education, clinic site, and medication self-efficacy (adjusted odds ratio [AOR] 2.76, 95% CI 1.11-6.87). Our findings indicate that IHISB is positively associated with ART adherence even after controlling for potentially confounding variables. Future studies should investigate the ways in which Internet health information may promote medication adherence among PLWHA.     

The prevalence of six species of Mycoplasmataceae in an HIV/AIDS population in Jiangsu Province, China

This study employed culture and polymerase chain reaction (PCR) to examine the prevalence of Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Mycoplasma fermentans, Mycoplasma penetrans and Mycoplasma pirum in 210 HIV/AIDS patients, 455 sexually transmitted infection (STI) clinic attendees and 245 healthy volunteers from first-void urine specimens for men and endocervical swabs for women. U. urealyticum and M. hominis were detected in 107 (51.0%) and 69 (32.9%) patients in the HIV/AIDS group. At least one of the other four organisms was detected in 34 (16.2%) HIV/AIDS patients, 29 (6.4%) STI clinic attendees and six (2.5%) healthy volunteers. This study showed that U. urealyticum, M. hominis and M. fermentans were significantly more prevalent in HIV/AIDS patients, as were other mycoplasmas. Our results suggest a possible role for co-infection.     

福建省AIDS流行特征及趋势分析

目的分析福建省艾滋病病毒／艾滋病(HIV／AIDS)流行现状、特征、影响因素及趋势，为制定AIDS防治策略提供依据。方法对全省1987～2003年AIDS常规监测、高危人群哨点监测、流行病学调查及实验室资料进行分析。结果自1987年发现首例AIDS病人至2003年底，累计报告发现HIV抗体阳性者457例，其中AIDS病人155例，死亡110例。HIV感染者／AIDS病例主要分布在福州、泉州等沿海经济发达地区，从境外感染为主转向境内蔓延扩散，经异性性接触感染是福建省HIV传播的主要途径，并已出现母婴传播的病例。HIV-1E亚型是福建省主要流行株。结论福建省AIDS流行速度明显加快，在静脉吸毒人群中也存在流行的危险，应采取措施预防HIV从商危人群向一般人群传播，加大健康教育、行为干预和监测力度。