Antiviral therapy of decompensated hepatitis B virus-related cirrhosis

Objective  To review the development, mechanism, necessity and limitation of antiviral therapy in decompensated hepatitis B virus-related cirrhosis.

Data sources  Most information was pulled from a literature search (Pubmed 2000 to 2011) using the keywords of antiviral and decompensated hepatitis B virus-related cirrhosis. Relevant book chapters were also reviewed.

Study selection  Well-controlled, prospective landmark studies and review articles on antiviral therapy in decompesated hepatitis B virus-related cirrhosis were selected.

Results  Specific antiviral agents not only control viral replication, which permits liver transplantation, but also improve liver function so significantly that patients could be removed from the transplant waiting list. However, the emergence of drug-resistant mutants can result in treatment failure. Combination therapy is a save-strategy in drug-resistant.

Conclusions  Although the treatment of end-stage liver disease is still a challenge worldwide, antiviral therapy has altered the natural history of hepatitis B patients with decompensated cirrhosis. The approval of the new generation of antivirals is opening new perspectives for finding the optimal antiviral treatment for patients with decompensated cirrhosis and preventing antiviral resistance. A combination of antivirals may be one of the future strategies for fulfilling these goals.

     

Expansion of China’s free antiretroviral treatment program

Background  In 2003, China’s National Free Antiretroviral Treatment Program (NFATP) was initiated as a pilot, which covered only 100 HIV/AIDS patients. By 2011, the pilot had evolved into a nationwide program and had provided free treatment for over 150 000 patients. The objective of this study was to report and evaluate the progress of China’s free antiretroviral treatment program.

Methods  The NFATP Database was systematically reviewed and a total of 150 692 HIV/AIDS patients were included in this study. Program progress indicators including the number of treated HIV/AIDS patients, follow-up visit rate, CD4 test rate, and viral load test rate were summarized and examined over a calendar year to evaluate the progress of NFATP quantitatively and qualitatively.

Results  By the end of 2011, a total of 150 692 HIV/AIDS patients had been treated through the NFATP and 122 613 of them were still on treatment. Of all patients, about 72% were enrolled during the past four years. The dominant transmission route was blood related in the early phase of the NFATP, but gradually changed to sexual contact. Besides quantitative improvements, progress indicators also demonstrated significant qualitative improvements that the program had made during the past 9 years.

Conclusions  Great achievement has been made by China’s NFATP. China’s experience indicates the importance of a comprehensive response to the success of its treatment program. However, to ensure the quality and sustainability of treatment in the long term, more attention and resources should be paid towards program management.

     

Diagnosis and treatment of fungal infection after liver transplantation

Background  Liver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient’s health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.

Methods  Clinical data for 232 liver transplant patients at risk of fungal infection were examined for the presence of fungus in the blood, fluid, sputum, urine and stools of patients and by chest or abdominal CT scans. Patients diagnosed with a fungal infection were treated with Fluconazole or, if this was not effective, Voriconazole or Amphotericin B. Immunosuppressive therapy was also reviewed.

Results  Thirty-seven of 232 (15.9%) patients were diagnosed with a fungal infection, which occurred 4 to 34 days post-transplantation. Candida infections were diagnosed in 23 cases (62.2%) and Aspergillus infections in 12 cases (32.4%). Twenty-one cases were effectively treated with Fluconazole, 11 cases with Voriconazole, and two cases with Amphotericin B; however, three cases were not effectively treated with any of the antifungal agents. Overall, treatment was effective in 91.9% of patients.

Conclusions  Fungal infection has a significant influence on survival rate after liver transplantation. Imaging studies, and pathogenic and biopsy examinations can diagnose fungal infections, which can be effectively treated with antifungal agents such as Fluconazole, Voriconazole or Amphotericin B.

     

Efficacy and safety of intravenous itraconazole followed by oral itraconazole solution in the treatment of invasive pulmonary mycosis

Background  Invasive pulmonary mycosis is the most common type of invasive fungal infection. It is often severe and difficult to treat, and is accompanied by high mortality. In this study, we aimed to evaluate the efficacy and safety of intravenous itraconazole followed by oral itraconazole solution in the treatment of invasive pulmonary mycosis and to determine the distribution of different fungi species.

Methods  This was a multi-center, open-label study which enrolled 71 patients who were diagnosed as invasive pulmonary mycosis between July 2007 and January 2009. All patients received intravenous itraconazole therapy followed by oral itraconazole solution with a total treatment duration of 6 weeks. Intravenous itraconazole was given at a dose of 200 mg bid (intravenous infusion every 12 hours) for the first two days, 200 mg qd for the subsequent 12 days. Sequential oral itraconazole solution was given at a dose of 200 mg bid for 4 weeks. Efficacy and safety were assessed according to clinical as well as microbiological criteria.

Results  Seventy one patients participated in this study. Of the 60 patients in the full analysis dataset, the clinical response rate was 61.7% and the mycological eradication rate was 66.7%. The overall response rate was 66.7%. Drug-related adverse events occurred in 18.0% of patients: hypokalemia, liver function impairment and mild gastrointestinal side effects were the most common. One patient suffered from severe adverse event, with limb and facial swelling.

Conclusion This study showed that in patients with invasive pulmonary mycosis, intravenous itraconazole followed by oral itraconazole solution therapy was safe and effective.

     

Awareness and knowledge of hepatitis B infection and prevention and the use of hepatitis B vaccination in the Hong Kong adult Chinese population

Background  Hepatitis B virus (HBV) infection remains a global public health problem and it is an important cause of acute, chronic and fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma. The prevalence of HBV infection in Hong Kong over the past decade remained unchanged at 10%, despite the implementation of universal neonatal and availability of adult vaccination. We suspect that the current state of affairs is attributable to inadequate awareness and knowledge of HBV transmission and prevention in the general population, resulting in a low rate of uptake of HBV vaccination by the lay public. Therefore, we have embarked in this study to evaluate the awareness and knowledge on HBV infection in our local Chinese population, their attitude on the prevention of horizontal transmission of HBV, and the use of HBV vaccination, especially in those who were born before the era of universal neonatal vaccination.

Methods  The factors associated with HBV screening, vaccination uptake, and knowledge were examined in a face-to-face questionnaire survey on a group of adult Chinese in Hong Kong.

Results  Within this group, 14% was considered to have good knowledge for HBV infection, and 26% had HBV vaccination. Age, occupation, having children, and family monthly income, are independent factors associated with vaccination.

Conclusion  This study suggests insufficient public awareness of HBV infection in the Hong Kong Adult Chinese population.

     

Changes in serum levels of soluble osteoclast-associated receptor in human rheumatoid arthritis

Background  Osteoclast-associated receptor (OSCAR) is a member of the newly identified leukocyte receptor complex, and has recently been described as a key molecule in osteoclastogenesis. In this study, we measured the levels of soluble osteoclast-associated receptor (sOSCAR) in the serum of rheumatoid arthritis (RA) patients and healthy controls to examine whether sOSCAR may play a role in the process of inflammatory arthritis.

Methods  Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of sOSCAR in the serum of 40 healthy controls and 40 RA patients.

Results  The serum levels of sOSCAR were significantly lower in RA patients than in healthy controls, and were inversely associated with inflammatory activity.

Conclusion  sOSCAR is decreased in patients with RA and reduced levels of the protein are associated with increased inflammatory response.

     

Application of echocardiography in resynchronization treatment of heart failure patients

Objective  To review the updated research progress about the application of echocardiography in resynchronization treatment of chronic heart failure patients.

Data sources  The data used in this review were from PubMed, published in English and using the key terms “heart failure”, “echocardiography” and “cardiac resynchronization therapy”.

Study selection  Relevant articles were reviewed and selected to address the stated purpose.

Results Increasing numbers of studies have suggested the importance of echocardiography in resynchronization treatment of chronic heart failure patients. Echocardiography can evaluate atrioventricular, inter- and intra-ventricular mechanical dyssynchrony before cardiac resynchronization therapy (CRT), as a guidance to assess the optimal left ventricular (LV) pacing location, optimize the atrioventricular and interventricular delays and predict response to CRT.

Conclusions  Echocardiography is both non invasive and easily repeatable, and plays a crucial role in appraisal of heart synchronism, instruction of actuator placement, optimization of the device procedure, and prediction of the response to CRT.

     

Engaging HIV-infected patients in antiretroviral therapy services: CD4 cell count testing after HIV diagnosis from 2005 to 2009 in Yunnan and Guangxi, China

Background  The initiation and expansion of China’s national free antiretroviral therapy program has led to significant improvement of survival among its participants. Success of further scaling up treatment coverage rests upon intensifying HIV screening and efficient linkage of care. Timely CD4 cell count testing after HIV diagnosis is necessary to determine whether a patient meets criteria for antiretroviral treatment, and represents a crucial link to engage HIV-infected patients in appropriate care, which has not been evaluated in China.

Methods  We evaluated all patients ≥16 years who tested HIV positive from 2005 to 2009 in Yunnan and Guangxi. Multivariate Logistic regression models were applied to identify factors associated with lack of CD4 cell count testing within 6 months after HIV diagnosis.

Results  A total of 83 556 patients were included. Over the study period, 30 635 (37%) of subjects received a CD4 cell count within 6 months of receiving the HIV diagnosis. The rate of CD4 cell count testing within 6 months of HIV diagnosis increased significantly from 7% in 2005 to 62% in 2009. Besides the earlier years of HIV diagnosis, negative predictors for CD4 cell count testing in multivariate analyses included older age, not married or unclear marriage status, incarceration, diagnosis at sexual transmitted disease clinics, mode of HIV transmission classified as men who have sex with men, intravenous drug users or transmission route unclear, while minority ethnicity, receipt of high school or higher education, diagnosis at voluntary counseling and testing clinics, and having HIV positive parents were protective.

Conclusions  Significant progress has been made in increasing CD4 testing among newly diagnosed HIV positive patients in Yunnan and Guangxi from 2005–2009. However, a sizable proportion of HIV positive patients still lack CD4 testing within 6 months of diagnosis. Improving CD4 testing, particularly among patients with identified risk factors, is essential to link patients with ART services and optimize treatment coverage.

     

Efficacy and safety of itraconazole as empirical antifungal therapy in febrile neutropenic patients with hematologic malignancies: an open-lable, multicenter, observational trial in a Chinese cohort

Background  Invasive fungal infection (IFI) is a common and fatal complication in neutropenic patients with hematological malignancy. Empirical antifungal therapy is widely used in practice due to the difficulty of pathogens determination and illness of the hosts. The aim of this study was to evaluate the efficacy and safety of itraconazole as empirical antifungal therapy for persistent fever in neutropenic patients with hematologic malignancies.

Methods  Two hundred and seventy-four patients with hematologic malignancies who had suspected fungal infections were enrolled in 18 centers across China between April 2008 and April 2009. Empirical antifungal therapy with intravenous itraconazole 200 mg twice daily was given for the first two days, followed by 200 mg once daily for the next 12 days. Oral itraconazole solution was sequential for follow-up therapy if necessary. Five composite end points were evaluated for the response, which was more restrictive and adopted for the first time in such study in China.

Results  The intent-to-treat analysis included data from 274 patients (full analysis set, FAS), of whom 248 were included as the per-protocol population (PPS). As the composite end point of five indices was concerned, the overall response rate was 43.4%. Seperately, defervescence was achieved in 90% of patients in which 55.5% occured during neutropenia. The mean time to defervescence was 2.71 days. Absence of breakthrough IFI during drug administration or within the first 7 days after study completion was observed in 71.5% of patients. Fifty-five point five percent patients with IFI at baseline was successfully treated. Ninety point five percent patients survived for at least 7 days after completing the study. PPS analysis revealed that the duration of neutropenia ≥10 days was a statistically significant negative predictor for the response. The withdrawal rate due to drug-related toxicity or lack of efficacy was 11.0%. The incidence of adverse events was 22.6%, in which 11.6% was study drug related. The most frequent adverse events were mild to moderate liver toxicity.

Conclusion  Itraconazole shows desirable efficacy and safety as empirical antifungal therapy for febrile neutropenic patients with hematologic malignancies.

     

Newborn screening in Zhejiang, China

Background  It has been 11 years since newborn screening started in Zhejiang in 1999. The aim of this study was to analyze and summarize the status of newborn screening in Zhejiang from 1999 to 2009.

Methods  Blood samples were collected from the heels of newborns 72 hours after birth. We have conducted laboratory tests that the congenital hypothyroidism (CH) and circulating levels of thyroid-stimulating hormone (TSH) was detected. Blood phenylalanine (Phe) was detected for phenylketonuria (PKU). Dissociation-enhanced lanthanide fluorescent immunoassay (DELFIA) was used for detection.

Results  From 1999 to 2009, 3 875 228 newborns were screened and 2309 cases were confirmed as CH and 155 cases were confirmed as PKU. The incidence of CH and PKU were 1:1678 and 1:25 001 respectively.

Conclusion  In 11 years, the Zhejiang newborn screening center screened more than 3.8 million newborns, and helped more than 2000 CH and PKU patients to obtain early treatment in order to prevent physical disability and mental retardation.

     

甘肃省敦煌地区普通人群卡波肉瘤相关疱疹病毒感染的血清学分析

目的 研究卡波肉瘤相关疱疹病毒(KSHV)在甘肃敦煌地区普通人群中的血清阳性率,并分析KSHV感染的危险因素.方法 随机收集1 000例敦煌地区普通人群血清,以KSHV 3个基因片段 orf65、orf73、orf k8.1编码蛋白为抗原,间接ELISA检测样本中KSHV抗体,SPSS软件分析危险因素. 结果 1 000份血清中,KSHV抗体总阳性率为19%,男性阳性率(22.9%)高于女性(16.6%)(P=0.016);KSHV感染与梅毒螺旋体(P=0.004)和丙肝病毒(P=0.027)感染间有相关性,而与年龄、乙肝五项无关.多因素Logistic回归分析显示梅毒螺旋体感染的OR(95% CI)为10.142 (1.920~53.577).结论 甘肃敦煌地区普通人群中KSHV的感染率较高,且与性别有关;梅毒螺旋体感染是该地区KSHV感染最重要的独立危险因素.     

台州市354名吸毒人员调查

目的了解台州市吸毒人员构成，规模及艾滋病和梅毒感染情况，为开展相关工作提供参考依据。方法对2007年2—5月新入戒毒所的人员进行流行病学调查，并检测HIV抗体和梅毒抗体，将上述资料录入EPIDATA数据库进行分析。结果吸毒人员构成，本省占48．59％，外省占51．41％；以烫吸为主，发生率为71．46％，注射吸毒发生率为26．27％，毒品以海洛因为主；93名注射者中，23．66％的人共用注射器吸毒，其中，男16名，女6名，共用注射吸毒率分别为24．62％、21，43％，男女注射吸毒差别无统计学意义；354名吸毒者中，49名发生商业性服务，发生率13．84％，每次使用安全套者为（2名）比率4．08％；吸毒人员HIV感染率0．85％，其中注射吸毒感染率3．23％；梅毒感染率0．85％。结论建议开展预防综合性控制措施，以消除毒品带来的社会、环境和健康问题。     

广西来宾市艾滋病高危人群及危险因素调查

目的 调查来宾市艾滋病高危场所和高危人群的分布情况和数量,为制定艾滋病防治决策提供科学依据.方法 采用调查问卷方法对全市娱乐场所从事商业性服务人员进行调查;应用酶联免疫吸附实验（ELISA）对吸毒人员进行HIV筛查及行为调查.结果 全市固定性服务人员712人,流动性服务人员149人;138名调查对象对艾滋病相关知晓率为49.34%,在商业性行为中能坚持使用安全套仅为42.86%;调查180名吸毒人员,55.11%承认共用注射器吸毒;检出HIV阳性者16例,阳性率为8.89%,其中14人承认共用注射器吸毒,占87.5%.结论 性服务人员对艾滋病相关防护知识知晓较少,在商业性行为中未能完全坚持使用安全套;HIV在吸毒人员中感染率较高,其中共用注射器吸毒对传播艾滋病危险性大.     

广州地区吸毒人员HBV、HCV感染流行病学特征

目的了解广州地区吸毒人员乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）的感染状况及其影响因素。方法收集广州地区吸毒人员的血液标本,采用ELISA检测HBsAg及HCV抗体,并对吸毒人员采取统一调查表进行问卷调查,采用统计学方法进行相关性分析。结果 1375名吸毒者HBV、HCV的感染率分别为20.8%、39.2%,HBV/HCV合并感染率为7.7%（106/1375）。其中采用静脉吸毒者HBV、HCV的感染率分别24.5%、84.5%,均高于非静脉吸毒者的19.2%、19.8%,差异有统计学意义（P〈0.05）。吸毒者年龄越大、吸毒时间越长越容易发生HBV或HCV感染。结论吸毒尤其是静脉吸毒是HBV、HCV感染的高危因素。吸毒者年龄、吸毒时间长短及吸毒方式与HBV、HCV感染相关。     

中国石油工人乙肝病毒感染的危险因素分析

为了分析我国石油工人乙肝病毒(HBV)感染的危险因素,1990年3月对河南石油勘探局1074名石油工人进行了HBV感染的血清流行病学研究。通过单因素及多因素分析方法均发现,性别、本人肝病史、同事肝病接触史、野外工作、经常出差等因素为我国石油工人HBV感染的主要危险因素。提示搞好野外工作场所的公共卫生,对长期从事野外工作的职工,加强个人防护、减少HBV感染之机会,是降低我国石油工人HBV感染的一个有效措施。     

分析重庆市HIV/AIDS患者合并HBV、HCV感染状况

目的 分析重庆市艾滋病病毒感染者(HIV)和获得性免疫缺陷综合征(acquired immunedeficiency syndrome,AIDS)患者(简称HIV/AIDS患者)合并感染乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)状况.方法 利用《艾滋病综合防治系统——抗病毒治疗管理》数据库,回顾收集重庆市2004-2015年HIV/AIDS治疗患者基本情况和HBsAg、Anti-HCV实验室检测结果,利用SPSS 19.0统计软件进行统计分析.结果 截至2015年12月31日,重庆市HIV/AIDS患者中HBsAg和(或)Anti-HCV总检测率55.1％ (11 231/20 397),其中HBsAg和Anti-HCV都进行检测的患者有9 307例.HIV/HBV、HIV/HBV/HCV、HIV/HCV合并感染的比例分别为9.8％、0.9％、4.5％.HIV/HCV合并感染在30 ～ 45岁年龄段构成比最高;HIV/HBV合并感染在男性中构成比最高,与HIV单纯感染组比较,差异均具有统计学意义(P＜0.05).HIV/HBV合并感染及HIV单纯感染均在性传播中构成比最高,差异无统计学意义(P=0.177);HIV/HCV和HIV/HBV/HCV合并感染在静脉吸毒中构成比最高,与HIV单纯感染比较,差异具有统计学意义(P＜0.05).主城9区中HIV/AIDS患者及合并感染患者比例最高.合并感染组病死率均高于HIV单纯感染组,HIV/HBV/HCV组病死率最高.结论 重庆市HIV/AIDS患者中HBsAg、Anti-HCV检测率较低,不同感染模式具有不同的流行病学特征,且合并感染的病死率较高,需要进一步加强对重庆市HIV/AIDS患者中HBV、HCV合并感染检测率和治疗情况的管理.     

广东省2009年高危人群HIV哨点综合监测结果分析

目的通过对吸毒人群(DUs)、暗娼(FCSWs)、男男性行为者(MSMs)和男性性病门诊就诊者(MSTDs)四类艾滋病(AIDS)主要高危人群的综合监测,了解他们的艾滋病病毒(HIV)流行情况及其高危行为。方法按照艾滋病行为和血清学监测方案的操作程序及调查方法对四类人群进行行为及血清学监测。结果 13620例DUs、5309例FCSWs、970例MSMs、4273例MSTDs的HIV阳性率分别为3.7%、0.2%、4.7%、0.3%,梅毒阳性率分别为4.5%、3.1%、12.0%、6.5%,丙肝阳性率分别为34.5%、0.6%、0.5%、0.7%,注射吸毒率分别为68.1%、0.7%、0.3%、3.7%,商业性交率分别为23.3%、100.0%、17.2%、41.4%,艾滋病知识知晓率分别为73.4%、69.4%、82.9%、66.4%,干预覆盖率分别为40.8%、47.0%、74.7%、31.5%。结论四类高危人群中均检出HIV感染者,感染率以MSMs最高,其次为DUs,FCSWs感染率最低,各高危人群均存在感染HIV的诸多危险因素,应加大综合干预力度。     

特殊人群病毒性肝炎感染状况分析

目的：探讨分析性病患、暗娼、吸毒、献血员等这些特殊人群病毒性肝炎的传播特点，为肝炎防治工作提供科学依据。方法：随机抽取深圳市性病患223人，暗娼189人，吸毒279人，献血员179人，共870人作为调查对象，同时以774名居民和480名农民作对比，用ELISA法检测血液标本。结果这四类人群中甲、乙、戊型肝炎特殊人群感染率比普通人群高，性病、吸毒二类人群各型肝炎的感染率最高，吸毒中丙肝感染率高达25．68％，乙型肝炎病毒表面抗原检出率为31．54％。结论：加强对特殊人群的管理，控制病毒性肝炎的蔓延。     

Health-related attitudes and risk factors for sexually transmitted infections of Chinese women who have sex with women

Background  Previous studies have shown evidence of health-related risk behaviors among women who have sex with women (WSW), such as sex with men, multiple bisexual partners, and drug use. Women who have sex with women have also been known to avoid routine physical examinations and conceal their same-sex history from physicians, which can affect their ability to receive an accurate diagnosis and treatment. No previous research has targeted women who have sex with women in China. We sought to describe women who have sex with women in China and explore risk factors for their reproductive tract infections (RTI)/sexually transmitted infections (STI).

Methods  Participants were recruited through outreach in venues and online for a cross-sectional study. Data were collected using interviews and laboratory tests.

Results  We recruited 224 women who have sex with women. In the year preceding their participation in the study, 92% (206/224) of women reported sexual relations with women. The RTI rates were: gonorrhea (15.8%), chlamydia (3.5%), syphilis (0.5%), bacterial vaginosis (14.4%), hepatitis B virus (HBV) (0.9%), hepatitis C virus (HCV) (0.5%), and candidiasis (6.9%). No HIV or herpes simplex virus (HSV) positive cases were detected. Factors associated with gonorrhea infection were non-Beijing local residency (odds ratio (OR)=2.1, 95% confidence interval (CI): 1.2–3.8) and genital-genital contact (OR=3.1, 95% CI: 1.3–7.2); factors associated with curable STI (excluding bacterial vaginosis, candidiasis, HBV and HCV) were non-Beijing local residency (OR=1.9; 95% CI: 1.2–3.0) and bleeding during or after sex (OR=18.1; 95% CI: 5.2–62.6); and the factor associated with RTI (including all the infections tested) was bleeding during or after sex (OR=37.8, 95% CI: 11.2–127.4).

Conclusions  Behaviors that may cause RTI/STI exist among Chinese women who have sex with women. Researchers should consider these behaviors when planning corresponding prevention and interventions.

     

浙江嵊县新建村人体蠕形螨流行情况调查

在浙江嵊县新建村,对353人(男179人,女174人;年龄3～81岁)作了人体蠕形螨的流行情况调查。检出蠕形螨阳性者144人,感染率约41％。男女感染率无显著差别;但感染率随年龄的增加而上升。在144例阳性者中,单纯感染毛囊蠕形螨或皮脂蠕形螨者分别为84人(约58％)和34人(约24％),混合感染者26人(约18％)。经统计分析,毛囊蠕形螨的感染率和感染严重度均明显高于皮脂蠕形螨。这两种蠕形螨的感染率和感染严重度在男女性别间无明显差别。本文还对蠕形螨的传播途径及致病性进行了讨论。