HIV-TB: the 'cursed duet'

Tuberculosis is the most common infection among HIV-infected patients in India. More deaths were reported due to tuberculosis in AIDS patients in pre-antiretroviral therapy era. HIV is the strongest of all known, risk factors for the development of TB. Tuberculosis can develop at any stage of the HIV disease. Extrapulmonary tuberculosis is more common and constitues half of the cases in HIV-infected individual with TB. Hilar lymphadenopathy is frequently observed. TB in HIV frequently poses a diagnostic challenge. Acid-fast bacillus demonstration on sputum smear microscopy is the main-stay laboratory investigation for TB. In addition to antituberculous therapy, antiretroviral therapy must be initiated in HIV-infected individual with TB. Early referrals to the RNTCP and ART programmes are the best option for management.     

陕西省TB与HIV/AIDS双向筛查及TB/HIV患者抗结核治疗转归队列分析

目的 了解陕西省TB/HIV (结核分枝杆菌 /艾滋病病毒)双重感染防治工作。提高TB/HIV发现、治疗和管理力度,控制结核病和艾滋病的进一步传播,保护公众健康。方法 收集整理和分析2010—2017年陕西省各地上报的《TB/HIV 双重感染防治管理工作年度报表》。结果 2010—2017年,累计接受HIV抗体检测的结核病患者43 304例,检测率25.10%,HIV检测阳性数16例,阳性检出率0.04%;同期,HIV /AIDS患者中,新检出的HIV/AIDS中接受X线胸片或查痰9 666人,结核病检查率76.81%;诊断TB/HIV双重感染患者224人,结核病患者检出率2.32%;既往的HIV/AIDS中接受X线胸片或查痰24 277人次,结核病检查率80.43%;诊断TB/HIV双重感染患者105人,结核病患者检出率0.43%;结核中筛HIV/AIDS,新检出HIV/AIDS中筛结核,既往HIV/AIDS中筛结核,三组检出率两两进行对比,差别均有统计学意义（P<0.001）;共进行抗结核治疗263例,抗结核治疗率76.23%;进行抗病毒治疗256例,抗病毒治疗率74.20%;抗结核治疗的TB/HIV患者中治愈35例（17.59%）,完成疗程率141例（70.85%）,结核死亡1例（0.50%）,非结核死亡15例（7.54%）,丢失2例（1.00%）,其他5例（2.51%）。结论 双向筛查是切实有效的早期发现TB/HIV的方法,有利于提高TB/HIV的早期发现,并能提高TB/HIV双重感染患者结核病的治疗成功率、降低结核病死亡率,有效的控制TB/HIV双重感染疫情。     

人类免疫缺陷病毒感染早期启动抗逆转录病毒治疗的意义

人类免疫缺陷病毒（HIV）感染者如在感染早期未及时诊断和治疗,HIV将在体内持续复制,损害免疫系统。目前,越来越多的指南建议HIV感染者应尽早启动抗逆转录病毒治疗（ART）,尤其是急性HIV感染者。早发现并在感染早期开始ART可以限制病毒储存库的规模,改善免疫细胞功能。从社会层面而言,感染早期的患者通过启动ART达到病毒抑制状态,可以减少HIV的传播机会,降低获得性免疫缺陷综合征（AIDS）的发病率,进而减少与AIDS相关的卫生支出。但HIV感染早期诊断及治疗存在个人因素和社会因素等方面的问题,阻碍了早期治疗的实施和开展。尽早启动ART,联合其他治疗策略,有可能真正实现功能性治愈。     

Immune reconstitution inflammatory syndrome: immune restoration disease 20 years on

Restoration of immune responses against opportunistic pathogens after commencing antiretroviral therapy (ART) may cause immune restoration disease (IRD) in about 10%-40% of HIV patients with low CD4(+) T-cell counts and usually presents clinically as a type of immune reconstitution inflammatory syndrome (IRIS). IRIS may be associated with many different opportunistic pathogens, but types associated with Mycobacterium tuberculosis, BCG, cryptococci, JC polyomavirus (the cause of progressive multifocal leukoencephalopathy [PML]), hepatitis C virus and hepatitis B virus infection are the most informative about disease pathogenesis and management. A CD4(+) T-cell count of < 50/μL and a high pathogen load are the most commonly identified risk factors for IRIS. Recovery of pathogen-specific T-cell responses and perturbations of innate immune responses before and after ART appear to cause immunopathological abnormality in tissues infected by the pathogen. Prevention of IRIS may be influenced by the timing of ART: The risk of tuberculosis (TB)-associated-IRIS can be reduced by commencing ART after 8 weeks of TB treatment, but rates of AIDS or death are lower if ART is commenced during the first 4 weeks of TB treatment. Outcomes for patients with HIV and treated cryptococcal or TB meningitis may be improved by deferring ART until the opportunistic infection is fully suppressed, but data are inadequate. As ART is currently the only effective treatment for PML in patients with HIV, PML-associated IRIS cannot be prevented by manipulating the timing of ART. A greater understanding of the immunopathogenesis of IRIS may lead to targeted therapies.     

人类免疫缺陷病毒并乙型肝炎病毒感染者终末期肝病影响因素分析

目的了解影响人类免疫缺陷病毒（HIV）合并乙型肝炎病毒（HBV）感染者发生终末期肝病的影响因素。方法对HIV合并HBV感染者进行调查,对影响终末期肝病的因素进行非条件logistic回归分析,计算比值比（彻）。结果255例HIV合并HBV感染者终末期肝病发生率为19．2％（49／255）。基线CD4〈200／μl、基线氨基转移酶异常、抗反转录病毒治疗6个月内HIVRNA降至检测下限、HIVRNA和HBVDNA持续阳性时间较长、使用含拉米夫定的抗反转录病毒治疗方案最终进入多因素分析的回归模型,OR值分别为6．503、14．456、0．049、1．814、1．536、0．012。结论HIV合并HBV感染者发生终末期肝病的风险与患者免疫功能、肝功能、HIV及HBV持续复制密切相关;为降低终末期肝病发生率,HIV合并HBV感染者宜首选含拉米夫定的抗反转录病毒治疗方案。     

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.     

山西省2011—2019年50岁及以上HIV/AIDS患者接受抗病毒治疗的生存状况分析

目的 分析山西省 2011—2019年接受抗病毒治疗（ART）的50岁及以上HIV/AIDS患者的生存状况,为进一步完善抗病毒治疗工作提供依据 。方法 收集山西省2011—2019年所有首次接受艾滋病抗病毒治疗的50 岁及以上HIV/AIDS患者的入组基本信息和治疗后的随访信息,建立Excel数据库并用SPSS23.0软件进行分析,采用回顾性队列研究方法,应用Cox比例风险回归模型分析影响生存时间的相关因素。结果 共纳入研究对象1 183例,死亡172例,其中因其他原因死亡84例（48.84%）,艾滋病相关死亡74例（43.02%）,因意外、自杀及不确定死亡共14例（8.14%）。将艾滋病相关死亡设为结局事件,寿命表分析显示研究对象在接受ART 后第1、3、5、7、9年的累积生存率分别为 96.61%、93.59%、90.35%、87.57%、83.44%,多因素Cox比例风险模型分析显示,60~<70岁年龄组及70岁以上年龄组患者的艾滋病相关死亡风险分别是50~<60岁年龄组患者的2.53倍（95%CI：1.51~4.23）和3.59倍（95%CI：1.74~7.40）、基线CD4⁺T淋巴细胞（CD4）≥200个/mm³组和50~<200个/mm³组患者的艾滋病相关死亡风险分别是基线CD4细胞计数<50个/mm³组患者的0.22倍（95%CI：0.12~0.41）和0.37倍（95%CI：0.21~0.67）,基线有机会性感染疾病组患者的艾滋病相关死亡风险是无机会性感染疾病组患者的1.99倍（95%CI：1.16~3.39）。结论 山西省2011—2019年接受抗病毒治疗的50岁及以上HIV/AIDS患者的生存率较高,今后应继续坚持并完善针对该人群的“早发现、早治疗”相关措施,注重加强对该人群因非艾滋相关疾病死亡的具体死因信息收集工作,进一步提高我省抗病毒治疗质量。     

广西2004—2019年初始抗病毒治疗儿童HIV感染者生长发育情况分析

目的 了解初始抗病毒治疗儿童HIV感染者的生长发育情况及其影响因素。方法 采用回顾性队列研究方法,从国家艾滋病抗病毒治疗信息系统下载广西2004—2019年初始抗病毒治疗儿童HIV感染者数据库。根据中国儿童生长发育标准计算Z评分,趋势性分析采用Cox-Stuart检验,广义估计方程用于分析HAZ（height-for-age Z-score）≥-2和WAZ（weight-for-age Z-score）≥-2的影响因素。结果 共计943例儿童HIV感染者进入队列。基线和治疗后第1、2、5、10年的HAZ中位数分别为-2.47、-2.14、-1.94、-1.55、-1.23,WAZ中位数分别为-1.85、-1.40、-1.30、-1.21、-1.09。经Cox-Stuart趋势检验,HAZ和WAZ随治疗时间均呈上升趋势（P<0.05）。基线和治疗后第1、2、5、10年HAZ≥-2的比例分别为38.1%、46.5%、51.6%、66.8%和74.6%,WAZ≥-2的比例分别为57.1%、76.9%、81.1%、85.8%和89.2%。经Cox-Stuart趋势检验,HAZ≥-2和WAZ≥-2的比例随治疗时间均呈上升趋势（P<0.05）。多因素广义估计方程分析结果显示,与HAZ≥-2的关联性因素有初始抗病毒治疗年龄为3~7岁（aOR=0.71,95%CI：0.53~0.94）、初始抗病毒治疗年龄为>7岁（aOR=0.66,95%CI：0.47~0.93）、治疗前CD4⁺T淋巴细胞计数<200个/μL（aOR=0.64,95%CI：0.47~0.87）、治疗前WHO临床分期为Ⅲ/Ⅳ期（aOR=0.74,95%CI：0.56~0.97）以及治疗时间（aOR=1.01,95%CI：1.01~1.01）;与WAZ≥-2的关联性因素有男性（aOR=0.72,95%CI：0.53~0.97）、治疗前WHO临床分期为Ⅲ/Ⅳ期（aOR=0.63,95%CI：0.45~0.86）以及治疗时间（aOR=1.01,95%CI：1.01~1.01）。结论 抗病毒治疗有效改善了儿童HIV感染者的生长发育状况,但治疗后第10年仍有较大比例的儿童生长发育迟缓,需加强抗病毒治疗工作人员培训和儿童HIV感染者父母宣传教育以提高抗病毒治疗效果并合理指导儿童营养。     

广西HIV/AIDS患者合并巨细胞病毒感染特征与影响因素分析

目的调查HIV/AIDS患者巨细胞病毒(CMV)感染情况,比较不同标本(血液、尿液)在HIV合并CMV感染早期筛查的应用价值,分析HIV合并CMV感染的影响因素。方法收集2018年1月—2020年12月南宁市第四人民医院诊治的848例HIV/AIDS患者的性别、年龄、CD4^(^(+))T细胞计数、抗逆转录病毒治疗(ART)等资料信息,采用荧光PCR(FQ-PCR)检测血液/尿液CMV-DNA载量。采用卡方检验、Fisher确切概率法分析感染的差异,以二项Logistic回归分析HIV合并CMV感染的危险因素。结果848例HIV/AIDS患者中,有205例(24.17%)CMV-DNA阳性。尿液CMV-DNA检出率20.03%(142/709)高于血液CMV-DNA检出率12.04%(102/847)。多因素二项Logistic回归分析显示男性合并CMV感染的危险是女性2.30倍(95%CI:1.43~3.71),年龄30~<50岁和≥50岁合并CMV感染危险是年龄<30岁的2.43和2.32倍(95%CI分别为:1.20~4.91,1.15~4.65)、CD4^(+)T<50个/μL合并CMV感染的危险是CD4^(+)T≥100个/μL的3.88倍(95%CI:2.50~6.03),ART治疗患者合并CMV感染的危险比非ART治疗下降89%(OR=0.11,95%CI:0.05~0.24)。结论尿液在CMV感染的早期筛查比血液准确度更高,应重视CD4^(+)T计数较低、中年以上男性,加强其CMV感染的早期筛查和抗病毒治疗。     

广西新登记结核病人艾滋病病毒感染流行病学分析

目的调查广西新登记结核病人的艾滋病病毒感染流行病学特征,为TB/HIV双重感染防治策略的制定及资源的合理配置提供理论依据。方法采取系统抽样法,选择广西15个有HIV感染疫情的地区开展结核病人中的HIV相关问卷调查及检测。结果2007年9~12月2795例结核病人纳入调查,23名结核病人拒绝调查,实际调查2772名。调查发现54名HIV感染者,总的感染率为1.95%;男性HIV感染者46人,感染率为2.38%;15~49岁结核病人中HIV感染率为2.54%;教师干部等HIV感染率为3.54%,服务业HIV感染率为2.94%;初中文化程度的结核病人HIV感染率为3.09%;已婚者的HIV感染率为2.15%,未婚者的HIV感染率为0.86%,其他婚姻状况的结核病人HIV感染率为5.66%;淋巴结核HIV感染率为22.22%。结论有必要加强结核病与艾滋病防治的协调工作,开展有针对性的双重感染防治工作,以早期发现、治疗双重感染病人,减少结核、HIV的传播,降低双重感染病人的发病率和死亡率。     

A retrospective study of death among patients treated for tuberculosis in the Klang Chest Clinic for the year 1999

A retrospective epidemiological study was done on 41 deaths among patients treated for TB in the Klang Chest Clinic for the year 1999. The findings revealed a male preponderance of TB deaths with Indians having the highest case fatality rate (8.6%). The majority of deaths occurred within the 25-44 year age group. Of those cases diagnosed as Pulmonary TB, 69% were diagnosed as far-advanced, at presentation, based on chest x-rays reported. Eighty three percent of these patients were still on treatment when they died. HIV was the most common co-existing disease condition and was implicated in 14.6% of the deaths. The recommendations include implementation of clinical guidelines on TB screening for HIV patients, a study to evaluate the effectiveness of the current TB surveillance programme and for chest x-rays of all sputum smear negative patients to be reported by the radiologist to reduce the risk of misdiagnosis.     

Prevention and control of HIV/AIDS in China: lessons from the past three decades

In the past 37 years, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has undergone various major transmission routes in China, with the world most complex co-circulating HIV-1 subtypes, even the prevalence is still low. In response to the first epidemic outbreak of HIV in injecting drug users and the second one by illegal commercial blood collection, China issued the Anti-Drug Law and launched the Blood Donation Act and nationwide nucleic acid testing, which has avoided 98,232 to 211,200 estimated infections and almost ended the blood product-related infection. China has been providing free antiretroviral therapy (ART) since 2003, which covered >80% of the identified patients and achieved a viral suppression rate of 91%. To bend the curve of increasing the disease burden of HIV and finally end the epidemic, China should consider constraining HIV spread through sexual transmission, narrowing the gaps in identifying HIV cases, and the long-term effectiveness and safety of ART in the future.     

HIV/AIDS患者抗逆转录病毒治疗退出影响因素研究进展

艾滋病是由人类免疫缺陷病毒(H1V)引起的一种危害性极大的传染病,需要HIV/AIDS患者每日按时按量服药才能有效抑制体内HIV复制.中国实施抗逆转录病毒疗法(ART)和扩大治疗策略将所有符合条件的HIV感染者纳人治疗范围,越来越多的HIV感染者接受ART,同时退出(停药和失访)ART的HIV/AIDS患者人数也在逐年...     

四川省越西县和昭觉县HIV抗病毒治疗停药患者耐药调查

目的 了解四川凉山州HIV抗病毒治疗停药患者的耐药情况。方法 在四川省凉山州选择抗病毒治疗人数较多的越西县和昭觉县两个治疗点,对其2018年HIV抗病毒治疗停药患者按照抗病毒治疗号顺序进行横断面调查,收集调查对象社会人口学、高危行为以及抗病毒治疗情况等数据;采集全血分离血浆检测病毒载量,提取核酸和pol基因区扩增测序进行耐药检测。结果 调查273例患者,54.7%（140/273）患者的病毒载量≥1 000 拷贝/mL;成功获得206份序列进行耐药分析,16.0%（33/206）患者检出耐药。病毒载量≥1 000拷贝/mL的比例随着停药时间的延长而增大,而耐药的比例随着停药时间的延长而减小。昭觉县的耐药率高于越西县（aOR=2.97,95%CI=1.17~7.54,P=0.022）;未婚的患者耐药率比在婚或同居的患者高（aOR=2.58,95%CI=1.27~7.40,P=0.042）。停药时间 >24个月患者的耐药率比停药时间1~<24个月低（aOR=0.32,95%CI=0.14~0.76,P=0.001）。近一年内发生无保护性行为的比例为72.2%。结论 HIV抗病毒治疗停药患者耐药和无保护性行为比例均高,需对该人群加强宣传教育,减少HIV毒株尤其是耐药株的传播。     

Diagnosis of pulmonary tuberculosis among asymptomatic HIV+ patients in Guangxi, China

Background Pulmonary tuberculosis （PTB） among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB among asymptomatic patients with HIV/AIDS in Guangxi to facilitate the development of diagnostic and treatment strategies.Methods All asymptomatic adult HIV-infected patients with CD4 ＜350 cells/μl who attended four HIV clinics in Guangxi between August 2006 and March 2008 were evaluated for active PTB with physical examination, chest X-ray （CXR）,sputum smear and/or sputum liquid culture. Data were described using median （interquartile range, IQR） and frequencies.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with PTB.Results Among 340 asymptomatic subjects, 15 （4%） were diagnosed with PTB, with 4 （27%） sputum smear positive and 8 （53%） sputum culture positive. CXR has higher diagnostic sensitivity （87%） than sputum smear （25%） and sputum culture （67%）, but lower specificity （56%） compared with sputum smear （99%） and culture （100%）. In univariate analysis,injection drug user, body mass index （BMI） ＜18 kg/m2, CD4 ＜50 cells/μl and presence of peripheral lymphadenopathy were associated with an increased risk of asymptomatic PTB, while in multivariate analysis only peripheral lymphadenopathy maintained statistical significance （OR=7.6, 95% CI 1.4-40）. Patients with negative smear and minor or no abnormalities on CXR had longer interval between screening and TB treatment.Conclusions PTB was relatively common in this group of HIV＋ asymptomatic Chinese patients. Diagnosis is challenging especially where sputum culture is unavailable. These findings suggest that an enhanced evaluation for PTB needs to be integrated with HIV care in China and transmission prevention in China to control at both households and health care facilities, especially for patients with factors associated with a higher risk of PTB.     

The outcome of prevention of mother-to-child transmission of HIV infection at King Abdulaziz University Hospital,Western Region of Saudi Arabia: A Descriptive Study

Objectives:To describe the effectiveness of HIV guidelines in prevention of mother-to-child transmission (PMTCT).Methods:A retrospective review from January 2009 to December 2018 at the King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. The main outcome measures were characteristics of HIV-exposed patients and transmission rate.Results:A total of 18 HIV-positive mothers and their 26 infants were included. The mean age of mothers at delivery was 31.69 years, and 50% were under 30 years old. All mothers received lifelong ART, except one who was not diagnosed until the 27th week of gestation. Among the mothers, 83% complied with treatment regimens, and 11% had ART resistance. Human immunodeficiency virus polymerase chain reaction (PCR) was undetectable in 19 pregnancies. Seven mothers had opportunistic infections and treatment was immediately initiated. After reviewing the infants’ HIV PCR tests, the transmission rates of HIV were 0% for both spontaneous vaginal delivery and cesarean section.Conclusion:Many challenges face the efforts to decrease vertical HIV transmission, and a particular focus on the transitions between stages of care is needed. We believe that early screening, counseling, and regular follow-up have contributed to MTCT elimination.     

Challenges of Childhood TB/HIV Management in Malawi

The diagnosis and management of childhood tuberculosis (TB) are major challenges in countries such as Malawi with high incidence of TB and human immunodeficiency virus (HIV) infection. Diagnosis of TB in children often relies only on clinical features but clinical overlap with the presentation of HIV and other HIV-related lung disease is common. The tuberculin skin test (TST), the standard marker of M. tuberculosis infection in immune competent children, has poor sensitivity in HIV-infected children and is not usually available in Malawi. HIV test should be routine in children with suspected TB as it improves clinical management. HIV-infected children are at increased risk of developing active disease following TB exposure which justifies the use of isoniazid preventive therapy (IPT) once active disease has been excluded but this is difficult to implement and appropriate duration of IPT is unknown. HIV-infected children with active TB experience higher mortality and relapse rates on standard TB treatment compared to HIV-uninfected children, highlighting the need for further research to define optimal treatment regimens. HIV-infected children should also receive appropriate supportive care including cotrimoxazole prophylaxis and anti-retroviral treatment (ART) if indicated. There are concerns about concurrent use of some anti-TB drugs such as rifampicin with some ARTs.     

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.

     

Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study

Background and objective

There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on appropriate placement on ART among eligible patients.

Methods

We conducted a retrospective, pre-post EMR study among patients enrolled in HIV care and eligible for ART at 17 rural Kenyan clinics and compared the: (1) proportion of patients eligible for ART based on CD4 count or WHO staging who initiate therapy; (2) time from eligibility for ART to ART initiation; (3) time from ART initiation to first CD4 test.

Results

7298 patients were eligible for ART; 54.8% (n=3998) were enrolled in HIV care using a paper-based system while 45.2% (n=3300) were enrolled after the implementation of the EMR. EMR was independently associated with a 22% increase in the odds of initiating ART among eligible patients (adjusted OR (aOR) 1.22, 95% CI 1.12 to 1.33). The proportion of ART-eligible patients not receiving ART was 20.3% and 15.1% for paper and EMR, respectively (χ²=33.5, p<0.01). Median time from ART eligibility to ART initiation was 29.1 days (IQR: 14.1–62.1) for paper compared to 27 days (IQR: 12.9–50.1) for EMR.

Conclusions

EMRs can improve quality of HIV care through appropriate placement of ART-eligible patients on treatment in resource limited settings. However, other non-EMR factors influence timely initiation of ART.     

初治人类免疫缺陷病毒感染者合并代谢综合征及心血管病风险状况及其临床特点分析

目的 探讨尚未进行高效抗反转录病毒治疗（highly active antiretroviral therapy,HAART）的人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者代谢综合征（metabolic syndrome,MS）及心血管病风险状况及其临床特点。方法 以HIV感染者193人为研究对象,按照MS的诊断标准选择诊断为MS的患者为MS组,选对应的非MS患者为非MS组;按照Framingham风险评分筛选心血管病中高危患者为中高危组,低危者为低危组。分别比较2组的临床特征。结果 本研究中代谢综合征的患病率为9.33%,MS各组分中比例最大的为体质量指数（body mass index,BMI）≥25 kg/m²,其次为高密度脂蛋白胆固醇降低。与对照组相比,代谢综合征患者年龄更高,BMI较大,差异有统计学意义（P < 0.05）;MS患者的心血管病风险明显高于非MS患者,年龄、BMI和吸烟史与初治HIV感染者心血管病风险有关,冠状动脉粥样硬化性心脏病风险评估为中高危组患者HIV RNA载量更高,但差异无统计学意义。结论 年龄与BMI与初治HIV感染者代谢综合征风险有关,MS患者心血管病风险明显高于非MS者。HAART治疗前需评估相关危险因素,密切监测并控制患者代谢紊乱及心血管疾病。