艾滋病合并马尔尼菲青霉病7例临床分析

目的 通过对7例艾滋病合并马尔尼菲青霉病临床资料的分析，提高对该病的认识。方法 回顾分析2005年1月至2005年8月确诊的7例艾滋病合并马尔尼菲青霉病的住院患者的资料。PSM的确诊依靠培养和病理检查。结果 所有患者均有发热、皮肤损害、淋巴结肿大、贫血以及白细胞降低；其他表现有咳嗽、消瘦、腹泻、肝脾肿大；皮肤损害尤其是皮肤坏死性丘疹为临床特点，所有患者外周血CD。细胞计数均小于50／mm^3，7例患者均经骨髓培养鉴定确诊为马尔尼菲青霉菌。结论 当AIDS患者发热、皮疹、贫血、淋巴结肿大等情况时应考虑马尔尼菲青霉病并行相关检查，此对PSM的早期诊断、早期治疗和改善预后有重要意义。     

德宏州艾滋病抗病毒治疗脱失找回病人疗效及影响因素

目的了解德宏州艾滋病抗病毒治疗脱失找回病人再次入组治疗后艾滋病病毒(HIV)病毒载量(HIVRNA)抑制情况,分析其影响因素,为脱失找回病人提供治疗和管理建议。方法收集德宏州2015年6月至2017年12月脱失找回再次入组抗病毒治疗且至少有一次近期病毒载量结果的HIV感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)基本情况、脱失原因、病毒载量、随访情况、药物方案等,运用Logistic回归分析疗效及影响因素。结果 306例HIV/AIDS病人纳入分析,其中男性占72.9%(223例);传播途径为异性性传播147例(48.0%),注射吸毒传播147例(48.0%);入组平均年龄(41.5±10.2)岁,31～49岁223例(72.9%);已婚占62.7%(192例);小学及以下文化占71.2%(218例);农民占85.0%(260例);脱失原因非健康原因占79.7%(244例),504人次非健康原因中病人自身依从性的原因导致脱失占82.5%(416/504);最终本组病人中10.5%(32例)发生再次终止治疗;最近一次病毒载量结果显示222例(72.5%)病人HIV-RNA400拷贝/mL,HIV-RNA50拷贝/mL的病人比例为64.1%(196例)。Logistich回归多因素结果显示,HIV感染者、目前继续保持在治状态、接受1天1次的服药方案病毒抑制率高。结论脱失找回再次入组治疗病人仍然有望获得较高比例的HIV-RNA完全抑制,加强依从性教育,优化药物方案,选用1天1次的服药方案可以更好地保证病人的依从性,从而进一步提高治疗效果。     

德宏傣族景颇族自治州2004-2019年HIWAIDS患者接受抗病毒治疗后血脂变化及其影响因素分析

目的 了解德宏傣族景颇族自治州(简称德宏州)HIV/AIDS患者启动ART前高脂血症患病率和启动ART后高脂血症发病率及其影响因素.方法 采用回顾性队列研究的方法,基于国家艾滋病防治基本信息系统,分析德宏州2004-2019年启动ART的HIV/AIDS患者资料.TG、TC任意一项水平升高判定为高脂血症.采用Logis...     

165例老年肺结核病医院感染的临床研究

目的：探讨老年肺结核病患者医院感染的临床特点及易感因素，以采取有效防治措施。方法：采用回顾性调查方法对1468例肺结核病患者医院感染进行调查。结果：老年肺病患者医院感染率28．1％，感染部位以呼吸道为主，泌尿道，肠道次之；医院感染病菌以革兰阴性菌为主，病程，原发病情况，并存率，抗生素的使用及侵袭性操作为易感因素，结论L积极治疗原发疾病，减少复治，难治老年肺结核病患者，防治并存症，合理使用抗生素，减少，避免侵袭性操作，是防治老年肺结核病医院感染的有效措施。     

70例艾滋病患儿高效抗反转录病毒治疗的临床观察

Objective To observe the treatment response and potential issues related to antiretroviral therapy (ART) in pediatric patients with acquired immunodeficiency syndrome (AIDS) and to provide a basis for revising the treatment guideline and improving the clinical practice. Methods Children eligible for ART according to the current treatment guideline were recruited from Dehong area. Enrolled patients were provided with ART and followed up for regular clinical check and laboratory tests. Results By the end of March 2009, a total of 70 children had received ART. Among them, 60 patients were treated with regimen including zidovudine (AZT)+ lamivudine (3TC)+nevirapine (NVP). Twelve, eighteen, twenty-three and nineteen patients have tested for HIV viral load after 3 month, 6 month, 12 month and 18 month treatment, respectively. Among them, 7, 12,14 and 14 patients respectively achieved HIV viral load lower than 1000 copy/mL. Average CD4+ Tlymphocyte count increased from (317.8±288.8) × 106/L at baseline to (1037.2±1086. 1) × 106/Lafter 18 month treatment. Side effects mainly occurred within the first 3 months of treatment. Nearly 50% of children had gastrointestinal symptoms. Resistance to 3TC, NVP and efavirenz (EFV) were found in five patients who have completed 12 months of treatment. Conclusions Pediatric AIDS patients show good compliance and treatment response to ART. Most side effects happen in the first 3months of treatment and the most common side effects are gastrointestinal symptoms.     

云南省德宏州3014例艾滋病患者接受抗病毒治疗后药物不良反应分析

目的了解云南省德宏州艾滋病患者接受国家免费抗病毒治疗后90 d内的药物不良反应率及其影响因素。方法采用回顾性队列研究方法,将德宏州2004年7月1日至2009年12月31日开始接受抗病毒治疗、年满16周岁且在治疗后90 d内至少有一次随访记录的全部艾滋病患者纳入研究进行分析。结果共有3 014例患者纳入本研究,平均年龄（35.8±9.9）岁,61.2%是男性,55.4%为少数民族,已婚或同居者占71.4%,55.0%文化程度在小学以下,75.1%职业为农民;感染途径以经异性性传播为主,占67.0%;主要治疗方案为司他夫定（d4T）＋拉米夫定（3TC）＋奈韦拉平（NVP）（53.9%）和齐多夫定（AZT）＋3TC＋NVP（33.4%）。基线评估时相关实验室指标无异常的患者在治疗开始后90 d内,药物不良反应以转氨酶升高（49.0%）、白细胞减少（32.0%）、贫血（23.6%）、消化系统症状（25.8%）和皮疹（10.6%）为主。logistic多因素回归分析显示：女性、年龄较长者、少数民族患者、使用含AZT或依非韦伦（EFV）的治疗方案以及基线CD4＋T淋巴细胞计数水平较低的患者贫血发生率较高;而女性、年龄较长者、汉族、使用含AZT或NVP的治疗方案以及基线CD4＋T淋巴细胞计数水平较低的患者较易发生白细胞减少;男性、年龄长者、文化程度较低者、使用含d4T的治疗方案以及基线CD4＋T淋巴细胞计数较高的患者转氨酶升高发生率较高。结论云南省德宏州艾滋病患者抗病毒治疗后90 d内不良反应发生率高,不良反应发生率与患者人口学特征、基线免疫状态和用药方案有关。临床医生应针对患者特征选择适当的治疗方案以减少药物不良反应的发生,并应熟悉药物不良反应的相关处理。     

德宏傣族景颇族自治州2010-2019年HIV感染者抗病毒治疗后艾滋病和非艾滋病相关死亡及其影响因素分析

目的:分析德宏傣族景颇族自治州（德宏州）2010-2019年HIV感染者开始抗病毒治疗（ART）后艾滋病相关死亡和非艾滋病相关死亡情况、变化趋势及其影响因素。方法:基于国家HIV感染者ART库,分析德宏州2010-2019年开始ART的HIV感染者。用累积发生函数（CIF）估算HIV感染者的死亡概率,用亚分布比例风险模...     

获得性免疫缺陷综合征合并红皮病1例

患者男,48岁。以获得性免疫缺陷综合征合并红皮病收治入院,糖尿病史10余年。治疗过程中出现右下肢坏死性筋膜炎,后死于败血症。     

70例艾滋病患儿高效抗反转录病毒治疗的临床观察

目的 观察AIDS患儿抗病毒治疗疗效及存在的临床问题,为提高我国现行儿童AIDS规范治疗和管理水平提供依据.方法 根据我国现行儿童AIDS治疗方案,为德宏州符合条件的AIDS患儿提供抗反转录病毒治疗(ART),并定期进行临床随访观察和相关实验室检测.结果 截至2009年3月底,共有70例AIDS患儿进行抗病毒治疗,采用齐多夫定(AZT)+拉米夫定(3TC)+奈韦拉平(NVP)方案的共60例.治疗3、6、12和18个月时有12、18、23和19例患儿检测病毒载量(VL),VL≤1000拷贝/mL的分别有7、12、14和14例.CD4+T淋巴细胞计数治疗前为(317.8±288.8)×106/L,18个月时回升至(1037.2±1086.1)×106/L.不良反应多出现于治疗的前3个月,近50%患儿有不同程度的消化道反应.对治疗12个月的5例耐药患儿检测表明,均出现对3TC、NVP和依非韦伦不同程度的耐药.结论 儿童抗病毒治疗具有良好的依从性,治疗效果明显,不良反应主要发生在治疗的前3个月,以消化道反应最常见.

Abstract：

Objective To observe the treatment response and potential issues related to antiretroviral therapy (ART) in pediatric patients with acquired immunodeficiency syndrome (AIDS) and to provide a basis for revising the treatment guideline and improving the clinical practice. Methods Children eligible for ART according to the current treatment guideline were recruited from Dehong area. Enrolled patients were provided with ART and followed up for regular clinical check and laboratory tests. Results By the end of March 2009, a total of 70 children had received ART. Among them, 60 patients were treated with regimen including zidovudine (AZT)+ lamivudine (3TC)+nevirapine (NVP). Twelve, eighteen, twenty-three and nineteen patients have tested for HIV viral load after 3 month, 6 month, 12 month and 18 month treatment, respectively. Among them, 7, 12,14 and 14 patients respectively achieved HIV viral load lower than 1000 copy/mL. Average CD4+ Tlymphocyte count increased from (317.8±288.8) × 106/L at baseline to (1037.2±1086. 1) × 106/Lafter 18 month treatment. Side effects mainly occurred within the first 3 months of treatment. Nearly 50% of children had gastrointestinal symptoms. Resistance to 3TC, NVP and efavirenz (EFV) were found in five patients who have completed 12 months of treatment. Conclusions Pediatric AIDS patients show good compliance and treatment response to ART. Most side effects happen in the first 3months of treatment and the most common side effects are gastrointestinal symptoms.     

70例艾滋病患儿高效抗反转录病毒治疗的临床观察

Objective To observe the treatment response and potential issues related to antiretroviral therapy (ART) in pediatric patients with acquired immunodeficiency syndrome (AIDS) and to provide a basis for revising the treatment guideline and improving the clinical practice. Methods Children eligible for ART according to the current treatment guideline were recruited from Dehong area. Enrolled patients were provided with ART and followed up for regular clinical check and laboratory tests. Results By the end of March 2009, a total of 70 children had received ART. Among them, 60 patients were treated with regimen including zidovudine (AZT)+ lamivudine (3TC)+nevirapine (NVP). Twelve, eighteen, twenty-three and nineteen patients have tested for HIV viral load after 3 month, 6 month, 12 month and 18 month treatment, respectively. Among them, 7, 12,14 and 14 patients respectively achieved HIV viral load lower than 1000 copy/mL. Average CD4+ Tlymphocyte count increased from (317.8±288.8) × 106/L at baseline to (1037.2±1086. 1) × 106/Lafter 18 month treatment. Side effects mainly occurred within the first 3 months of treatment. Nearly 50% of children had gastrointestinal symptoms. Resistance to 3TC, NVP and efavirenz (EFV) were found in five patients who have completed 12 months of treatment. Conclusions Pediatric AIDS patients show good compliance and treatment response to ART. Most side effects happen in the first 3months of treatment and the most common side effects are gastrointestinal symptoms.