690例HIV+/AIDS首诊病例的临床特征及与免疫状态和病毒载量相关性研究

目的以艾滋病病毒（HIV）感染的首诊病例分析临床特征与免疫状态和病毒载量的关系。方法横断面分析了690例HIV感染病例,采用SPSS13．0统计软件分析。结果690例HIV感染病例中男性是女性的2倍,平均年龄35.3岁;感染途径以性途径传播为主,其中因男男性行为和异性性行为而感染的分别是17．5％和16．7％;男男性行为感染者以来自北京地区且学历在大学以上者为主;夫妻间性传播感染占7.8％,双性性行为感染占11．6％。来自河南、安徽、山西、河北等地区的非法采供血／血浆和接受HIV污染的受血者,在发现感染原因中以医院的各种筛查为主,尤其是因皮肤病性病的筛查而发现占多数,发现时多数病例已有严重的免疫缺陷,其中37．3％的病例CD4^＋ T淋巴细胞〈50个／μl;此外,婚前和孕期检查、出入境检疫等都是重要的发现环节;首诊时临床的系统疾病发病率前五位依次是：皮肤病、肺炎、上呼吸道感染、肝炎、消化道念珠菌病;此时患者同时合并的病种增加;但当CD4^＋ T淋巴细胞〉251个/μl时,各种疾病的发病减少;病毒载量越高,CD4^＋ T淋巴细胞数越低,机会感染和并发症越多。结论首诊时HIV感染患者的免疫水平已经很低,病情已经接近艾滋病期。

Study on the association of clinical characteristic,CD4+ and level of HIV viral load among 690 initial HIV-infection

OBJECTIVE: To understand the correlation between CD4+ cell count, HIV viral load (VL) and clinical characteristics among patients when HIV-1 was tested positive and initial AIDS diagnosis was made. METHODS: 690 HIV-infected cases from Beijing Di-Tan Hospital were included and under a cross sectional study while SPSS statistical method was used. RESULTS: The 690 HIV-infected cases would include 458 males and 232 females with age range from 2-72 years (mean age as 35.3). The modes of transmission showed that: homosexual contact taking up 17.5% while heterosexual was 16.7%. Most of the homosexual-infected ones lived in Beijing and most of them had bachelor or master's degrees. 19.4% of the transmission happened between heterosexual/bisexual couples, suggesting that HIV was transmitted through the "bridge population" while the rest were infected by contaminated blood/plasma. Many of the cases were identified when they lately visited the pre-operation surveillance point in the hospital. Serious immunodeficiency symptoms or sighs were discovered as: CD4+ count < 50 cell/microl, serious opportunistic infections including pneumocystosis pulmonary, cerebral toxoplasmosis and cryptococcal meningitis. Higher frequencies of diseases seen were dermotosis, pneumonia, upper respiratory tract infection, hepatitis and digestive tract moniliasis. CONCLUSION: Because of the late identification of the disease, serious immuo-suppression situation often appeared, suggesting that there was an urgent need to improve STD/AIDS knowledge on those HIV (+) people so they might have an early access to accept medical care.