Cochrane系統評價證據表明,口服替代治療能降低阿片類藥癮者HIV的血液傳播.使用避孕套可有效預防HIV的性傳播,同時聯合其他一些干預措施可進一步降低個人感染HIV的風險.對于貧困人口和不發達地區,孕婦短程服用奈韋拉平是防治母嬰傳播最現實有效的方法;而基于發達國家的研究表明,剖腹產、母乳替代品可能是有效的干預.病毒逆轉錄酶抑制劑是初期治療HIV感染的有效方法.特效藥對于減少艾滋病相關的機會感染是必需的.積極的體育鍛煉已被證實是提高艾滋病人生存和生活質量的有效手段.
【摘要】 目的 探討艾滋病患者合并機會性感染的臨床特征并評價其治療效果。 方法 回顧分析2003年-2009年53例確診為艾滋病患者的臨床資料，對患者合并機會性感染的臨床特征，包括發生機會性感染的時間、發生機會性感染時CD4+T細胞計數、起病急緩、嚴重程度等，進行觀察和分析，并給予國家推薦的標準治療方案進行治療，通過臨床癥狀、病毒載量、CD4+T細胞計數、影像學監測進行療效分析，隨訪時間為初治至出院后6年。 結果 53例艾滋病患者均為重癥感染，41例為混合感染，其中2個以上部位感染者為36例（67.9%），2種以上病原體感染者為28例（52.8%），3種以上病原體感染者13例（24.5%）。最常見的機會性感染為結核35.8%（19/53）；其次為卡氏肺孢子菌肺炎30.2%（16/53）；敗血癥20.8%（11/53），此外，尚有隱球菌感染15.1%（8/53）、弓形蟲感染3.8%（2/53）、帶狀皰疹病毒感染7.5%（4/53）、念珠菌感染17.0%（9/53）、巨細胞病毒感染7.5%（4/53）、合并乙肝11.3%（6/53）、丙肝3.8%（2/53）。機會性感染治療有效率為77.4%（41/53），病死率為22.6%（12/53），其中隱球菌腦膜炎或混合感染者病死率最高。 結論 艾滋病患者在CD4+T細胞計數lt;350/mm3時各種機會感染明顯升高，且隨著CD4+T細胞計數的下降呈增高趨勢，艾滋病合并機會性感染最常見的是結核，其次卡氏肺孢子菌肺炎；合并結核的治療效果較好，合并隱球菌腦病的病死率最高。早期啟動高效抗逆轉錄病毒治療效果好。【Abstract】 Objective To investigate the clinical characteristics of acquired immune deficiency syndrome (AIDS) combined with opportunistic infections and its treatment. Methods We retrospectively analyzed the clinical data of 53 patients diagnosed to have AIDS in our hospital between 2003 and 2009. The clinical features (such as time of the onset of opportunistic infections, CD4+ T cells value at the onset, severity of the infection, etc.) of the opportunistic infections (such as tuberculosis, Pneumocystis carinii pneumonia, toxoplasmosis, etc.) were also observed and analyzed. The patients were treated according to the national standards. The clinical outcome was analyzed based on such indicators as clinical symptoms, viral load, CD4+ T cells value at the onset, and the results of various imaging. Follow-up was done for six years. Results All 53 patients had severe AIDS infection. Forty-one of them had combined infections, among whom 36 (67.9%) had infections in two or more parts of the body, 28 (52.8%) were infected by two or more pathogens, and 13 (24.5%) were infected by three or more pathogens. The most common opportunistic infection was tuberculosis (35.8%,19/53) followed by pneumocystis carinii pneumonia (30.2%,16/53) and septicemia (20.8%,11/53). Other infections included cryptococcal infection (15.1%, 8/53), toxoplasma gondii infection (3.8%, 2/53), herpes zoster virus infection (7.5%, 4/53), candidiasis (17.0%, 9/53), cytomegalovirus infection (7.5%, 4/53), combined hepatitis B (11.3%, 6/53), and hepatitis C (3.8%, 2/53). Effective treatment rate for opportunistic infections was 77.4% (41/53) with a mortality of 22.6% (12/53). The highest fatality rate occurred to those patients with cryptococcal meningitis or mixed infections. Conclusions The occurrence of opportunistic infections rises obviously when CD4+ T cells is lower than 350/mm3, and it increases more significantly as the value of CD4+ T cells goes down. The most common opportunistic infection is tuberculosis followed by pneumocystis carinii pneumonia. The clinical outcome for the combined cases of tuberculosis is good, while combined cryptococcal encephalopathy has the highest mortality rate. High active anti-retroviral therapy should be initiated as early as possible.
Objective To evaluate the effect of a health education for preventing HIV/AIDS in floating population. Methods A computerized literature search was carried out in PubMed, CBM (Chinese Biomedical Database), CNKI (Chinese National Knowledge Infrastructure), Wanfang (Chinese) and VIP (Chinese) databases to collect articles published between 1996 and 2006 concerning the effect of a HIV/AIDS education intervention in floating population. We also checked the reference lists of relevant articles. The study type was self-control intervention study. Meta-analyses were performed to assess 3 outcomes of the intervention, i.e. knowledge about HIV transmission, means of prevention and attitudes towards HIV/AIDS patients. Fixed and random effect models were employed to combine results after a heterogeneity test, with rate difference (RD) used as the indicator of intervention effect. Results The analysis showed that the RD for knowing the sexual transmission route of HIV, the RD for knowing the effect of condoms for HIV prevention, and the RD for changing attitudes towards HIV/AIDS patients, i.e. treating them as ordinary people, were increased by 16% (0.10, 0.22), 22% (0.17, 0.28) and 19% (0.13, 0.25), respectively. Conclusion Health education for preventing HIV/AIDS is effective in changing knowledge and attitudes in floating population.
The latest global big data evidence indicated the changes of skin and venereal disease burden was huge. HIV/AIDS disease burden was the heaviest diseases among all skin and venereal diseases, and its skin manifestation was serious. The evidence of skin manifestation was searched and classified by subjects such as clinical symptoms, diagnosis & treatment, nursing, etc. The results showed, that the skin manifestation of HIV/AIDS with high incidence was serious, atypical, difficult to cure which was easy to misdiagnose or miss diagnosis. After analyzing the global HIV/AIDS guidelines, we found that many high quality guidelines with widely-covered subjects were produced by developed countries, while quite a few low quality and ones with narrowly-covered subjects were produced by developing countries. Only one guideline was for treatment of HIV/AIDS skin lesion. Based on the current evidence, we call for that all healthcare professionals to increase their awareness, update knowledge, and joint in cooperative prevention and treatment of HIV/AIDS. We also call for that we should produce high quality primary evidence for clinical diagnosis and treatment of HIV/AIDS skin manifestation, and clinical practice guidelines based on good evidence. For the increasing heavy burden of skin and venereal diseases, we should adjust and expand research directions, enrich and improve new interdisciplinary knowledge. We also should constantly train professionals and spread out knowledge in public on prevention and treatment for skin manifestation, so as to transform the evidence in time, effectively protect medical staff and susceptible population, effectively prevent and treat this disease, and improve the satisfaction of our country, hospitals and patients.
ObjectiveTo analyze the clinical characteristics of acquired immune deficiency syndrome (AIDS) complicated with intracranial infection and to explore the nursing countermeasures. MethodsWe retrospectively analyzed the clinical features, laboratory examination indexes, and nursing methods of 12 AIDS patients complicated with intracranial infection between January and December 2010. ResultsIn the 12 patients, 8 were male, 4 were female; 11 were married and 1 was unmarried. The first symptom of headache occurred in 8 patients, and feverin 4 patients. Detection of HIV-1P24 antigen in all the 12 patients with HIV was positive for nucleic acid analysis. After treatment and symptomatic care, 3 cases were cured, 3 quit the treatment voluntarily, 2 improved patients were transferred to a higher-level hospital, 3 patients were readmitted to our hospital after improvement of the situation, and 1 patient died. ConclusionThe most common symptom of AIDS was neural disease. The diagnosis should be based on clinical manifestations, and the epidemiological data should be used as reference. At the same time, attention should be paid to the admission assessment and good occupation protection, health education promotion, improvement of patients' quality of life, and reduction of the incidence of complications and mortality rate.
Objective To assess the effectiveness and safety of combination therapy of zidovudine and lamivudine (ZDV+3TC) for preventing mother-to-child transmission (MTCT) of HIV. Methods A systematic review of randomized controlled trials (RCTs) was conducted using the methodology of The Cochrane Collaboration. PUBMED, EMBASE, CINAHL, AIDSearch, AIDSLINE, AIDSTRIALS, The Cochrane Library (Issue 2, 2007), AIDSDRUGS, AIDSinfo, CRD (Center of Review and Dissemination) databases and three Chinese Databases (CBM, CNKI, VIP) were searched from their establishment to 31 May 2007. We also searched documents of governmental and non-governmental organizations (NGOs), and the proceedings of relevant conferences, including the International AIDS Conferences, and the annual Conference on Retroviruses and Opportunistic Infections. RCTs assessing the effects of ZDV+3TC for preventing MTCT were included. Trial selection, quality assessment and data extraction were done by two reviewers independently. Different opinions were resolved by discussion with a third party. Meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2.9 software. Results Three studies in breastfeeding populations were included. One trial (PETRA, 1797 participants) found that ZDV+3TC decreased the risk of transmission by 35%-65% within 15 months compared with placebo. However, there was no evidence that ultra-short course ZDV+3TC (during labor) decreased the risk of transmission, compared with placebo. The safety of different courses of ZDV+3TC and placebo were similar (Pgt;0.05). Another trial (SAINT, 1317 participants) found that short course ZDV+3TC (from 36weeks gestation to labor) did not significantly reduce HIV infection among children at 8 weeks after delivery, when compared with single dose nevirapine given to the mother and the infant (Pgt;0.05). No significant difference was found in the maternal and infants mortality and side effects of two groups. One small trial (Moodley1998, 20 participants) found no infant infection in both ZDV+3TC and 3TC alone within 2 weeks after birth. Conclusions Long course (from 36 weeks gestation to 1 week after delivery) and short course (from 36 weeks gestation to labor) ZDV+3TC were more effective than placebo in preventing MTCT of HIV in breastfeeding women with a similar safety profile. Short course ZDV + 3TC had similar effects to single dose nevirapine, and long course ZDV + 3TC had similar effects to lamivudine alone.