感染HIV的孕产妇预防艾滋病母婴传播服务利用及影响因素分析

目的了解感染艾滋病病毒（HIV）的孕产妇对预防艾滋病母婴传播（PMTCT）服务的利用状况，分析影响因素。方法在河南、广西、新疆、云南省（自治区）的15个县／市／区，对2004年1月至2006年6月检测发现的感染HIV的孕产妇346人，通过问卷调查方式，结合相关医疗记录在孕期、产时和产后分阶段完成调查。调查内容包括人口学特征、相关行为、感染途径、PMTCT服务的利用情况等。结果346名感染HIV的孕产妇中94.80％接受过产前检查，95．95％住院分娩，其希望住院分娩的原因是医院医疗技术水平高（58．28％），服务质量好（47．27％），收费低（33．33％），能够提供PMTCT服务（33．03％），保密性好（26．97％），交通方便（23.33％）等。87．57％的母婴应用抗艾滋病病毒药物，规范应用抗病毒药物者占46.82％。感染HIV的孕产妇所娩婴儿中，89．02％采取人工喂养方式，满18月龄时进行HIV检测者占93.75％。检测后咨询包含PMTCT内容、民族和文化程度对规范应用抗病毒药物有影响作用（P〈0.05）。结论感染HIV的孕产妇对PMTCT服务的需求特殊，PMTCT服务利用尚不足，检测后咨询及咨询内容影响抗病毒药物的规范应用。建议加强HIV／ADIS高发地区基础妇幼保健服务，提高妊娠妇女早期和孕中期HIV抗体检测水平，重视感染HIV孕产妇抗病毒药物的规范应用和安全助产，为感染HIV的孕产妇及所娩婴儿提供个性化的、综合的PMTCT服务。     

河南省艾滋病母婴传播可疑危险因素的调查分析

目的探讨艾滋病母婴传播的主要危险因素.方法对艾滋病母婴传播的可能危险因素进行病例对照研究.结果母亲怀孕时合并机会性感染者其母婴传播的发生率（90.48%）显著高于无合并者（15.38%）;怀孕时合并有性病的母亲（66.67%）高于无合并者（23.42%）;早产儿阳性者的比例为55.56%,大于非早产儿的23.23%;头胎的母婴传播比例为45.76%,二胎、三胎的传播比例分别为13.83%和9.09%（P＜0.05）,其差异有显著的统计学意义;择期剖腹产者的母婴传播比例为4.55%,显著低于普通阴道产者的28.17%;产程较短的母婴传播比例为4.35%,显著低于产程较长者的40.00%;人工喂养、母乳喂养、混合喂养者母婴传播发生率（3.45%、26.13%和45.83%）的差异,有显著的统计学意义（P＜0.05））.结论在影响母婴传播的危险因素中,母体妊娠时的机会性感染会增加母婴传播的可能性,早产儿与低体重儿也会增加传播机会,而胎次、生产方式、产程以及喂养方式等也可能会对母婴传播的发生造成影响.     

预防艾滋病母婴传播项目长效工作机制研究

目的通过对深圳市预防艾滋病母婴传播项目工作,与卫生系统多部门常规工作相整合的运行机制进行系统的研究,为其他地区提供有益的借鉴。方法采用定性研究和定量研究。通过文献检索和现有资料收集的方法,了解2008-2010年深圳市孕产妇艾滋病病毒(HIV)抗体检测情况和感染HIV孕妇抗病毒治疗情况。通过小组访谈方法,了解项目运行机制。结果深圳市预防艾滋病母婴传播项目的覆盖率为100%,孕产妇检测率超过95%,孕妇和分娩儿童抗病毒治疗率超过90%。HIV感染孕产妇的产前保健和助产服务整合入妇幼保健常规工作,母婴随访整合入疾控系统HIV感染者随访工作,孕期抗病毒治疗整合入医政系统抗病毒治疗工作。结论与卫生系统多部门的常规工作相整合的工作机制,能够明显提高项目的运行质量,有助于建立高标准的长效运作机制。     

HAART后艾滋病病人脂肪肝临床特点分析

目的为提高艾滋病(AIDS)病人高效抗反转录病毒治疗(HAART)后合并非酒精性脂肪肝(NAFLD)的确诊率,对艾滋病病毒(HIV)感染者/AIDS病人(简称HIV/AIDS病人)HAART后出现的高脂血症、NAFLD的临床特征进行横断面研究,初步探讨艾滋病病人HAART后合并非酒精性脂肪肝的临床和流行病学特征。方法以HAART后高脂血症作为切入点,分析HAART后高脂血症病人的体重指数(BMI)、血压、HIV感染时间、HAART治疗的药物和治疗时间、CD4细胞水平、空腹血糖、血脂水平、肝肾功能,完善腹腔彩超检查,通过影像学发现艾滋病病人中脂肪肝的变化。对有或无脂肪肝病人的上述指标进行比较。结果从2004年开始免费抗病毒治疗的300例病人中,筛查出42例HIV/AIDS病人,其中28例(66.7%)为NAFLD组,14例(33.3%)为非脂肪肝组。NAFLD组病人体重指数(23.61±2.55)kg/m2、空腹血糖(6.98±2.34)mmol/L、丙氨酸转氨酶(ALT)为(47.95±25.4)U/L;非脂肪肝组体重指数(22.06±1.96)kg/m2、空腹血糖(5.86±0.70)mmol/L,ALT为(25.22±6.75)U/L,两组比较差异有统计学意义。结论 NAFLD是HAART治疗后HIV/AIDS病人中常见的并发症,高脂血症、体重指数和高血糖与NAFLD的发生具有相关性;ALT升高是HIV/AIDS病人并发NAFLD的结果;HAART治疗的方案和治疗时间与NAFLD的发生无关。     

艾滋病高发地区预防HIV母婴传播项目实施效果分析

目的了解艾滋病高流行的4省（自治区）的6个县（市、区）,预防艾滋病病毒（HIV）母婴传播项目的实施效果。方法通过全国预防艾滋病母婴传播信息管理系统,收集2007年1月至2010年9月研究地区艾滋病病毒（HIV）感染孕产妇个案卡及其所生儿童的随访登记卡,分析预防HIV母婴传播干预措施落实情况及效果。结果2007-2010年,研究地区HIV感染孕产妇抗病毒药物应用比例和孕期抗病毒药物应用比例,分别从78.4%和27.8%增加至93.7%和78.8%（趋势χ2=17.636,P〈0.01;趋势χ2=76.835,P〈0.01）;HIV感染孕产妇应用三联抗病毒药物方案的比例自19.8%增加至89.9%（趋势χ2=161.757,P〈0.01）。满18月龄艾滋病感染孕产妇所生儿童接受HIV抗体检测比例为84.8%（318/375）,13例儿童抗体检测阳性,艾滋病母婴传播水平为4.1%（95%可信区间：2.98%-5.20%）。结论研究地区预防HIV母婴传播干预措施落实指标逐年提高,HIV母婴传播水平显著下降,孕产妇及早抗病毒用药以及儿童随访检测仍为工作中的薄弱环节。     

四川省凉山州预防艾滋病母婴传播的成本研究

目的 研究凉山州预防艾滋病母婴传播成本.方法 使用分层抽样方法,从凉山州17个市县按照艾滋病疫情高、中、低疫情县分别抽取2个县,共6个市县,在县妇计中心、疾病预防控制中心和人民医院开展2017年预防艾滋病母婴传播成本调查,在2个高疫情县开展艾滋病病毒(HIV)阳性产妇个人成本调查,按照筹资渠道和可追溯性进行分析.结果 ...     

抗逆转录病毒药物预防艾滋病母婴传播的研究进展

随着艾滋病流行形势的日益加重和女性感染者所占比例的不断增高,预防艾滋病病毒(HIV)母婴传播成为人们非常关注的问题.阻断这一传播过程的相关研究包括了逆转录病毒抑制剂、疫苗、维生素营养治疗、改变分娩方式等.其中,逆转录病毒抑制剂的药物组合、应用时间和方法,是其中最受人们所关注,也是疗效最为确切的.     

艾滋病母婴传播的预防与控制--深圳的策略与实践

艾滋病病毒 (HIV)经母婴传播是儿童感染的首要原因。自艾滋病 (AIDS)流行至今 ,全球约有 4 0 0多万 <15岁儿童死于AIDS ,存活的HIV感染儿童估计有 2 5 0多万。目前仍以每年 80多万、每天 2 0 0 0多例新生儿HIV感染者的速度递增 ,其中 >90 %是因HIV感染母亲经母婴垂直传播感染 ,>95 %HIV感染儿童生活在发展中国家[1] 。HIV的母婴传播可以发生于HIV感染妇女的妊娠、分娩和产后哺乳等过程中 ,其自然传播率通常为 15 %～ 4 8%。自1994年艾滋病临床治疗合作组 0 76号 (AIDSClinicalTrialGroup 0 76 ,简称ACTG 0 76 )研究开展以来…     

感染疟原虫将增加艾滋病母婴传播可能

据医学空间网11月23日报道，感染艾滋病病毒的孕妇感染疟原虫后，其体内的艾滋病病毒传染给胎儿的危险会大大提高。     

HIV+ MALT lymphoma remission induced by highly active antiretroviral therapy alone

MALT lymphoma is usually described in association with Helicobacter pylori, HCV, HHV8, Campylobacter jejuni or in a setting of overreactive immunity. In HIV(+) patients, MALT lymphoma is most commonly described in children. We describe here an original case of HIV(+) MALT lymphoma with bronchial, conjuctival and laryngeal involvement for which a clinical and histopathological remission has been obtained with HAART alone. We conclude that HIV, as well as H. pylori, C. jejuni and HCV can target lymphogenesis in MALT lymphoma.     

Prevalence,severity, and duration of thrombocytopenia among HIV patients in the era of highly active antiretroviral therapy

Thrombocytopenia is a clinically relevant outcome in HIV. However, the epidemiology of this condition, including frequency, severity, and duration, has not been well-characterized in the era of highly active antiretroviral therapy (HAART). In this study, we describe the epidemiology of thrombocytopenia using two methods. We conducted a systematic review of the literature published between 1997 and 2009 to characterize the frequency of thrombocytopenia in different populations in the HAART era. Secondly, we examined the frequency, severity, and duration of thrombocytopenia among HIV patients in the Collaborations in HIV Outcomes Research/US (CHORUS) Cohort from 1997 to 2006 and among HIV patients participating in GlaxoSmithKline HIV Clinical Trials between 1996 and 2004. Prevalence estimates of thrombocytopenia (<150?000 platelets/µl) in the literature varied greatly but were generally above 10%. The thrombocytopenia prevalence estimates in the CHORUS Cohort and the HIV Clinical Trials were both 14%. In the CHORUS Cohort, the platelet count was ≤50?000/µl among 3.1% and ≤30?000/µl among 1.7%; in the HIV clinical trials database, the platelet count was ≤50?000/µl among 1.3% and ≤30?000/µl among 0.67%. Duration of severe thrombocytopenia varied greatly, with the medium duration to ≥75?000 platelets/µl taking 147 days in the CHORUS Cohort and 33 days in the HIV clinical trials database. Among 111 patients with severe thrombocytopenia in the CHORUS Cohort, 23% never achieved a higher platelet count over follow-up. In conclusion, while the prevalence of severe thrombocytopenia was low, it occurred at levels associated with bleeding and was persistent among a small proportion of patients despite receipt of HAART.     

HAART后HIV感染者免疫重建炎症综合征的口腔表征

艾滋病病毒(HIV)感染者经高效抗反转录病毒治疗(HAART)后,能够恢复对病原体的免疫反应,并大大降低感染者的死亡率。然而,一些HIV感染者接受HAART后,重建的免疫系统又导致了新的病理性炎症反应,称为免疫重建炎症综合征(IRIS),它可导致大量的患者在短期内发病甚至死亡。文章对免疫重建炎症综合征的发病机制和口腔临床表现等方面的最新进展进行了综述。     

Pulmonary Kaposi sarcoma in the era of highly active antiretroviral therapy

OBJECTIVE: Since the introduction of highly active antiretroviral therapy (HAART) there has been a dramatic reduction in the incidence of Kaposi sarcoma (KS) and an improvement in survival. We wished to examine whether the outcome in pulmonary KS (pKS) has also altered. METHODS: In a single-institution cohort of 1140 HIV-positive patients with KS, 305 patients were diagnosed in the HAART era (1996-2004). We examined the clinicopathological features and outcomes of these patients, of whom 25 had pKS and 280 did not. RESULTS: Patients with pKS had lower CD4 cell counts at the time of KS diagnosis (Mann-Whitney U-test P=0.005). The incidence of pKS was higher in African patients than in non-African patients in this sample (Fisher's test, P=0.001). There were no significant differences in age, gender, plasma HIV-1 viral load or prior HAART treatment at the time of KS diagnosis. Five-year overall survival in the pKS group was 49% [95% confidence interval (CI) 26-73%] as compared with 82% (95% CI 76-87%) for the non-pKS group (log rank, P<0.0001). CONCLUSION: PKS remains an ominous diagnosis in the era of HAART, with a median survival of just 1.6 years.     

The prevalence and risk of immune restoration disease in HIV-infected patients treated with highly active antiretroviral therapy

BACKGROUND: It is becoming increasingly clear that, during successful highly active antiretroviral therapy (HAART), a proportion of treated patients develop opportunistic infections (OIs), referred to in this setting as immune restoration disease (IRD). We examined the risk of developing IRD in HAART-treated HIV-infected patients. METHODS: A retrospective study of a cohort including all 389 patients treated with HAART between 1 January 1998 and 31 May 2004 in our HIV unit was performed to evaluate the occurrence of and risk factors for IRD during HAART. Baseline and follow-up values of CD4 T-cell counts and plasma viral loads (pVLs) were compared to assess the success of HAART. RESULTS: During successful HAART (significant increase in CD4 T-cell counts and decrease in pVL), at least one IRD episode occurred in 65 patients (16.7%). The median time to IRD was 4.6 months (range 2-12 months). IRDs included dermatomal herpes zoster (26 patients), pulmonary tuberculosis (four patients), tuberculous exudative pericarditis (two patients), tuberculous lymphadenitis (two patients), cerebral toxoplasmosis (one patient), progressive multifocal leucoencephalopathy (PML) (one patient), inflamed molluscum (one patient), inflamed Candida albicans angular cheilitis (three patients), genital herpes simplex (two patients), tinea corporis (two patients), cytomegalovirus (CMV) retinitis (two patients), CMV vitritis (one patient) and hepatitis B (three patients) or C (fifteen patients). A baseline CD4 T-cell count below 100 cells/microL was shown to be the single predictor [odds ratio (OR) 2.5, 95% confidence interval (CI) 0.9-6.4] of IRD, while a CD4 T-cell count increase to >400 cells/microL, but not undetectable pVL, was a negative predictor of IRD (OR 0.3, 95% CI 0.1-0.8). CONCLUSIONS: To avoid IRD in advanced patients, HAART should be initiated before the CD4 T-cell count falls below 100 cells/microL.     

Oral candidiasis and seborrheic dermatitis in HIV-infected patients on highly active antiretroviral therapy

Background

Mucocutaneous manifestations such as oral candidiasis (OC) and seborrheic dermatitis (SD) are very common HIV‐related opportunistic events and are usually initial markers of immunodeficiency.

Aim

The purpose of this study was to evaluate the efficacy of highly active antiretroviral therapy (HAART) in the regression of HIV‐associated OC and SD.

Methods

In a prospective study, 120 HIV‐infected patients with OC and SD were divided into two groups: HAART‐treated patients (group 1, n=76) and non‐HAART‐treated patients (group 2, n=44). Non‐HAART‐treated patients were given antimicrobial therapy. Study subjects were matched for sex, age, risk, and stage of HIV infection. The results were analysed by χ² test and the Kaplan‐Meier method.

Results

At baseline, OC was evident in 59 (77.7%) of the HAART‐treated patients and in 34 (77.3%) of the non‐HAART‐treated patients, while SD was present in 19 (25.0%) of the HAART‐treated patients and in 17 (38.6%) of the non‐HAART‐treated patients. After a median follow‐up period of 22 months, regression of OC and SD occurred in 49 (83.1%) and 16 (84.2%) of the HAART‐treated patients, respectively. In the control group, regression of OC and SD occurred in only five (14.7%) and seven (41.2%) patients, respectively, during the same period.

Conclusions

HAART showed greater efficacy than standard antimicrobial therapy for the treatment of OC and SD in HIV‐infected patients.

     

Evidence of thymic reconstitution after highly active antiretroviral therapy in HIV-1 infection

Objectives

We aimed to provide evidence of thymic reconstitution after highly active antiretroviral therapy (HAART) in HIV‐1 infected patients and to correlate this with the restoration of peripheral naïve T cells.

Methods

Positron emission tomography (PET) enables definitive evidence of thymic activity, indicating functional potential. In this case study, a single patient who initiatiated HAART demonstrated reconstitution of the naïve T‐cell pool and underwent thymic PET scans at baseline and 2 and 6 months following initiation of therapy. Two patients who failed to demonstrate such reconstitution acted as controls. These patients (mean age 27 years) had chronic HIV infection with low CD4 T‐cell counts (mean 82, range 9–160 cells/μL blood). Increased function of the thymus visualized by PET was correlated with phenotypic changes in CD4 and CD8 T cells in the periphery measured by flow cytometry, and with numbers of recent thymic emigrants measured by quantification of the numbers of T‐cell receptor excision circles (TRECs) in peripheral cells.

Results

In one patient, clear correlations could be drawn between visible activity within the thymus, as measured by increased [F18]fluorodeoxyglucose (FDG) uptake, and regeneration of naïve CD4 (CD45RA/CD62L) T cells, increased numbers of CD4 T cells, controlled viraemia and increased numbers of recent thymic emigrants. A second patient displayed no increase in peripheral CD4 count and no increase in thymic activity. The third patient elected to stop therapy following the 2‐month time point.

Conclusions

The use of PET suggests that thymic activity may increase after HAART, indicating that the thymus has the potential to be functional even in HIV‐1 infected persons with low CD4 T‐cell counts.

     

Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active antiretroviral therapy

Background To determine if infectious disease events in HIV-infected patients treated with highly active antiretroviral therapy (HAART) are a consequence of the restoration of pathogen-specific immune responses, a single-centre retrospective study of all HIV-infected patients commencing HAART prior to 1 July 1997 was undertaken to determine the incidence, characteristics and time of onset of disease episodes in HAART responders (decrease in plasma HIV RNA of > 1 log₁₀ copies/mL).
Methods Baseline and post-therapy changes in CD4 T-cell counts and HIV RNA were compared in patients with and without disease and delayed-type hypersensitivity responses to mycobacterial antigens were measured in selected patients.
Results Thirty-three of 132 HAART responders (25%) exhibited one or more disease episodes after HAART, related to a pre-existent or subclinical infection by an opportunistic pathogen. Disease episodes were most often related to infections by mycobacteria or herpesviruses but hepatitis C virus (HCV), molluscum contagiosum virus and human papilloma virus were also implicated. They were most common in patients with a baseline CD4 T-cell count of < 50/uL and occurred most often during the first 2 months of therapy and when CD4 T-cell counts were increasing. Mycobacteria- and HCV-related diseases were associated with restoration of pathogen-specific immune responses.
Conclusions We conclude that improved immune function in immunodeficient patients treated with HAART may restore pathogen-specific immune responses and cause inflammation in tissues infected by those pathogens.