目的:进一步认识获得性免疫缺陷综合征（AIDS）并发机会感染的临床特点，提高临床诊断水平，减少误诊。方法:回顾性分析我院85例住院的AIDS患者的临床资料。包括临床表现、常见的机会感染、实验室检查异常情况及机会感染的确诊时间等情况。结果:本组资料中发生机会感染患者主要为青壮年男性，发病后误诊率为70%，大多经两家医院就诊后确诊。60%以上患者首诊于非感染科。临床表现主要有发热、咳嗽、腹泻、消瘦、皮疹、贫血等症状和体征。肺部感染35例（14%），肺结核12例（14%），乙型肝炎9例（10%），丙型肝炎10例（11%），梅毒 7例（8%），耶氏肺孢子菌肺炎（PCP）15例（17%），败血症1例 （1%）。结论:HIV机会感染呈多器官受累，临床表现复杂，不具特异性。临床应提高认识，减少误诊。
【摘要】 目的 探讨艾滋病患者合并机会性感染的临床特征并评价其治疗效果。 方法 回顾分析2003年-2009年53例确诊为艾滋病患者的临床资料，对患者合并机会性感染的临床特征，包括发生机会性感染的时间、发生机会性感染时CD4+T细胞计数、起病急缓、严重程度等，进行观察和分析，并给予国家推荐的标准治疗方案进行治疗，通过临床症状、病毒载量、CD4+T细胞计数、影像学监测进行疗效分析，随访时间为初治至出院后6年。 结果 53例艾滋病患者均为重症感染，41例为混合感染，其中2个以上部位感染者为36例（67.9%），2种以上病原体感染者为28例（52.8%），3种以上病原体感染者13例（24.5%）。最常见的机会性感染为结核35.8%（19/53）；其次为卡氏肺孢子菌肺炎30.2%（16/53）；败血症20.8%（11/53），此外，尚有隐球菌感染15.1%（8/53）、弓形虫感染3.8%（2/53）、带状疱疹病毒感染7.5%（4/53）、念珠菌感染17.0%（9/53）、巨细胞病毒感染7.5%（4/53）、合并乙肝11.3%（6/53）、丙肝3.8%（2/53）。机会性感染治疗有效率为77.4%（41/53），病死率为22.6%（12/53），其中隐球菌脑膜炎或混合感染者病死率最高。 结论 艾滋病患者在CD4+T细胞计数lt;350/mm3时各种机会感染明显升高，且随着CD4+T细胞计数的下降呈增高趋势，艾滋病合并机会性感染最常见的是结核，其次卡氏肺孢子菌肺炎；合并结核的治疗效果较好，合并隐球菌脑病的病死率最高。早期启动高效抗逆转录病毒治疗效果好。【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.
Objective To assess the effect of early antiretroviral therapy on acquired immune deficiency syndrome in Butuo County, Liangshan Autonomous Prefecture. Methods A total of 1 037 patients who underwent antiretroviral therapy between January 1st 2012 and December 31st 2013 in Butuo Coungty were divided into 2 groups. The early treatment group (with CD4+ lymphocyte count >350 /mm3) was group A (n=459) and delayed treatment group (with CD4+ lymphocyte count≤350 /mm3) was group B. After 18-month treatment, the treatment retention rate, clinical effect and the side effects of medication in two groups were observed and analyzed. Results After 18 months, there were 297 (64.7%) and 320 (55.4%) patients who were persisting in treatment in group A and B, respectively; while the mortality was 6.1% (28/459) and 14.4% (83/578), respectively in group A and B. The differences were significant (P<0.001). The rate of virological suppression in group A and B was 64.0% (190/297) and 63.8% (204/320) respectively without any significant difference (P>0.05). Compared with baseline CD4+ T lymphocyte counts, the growth rate of CD4+ T lymphocyte count in group A and B was 5.7% and 37.5%, respectively; the difference was significant (P<0.001) Conclusions Early treatment for acquired immune deficiency syndrome in Butuo County, Liangshan Autonomous Prefecture is effective, however, its growth rate of CD4+ T lymphocyte count is lower than that of delayed treatment. Early treatment doesn’t cause the increasement of the risk of common adverse reactions of medication, and it can reduce the mortality.
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 explore the methods of intervention for street-based female sex workers (FSWs) by assessing the intervention process, and evaluate the effectiveness. Methods By cluster sampling procedure, many streetbased female sex workers in Yuzhong district were intervened systematically after informed consent. Before and after the intervention, questionnaire survey was conducted to understand their KAP towards AIDS and analyzed the results of the questionnaire and the effectiveness of intervention. Results The recognition rate abut AIDS knowledge was improved markedly, from the previous 28% to the later 70.5%; condom use in last act increased the previous 59% to the later 75%, consistent use in recent month changed from 4% to 26%; Peer education was trained. Conclusion systematical intervention among street-based female sex workers is critical for spread of AIDS.