【摘要】 目的 观察人类免疫缺陷病毒（HIV）感染后对人体各个系统的影响，为其诊断和治疗提供经验。 方法 回顾性分析2005年1月—2010年6月于华西医院确诊为HIV感染13例患者的临床表现和相关实验室指标。 结果 13例HIV感染患者均合并其他感染，以结核病最为常见；除有T淋巴细胞异常外，多数患者可合并出现血液学异常，包括贫血、白细胞和血小板降低；生化异常，包括球蛋白升高、白蛋白降低；HIV感染患者可合并出现风湿病症状和免疫学异常。 结论 HIV感染患者临床表现复杂多样，可合并出现多种感染和风湿病症状，血液学及免疫学异常也比较常见。【Abstract】 Objective To observe the impact of human immunodeficiency virus (HIV) on each system of human body after its infection, in order to provide experiences for diagnosis and treatment of this disease. Methods The clinical manifestations and related laboratory results of 13 inpatients treated in West China Hospital of Sichuan University from January 2005 to June 2010 were reviewed retrospectively. Results The incidence of infection in these patients was 100% with tuberculosis as the most common infection. Apart from the abnormality of T lymphocytes, most patients had a change of hematology and biochemistry, including anemia, depression of leucocytes and platelets, hyperglobulinemia and hypoproteinemia; HIV-infected patients may also presented with rheumatic manifestations or abnormality in the immune system. Conclusion The clinical manifestations of patients with AIDS are complicated. Many kinds of infections and rheumatic manifestations may merge and the change in hematology and immunology is common.
Objective To evaluate the relation of human immunodeficiency virus (HIV)-1 ribonucleic acid (RNA) loads in cerebrospinal fluid with central neurological diseases. Methods The inpatients with HIV-1 infection diagnosed by Public Health Clinical Center of Chengdu between January 1st, 2015 and March 1st, 2018 were retrospectively included. The included patients were divided into central neurological disease group and non-central neurological disease group, and high viral load group and low viral load group. The demographic data, CD4+ T lymphocyte count, routine detection of cerebrospinal fluid, HIV RNA load in cerebrospinal fluid and plasma of patients with and without central neurological diseases were observed and compared.Multiple logistic regression analysis was used to identify risk factors for central neurological diseases. Results A total of 367 patients were included. In the central neurological disease group, 210 cases (57.22%) were complicated with central neurological diseases, and cryptococcus infection was the most. Compared with the non-central neurological disease group, the increase rate of cerebrospinal fluid cell counts, cerebrospinal fluid cell counts, cerebrospinal fluid HIV RNA positivity and cerebrospinal fluid HIV RNA load were higher in the central neurological disease group (P<0.05). Logistic regression analysis showed that HIV RNA load in cerebrospinal fluid≥100 000 copies/mL and CD4+ T lymphocyte count<200 cells/mm3 were risk factors for central neurological diseases. Conclusion Cerebrospinal fluid HIV RNA load≥100 000 copies/mL is an independent risk factor for HIV/AIDS patients with central neurological diseases and clinical treatment should take this factor into consideration to reasonably optimize the selection of antiretroviral therapy.
ObjectiveTo investigate the ultrasonic changes of liver during various immune periods with different number of CD4+ T lymphocytes in HIV/AIDS patients with chronic viral hepatitis. MethodsThe clinical data of 100 patients with chronic viral hepatitis diagnosed between January 2010 and December 2012 were selected. Among them, 50 simple chronic viral hepatitis patients were designated as the control group, and the other 50 HIV/AIDS patients with chronic viral hepatitis were regarded as the experimental group. Ultrasonographic observation was applied on patients of the experimental group according to different immune period based on the number of CD4+ T lymphocytes. Indexes observed included liver size, the edge of liver, capsule of liver and hepatic parenchymal echo. The cross-check analysis was employed between observed results and clinical laboratory results. ResultsAbnormal changes of the experimental group were shown on the ultrasound observation of liver in different CD4+ T lymphocyte count immune periods, including enlargement of the liver, slightly blunt liver margin, slightly thick capsule, dense and uniform, slightly rough and not so uniform, or rough and not uniform hepatic parenchymal echo. There was no significant difference in ultrasonic changes of liver between the two groups when the CD4+ T cell number was over 300/mm3. However, the difference was significant when the CD4+ T cell number was below 100/mm3. ConclusionLiver abnormalities become more obvious as CD4+ T cell count decreases in HIV/AIDS patients with chronic viral hepatitis. Comprehensive considerations of various liver ultrasound indicators are helpful in clinical evaluation of HIV/AIDS patients with chronic viral hepatitis.
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 研究人类免疫缺陷病毒(HIV)感染者和获得性免疫缺陷综合症(AIDS)患者CD4+T淋巴细胞数变化(ΔCD4+T)和外周血淋巴细胞总数变化(ΔTLC)的相关性。探讨用ΔTLC预测ΔCD4+T在监测HIV/AIDS患者疾病进展以及高效抗逆转录病毒治疗(HAART)疗效的价值。 方法 回顾性分析2005〖CD3/5〗2008年确诊的91例HIV/AIDS患者的临床资料。 结果 ΔTLC与ΔCD4+T呈直线正相关(r=0809,Plt;001),好于TLC与CD4+T的相关性(r=0712,Plt;001)。分别用ΔTLC 170、330、630、910个/μL细胞预测ΔCD4+T 50、100、200、300个/μL细胞时具有较好的预测价值,各项评价指标符合率基本达到90%以上,显著高于相同时间下用TLC预测CD4+T计数的价值。 结论 应用ΔTLC预测ΔCD4+T,可比TLC更加直观、准确的反映HIV感染者疾病进展和评价AIDS患者HAART的疗效。【Abstract 】Objective To assess the utility of total lymphocyte count (TLC) changes (ΔTLC) in place of TLC to predict the development of HIV/AIDS. To investigate the monitoring value of ΔCD4+T on progress of HIV/AIDS and HAART which predicted by ΔTLC. Methods Clinical data of 91 patiens with HIV/AIDS diagnosed from 2005 to 2009 were retrospectively analyzed. Results A linear correlation was found between the value of ΔTLC and the value of CD4+T changes(ΔCD4+T)(r=0809,Plt;001),which was better than the correlation between TLC and CD4+T (r=0712,Plt;001).Using ΔTLC as 170,330,630,910 cells/μL,respectively for forecasting ΔCD4+T as 50,100,200,300 cells/μL,respectively,had a better predictive value with the area under ROC curve near to 09,significantly higher than using TLC for predicting CD4+T counts. Conclusion ΔTLC is more accurate than TLC to reflect the development of HIV/AIDS.
ObjectiveTo compare the value of CURB-65 score and expanded CURB-65 score in evaluating prognosis of pneumonia in non-HIV infected patient and HIV infected patient.MethodsThe study included 206 hospitalized pneumonia patients without HIV infection and 299 pneumonia patients with HIV infection. According to their clinical prognosis within 4 weeks of treatment, they were divided into a deterioration group and an improvement group. The basic situation and the differences of clinical indicators between the two groups were compared. The predictive value of CURB-65 score and expanded CURB-65 score for clinical prognosis of pneumonia in non-HIV infected patients and HIV infected patients was compared by using receiver operator characteristic (ROC) curve.ResultsFor the pneumonia patients without HIV infection, the area under ROC curve (AUC) of CURB-65 score and expanded CURB-65 score were 0.862 and 0.848, respectively. There was no significant difference in AUC between CURB-65 score and expanded CURB-65 score (Z=0.661, P=0.5084). The Youden indexes of CURB-65 score and expanded CURB-65 score were 60.11% and 54.92%, respectively. For the pneumonia patients with HIV infection, the AUC of CURB-65 score and expanded CURB-65 score were 0.588 and 0.634, respectively. There was no significant difference between them (Z=1.416, P=0.1567). The Youden index of the two scores was 19.53% and 20.52%, respectively.ConclusionsThe CURB-65 score and expanded CURB-65 score can effectively evaluate the clinical prognosis of pneumonia in non-HIV infected patients, but their predicted values are limited in evaluating the prognosis of pneumonia in HIV infected patients.
Patients with acute human immunodeficiency virus (HIV) infection are the critical source of infection due to high viral load and strong transmission ability. The vast majority of patients in the acute infection stage have no or only mild clinical symptoms, and their screening and diagnosis often rely on laboratory tests. However, there are still some difficulties in early screening and detection for HIV infection due to the detection window period. In recent years, laboratory testing for acute HIV infection has made great progress. This article reviews the progress in laboratory testing of acute HIV infection, in order to provide a reference for follow-up related research.
Objective To investigate the level and influencing factors of perceived HIV stigma and discrimination among people living with HIV/AIDS (PLWHA). Methods By using convenience sampling method, 123 patients were recruited from the department of infectious diseases in a tertiary hospital in Chengdu from April to May in 2017. Berger HIV stigma scale was used to measure the level of perceived HIV stigma. Results The mean score of Berger HIV stigma scale was 113.72±17.890, which revealed a middle to upper level. Among the four subscales, the score of disclosure concerns (3.07±0.462) was the highest, while the score of negative self-image (2.70±0.494) was the lowest. Multiple regression analysis showed that gender and self-perceived health status were the influencing factors of perceived HIV stigma. Conclusions The level of perceived HIV stigma among PLWHA is from middle to upper level. Female gender and poor self-perceived health status are associated with a higher level of perceived HIV stigma. Individualized interventions are required in order to reduce the level of HIV stigma.