In recent years, the incidence rate of ischemic stroke in people living with HIV/AIDS (PLWHA) is increasing, attracting wide attention from scholars at home and abroad. In addition to traditional risk factors of stroke, the secondary ischemic stroke in PLWHA is also affected by HIV infection. This study reviews the incidence rate and risk factors of secondary ischemic stroke in PLWHA, in order to provide a theoretical basis for preventing and reducing the incidence of ischemic stroke in PLWHA.
【摘要】 目的 掌握德昌县艾滋病流行趋势，为制订防控措施提供准确依据。 方法 利用描述流行病学方法分析德昌县1995年以来艾滋病疫情资料。 结果 自1995年德昌县报告首例艾滋病感染者至2011年8月共报告艾滋病感染者/患者262例，年均报告发病率18.95/10万，2008年-2010年报告发病率呈快速增长趋势；男性年均发病率26.57/10万，女性11.05/10万，差异有统计学意义（χ2=43.94，P=0.002），男女性别比为2.49︰1；年龄分布以20~45岁和55~75岁高发为特征，两个年龄段合计占病例报告总数93.49%；农民、不详2项职业的艾滋病病例数占全部病例的82.4%，职业高峰明显；异性传播及注射毒品是德昌县艾滋病的主要传播途径，分别占病例总数的64.89%、32.82%。异性传播中有29例为夫妻间家庭式感染病例，另外还有3例为母婴传播病例。 结论 德昌县艾滋病疫情快速增长，形势严峻，须加强艾滋病防治知识宣传，提高全民预防艾滋病的意识；各部门互相合作，对娱乐场所进行监管；加强对流动人口的管理；进一步完善咨询检测网络，提高艾滋病的发现率，以有效控制艾滋病的蔓延。【Abstract】 Objective To understand the epidemiological trend of acquired immune deficiency syndrome (AIDS) in Dechang County so as to provide a scientific base for prevention and control of AIDS. Methods Descriptive epidemiological analysis was conducted on the AIDS epidemic data in Dechang county. Results From 1995 when the first case of HIV infection was confirmed to August 2011, a total of 262 cases of HIV/AIDS were reported with a total infection rate of 18.95/100 000. From 2008 to 2010, the reported infections showed rapid growth. The annual infection rate of male was 26.57/100 000 and female 11.05/100 000 with a significant difference (χ2＝43.94, P＝0.002). The ratio of male to female infections was 2.49∶1. Most of the AIDS cases were young adults aged between 20 and 45 years and old people aged between 55 and 75 years old who occupied 93.49% of the total infectious cases. The number of reported AIDS cases of farmer and unknown occupations accounted for 82.4% and there was an obvious occupations peak. Most patients in the county were infected by heterosexual sexual contact and injecting drugs, which accounted for 64.89% and 32.82% of the total respectively. The AIDS cases of 29 infected couples and 3 mother-to-child transmission. Conclusions AIDS epidemic growth is rapid in Dechang county with the situation being quite grim. We should enhance the AIDS prevention propaganda in the publicity, to raise national awareness of AIDS prevention. The related departments should cooperate to regulate the illegal entertainment and strengthen the management of migrant workers. The counseling and testing network should be improved so as to raise the detection rate and control the spread of AIDS.
Objective To investigate the feasibility and methods of surgical treatment for HIV/AIDS patients with otolaryngology diseases. Methods From January 2016 to February 2017, nineteen patients with HIV/AIDS who underwent otolaryngology surgery were included in this study. The demographic data of patients, including age, gender, course of disease, CD4+ T lymphocyte count before operation and disease type were collected and the clinical treatment methods were summarized. The curative effect was analyzed retrospectively. Results The operations of all the 19 patients were successful without occupational exposure among medical staff. One patient with papillary squamous cell carcinoma did not received further treatment. The other 18 patients recovered well and their life quality was significantly improved. Conclusions If HIV/AIDS patients with otolaryngological diseases are examined preoperatively and have no surgical contraindications, the operation shloud be performed by controlling the surgical indications strictly. The life quality of the patients may be improved and the patients’ life may be prolonged after the surgery.
目的 探究艾滋病(AIDS)合并马尔尼菲青霉病(PSM)的感染率，以及常规实验室检查结果和5种抗真菌药物对马尔尼菲青霉菌(PM)的体外抗菌活性。 方法 2006年1月-2009年11月间确诊AIDS患者326例，从其血液、骨髓培养出65株PM，检测该65例患者的血常规、肝功能和肾功能，并对20株酵母相PM进行体外药敏进行分析。 结果 AIDS合并PSM的感染率为19.94%；外周血常规：WBClt;4.0×109/L者48例，HBlt;100 g/L者51例，PLTlt;100×109/L者46例。肝功能检查：ALTgt;40 U/L者49，ASTgt;40 U/L者51例，GGTgt;60 U/L者44例，ALPgt;150 U/L者36例，ALBlt;35 g/L者53例，A/G倒置者50例。肾功能检查：BUNgt;7.2 mmol/L者9例，Crgt;150 μmol/L者4例。20株酵母相PM对5-氟胞嘧啶(5FC)、两性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)、伏立康唑(VRC)的敏感率分别为75%、90%、80%、90%、90%。 结论 AIDS合并PSM感染率较高；患者感染后外周血WBC、HB、PLT通常低于正常人，肝功能多表现异常，肾功能的改变较少；对PM的治疗以AMB、ITR、VRC为首选。
ObjectivesTo investigate the epidemiological and clinical characteristics of first diagnosed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in a general hospital, so as to improve early recognition and diagnosis of HIV/AIDS.MethodsWe retrospectively analyzed the data of HIV/AIDS patients who were diagnosed for the first time and had medical records in West China Hospital of Sichuan University from January 2015 to December 2016. Epidemiological information, clinical characteristics and opportunistic infection of these patients were analyzed.ResultsThe 1 036 HIV/AIDS patients were mainly from other regions of Sichuan Province except Chengdu. The overall ratio of male to female was 3.26∶1, and the ages of the patients were mainly between 15 and 59 years old (83.20%). In the occupational distribution, household or unemployed accounted for the largest proportion (36.39%). In terms of education level, junior high school accounted for the largest proportion (27.70%). Among marital status, married accounted for the largest proportion (52.41%). Among ethnic groups, the Han nationality accounted for the largest proportion (87.64%). The main infection route was sexual transmission (82.05%), of which heterosexual transmission accounted for 65.64% and homosexual transmission accounted for 16.41%. The clinical departments of confirmed patients had a wide range of sources, the top five of which were General Outpatient Clinic, Infection Center, Department of Emergency, Department of Dermatology & Venerology and Department of Neurology. Of the patients, 66.99% reported asymptomatic, and 33.01% had one or more symptoms. The most common symptoms were systemic symptoms such as fever, fatigue and lymphadenopathy, as well as clinical manifestations of respiratory system, nervous system and gastrointestinal system. The clinical stage of HIV/AIDS patients were mainly asymptomatic phase and AIDS phase, accounting for 98.65%. Among the HIV/AIDS patients, there were obviously more medical patients than surgical patients. The most common symptoms of the medical patients were fever, cough and expectoration, headache, fatigue and abdominal pain. The main symptoms of the surgical patients were headache, abdominal pain and lymphadenopathy. Compared with the surgical HIV/AIDS patients, the medical patients were younger (Z=−2.647, P=0.008), and the platelet counts (t=−2.110, P=0.036) and CD4+ T lymphocyte counts (Z=−4.639, P<0.001) were lower, the differences were statistically significant. Compared with the homosexually transmitted HIV/AIDS patients, the heterosexually transmitted patients were older (t=25.477, P<0.001), and had lower CD4+ T lymphocyte counts (Z=−2.779, P=0.005). And in males, the red blood cell count and hemoglobin content were lower. There were 214 patients (20.66%) with opportunistic infections, and 50 patients (4.83%) with tumors.ConclusionsHIV/AIDS patients in this general hospital come from different clinic departments, and were mainly Han nationality and married men. Sexual transmission is the main transmission route. Common clinical presentations of HIV/AIDS include fever, fatigue, cough and expectoration, headache, abdominal pain and lymphadenopathy. The diagnosis and treatment of HIV/AIDS patients combined with opportunistic infections and tumors need more attention.
ObjectiveTo evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).MethodsA prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.ResultsSix months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02 - 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased (21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times (Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study.ConclusionReduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.
ObjectiveTo observe and preliminarily explore the relationship between the area of active fundus lesions and aqueous cytomegalovirus (CMV)-DNA in patients with acquired immunodeficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR).MethodsA retrospective study. From November 2019 to December 2020, the study population consisted of 22 AIDS patients (31 eyes) with active CMVR at the Beijing Ditan Hospital, Capital Medical University. All the patients were male. The age of the patients was 38.0±8.7 years. In total, 13 patients accepted highly active antiretroviral therapy (HAART). The median duration of treatment was 4 months. There were 9 cases that did not receive HAART. Ultra-wide-angle fundus imaging examination was performed using Optos P200T laser scanning ophthalmoscope. The software was used that comes with the device to measure the area of active lesions. Anterior chamber puncture was performed in all the affected eyes, 100 μl of aqueous humor was extracted, and the CMV-DNA load was quantitatively detected by polymerase chain reaction. At the same time, 19 cases of peripheral blood CD4+T lymphocytes and CMV-DNA load were tested; 17 cases of the human immunodeficiency virus (HIV)-RNA load were tested. The area of active lesions was used as the independent variable, and the CMV-DNA load of aqueous humor was used as the dependent variable to construct a linear regression function.ResultsAll eyes were active CMVR, with lesions ranging from 1 to 264 optic disc diameters, with a median of 43 optic disc diameters. Among 31 eyes, 30 eyes (96.8%, 30/31) had a median aqueous CMV-DNA load of 1.3×104 copies/ml, and one eye was negative for CMV-DNA in aqueous humor. In 19 patients who underwent peripheral blood CD4+ T lymphocyte detection, the median CD4+T lymphocytes were 18 cells/μl; 4 cases (21.1%, 4/19) were detected with CMV-DNA load. In the 17 patients who underwent HIV-RNA load testing, the median HIV-RNA load was 4.1×104 copies/ml. The results of correlation analysis showed that the amount of CMV-DNA in aqueous humor was significantly correlated with the size of active fundus lesions (r=0.601, P＜0.001), and was correlated with CD4+ T lymphocytes, CMV-DNA load in blood, and HIV-RNA load. There was no significant correlation between the amounts (r=0.125, 0.202, －0.096; P＞0.05). The regression equation was CMV-DNA load in aqueous humor = 3.38 + 0.01 × active lesion area.ConclusionThe amount of CMV-DNA in the aqueous humor is significantly correlated with the area of fundus active lesions, which can reflect the activity of fundus lesions.