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Study on the Effectiveness and Problems in Implementing Acquired Immune Deficiency Syndrome Control and Prevention in Community Health Service Centers

ObjectiveTo analyze the effectiveness and problems existing in implementing acquired immune deficiency syndrome (AIDS) control and prevention in community health service centers, and to provide scientific evidence for promoting AIDS control and prevention. MethodsRelated information on AIDS control and prevention in community health service centers in a community in the whole year of 2013 was acquired. The effectiveness and problems existing in case management, laboratory testing and highly active antiretroviral therapy (HAART) based on the current community health service system were analyzed. ResultsBy the end of 2013, the rate of AIDS case management was from zero to 100%, the rate of CD4 T detection was from 76.60% (360/470) to 88.35% (508/575), and the rate of receiving highly active antiretroviral therapy among AIDS patients was from 81.40% (175/215) to 84.41% (287/340). But in the actual work on AIDS in community health service centers, there were still some common problems needing to be solved. ConclusionThe community level management mode of AIDS can promote the accuracy of AIDS patients' information, improve the rate of case management, the rate of CD4 T detection and HAART. It is suggested that the community level management mode of AIDS should be promoted in the cities where AIDS patients are concentrated.

New Evidence of The Cochrane Library(Issue 4, 2004)

医务人员艾滋病职业防护及医院感染知识与行为调查干预

目的　了解医务人员艾滋病职业防护和医院感染知识及行为的现状。 方法　2011年7月采用问卷调查法，分别对干预前299名、干预后254名医务人员进行艾滋病职业防护及医院感染预防知识、态度、行为调查。 结果　医务人员对艾滋病的基本知识知晓率较高（＞85.0%），但对较深层的问题缺乏认识，“窗口期”知晓率18.7%，“蚊虫叮咬”知晓率15.1%，消毒知识知晓率10.7%，干预前后比较差异有统计学意义（P＜0.01）。 结论　应加强艾滋病职业暴露防护和预防医院感染知识的教育与培训，提高职业防护能力，以保障医务人员职业安全，预防艾滋病医院感染。

艾滋病并发播散性非结核性分枝杆菌感染一例

艾滋病并发眼底病患者的护理

目的　总结艾滋病并发眼底病患者的护理要点。 方法　回顾分析2010年3月－2012年4月艾滋病并发眼底病7例患者（13只眼）的临床资料和护理经验。7例患者中3例放弃手术，4例实施7次手术治疗。护理重点是护理人员的培训和患者的心理护理、局部护理、全身症状护理和健康教育。 结果　艾滋病并发眼底病3例患者放弃手术，4例手术中接受玻璃体切割术者4例次，视网膜修复术2例次，硅油取出术1例次，硅油充填术3例；患者术后视网膜复位4例，术后视力：0.02者2例，数指5例。无1例不良事件和护理安全事件发生，出院随访康复和治疗情况较好。 结论　艾滋病并发眼底病患者的护理重点是眼部和全身疾病的护理、患者的心理护理、隐私保护，以及医护人员的职业防护。

Evidence for Treating and Preventing HIV Infection

Cochrane系统评价证据表明,口服替代治疗能降低阿片类药瘾者HIV的血液传播.使用避孕套可有效预防HIV的性传播,同时联合其他一些干预措施可进一步降低个人感染HIV的风险.对于贫困人口和不发达地区,孕妇短程服用奈韦拉平是防治母婴传播最现实有效的方法;而基于发达国家的研究表明,剖腹产、母乳替代品可能是有效的干预.病毒逆转录酶抑制剂是初期治疗HIV感染的有效方法.特效药对于减少艾滋病相关的机会感染是必需的.积极的体育锻炼已被证实是提高艾滋病人生存和生活质量的有效手段.

Analysis on Clinical Features of Acquired Immune Deficiency Syndrome Combined with Opportunistic Infections and Its Diagnosis and Treatment

【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.

Investigation on Other Infectious Diseases in Men Who Have Sex with Men, with Acquired Immune Deficiency Syndrome in Chengdu City

目的　总结成都市某男男性行为人群（MSM）中人类免疫缺陷病毒（HIV）感染者合并其他传染病的情况，为科学防治艾滋病提供依据。 方法　2010年1月－12月，采用网络、现场、活动场所收发调查问卷，用Excel统计结果数据。 结果　共调查104例艾滋病患者，合并肝炎感染者11例（10.58%），其中乙肝病毒感染者8例（7.69%），丙肝病毒感染者3例（2.88%）；合并性传播疾病感染61例（58.65%），其中梅毒感染26例（25%），尖锐湿疣感染者17例（16.35%），生殖器疱疹感染者10例（9.62%），淋病感染者2例（1.92%），沙眼衣原体感染者4例（3.85%），生殖道支原体感染者2例（1.92%）；合并真菌感染者87例（62.14%），其中耶氏肺孢子菌感染者6例（5.77%），马尔尼菲青霉菌感染者2例（占1.92%），隐球菌感染者5例（4.81%），组织胞浆菌1例（0.96%）；合并结核感染者23例（22.12%）及非结核分枝杆菌3例（2.88%）；病毒感染14例（13.46%），全部为水痘-带状疱疹病毒感染；寄生虫感染（弓形虫）1例（0.96%）。 结论　在MSM人群中HIV患者性传播疾病感染比例高；真菌感染率高；结核感染率高；HCV感染和弓形虫感染率低。

发热、活动后气促，两肺磨玻璃影（续）

Clinical studies on treatment of AIDS by traditional Chinese medicine compound preparations: an evidence map analysis

ObjectiveTo systematically search and sort out the clinical research literature on the treatment of AIDS by traditional Chinese medicine compound preparations by using the evidence map method, and to understand the distribution of evidence in this field. MethodsThe CNKI, WanFang Data, VIP, CBM, PubMed and Cochrane Library databases were electronically searched to collect studies on the treatment of AIDS with traditional Chinese medicine compound preparations from inception to August 2022. The distribution characteristics of evidence were analyzed and presented in the form of charts and words. ResultsA total of 337 articles were included, involving 268 intervention studies, 66 observational studies and 4 systematic reviews/meta-analysis. A total of 92 kinds of traditional Chinese medicine compound preparations were obtained, and the literature quantity of different preparations was obviously stratified, with Kangaibaosheng preparation being the most frequently reported. In recent years, the number of published literature has been declining, the quality of literature is generally low, and the level of evidence is not high. As for the intervention duration, this field tends to have a longer intervention observation period. As for the outcome indicators, the evaluation criteria of some indicators are not uniform, and the characteristics of TCM advantages are not reflected. The quantity and quality of systematic reviews/meta-analyses were insufficient. No normative consensus or guidelines for the treatment of AIDS with traditional Chinese medicine compound preparations had been formed. Conclusionstudies on the effectiveness and safety of traditional Chinese medicine compound preparations in treating AIDS has initially formed a certain scale of evidence group. In the future, it is necessary to further improve the quality of studies, explore outcome indicators that can reflect the advantages of TCM efficacy, and formulate relevant guidelines in a standardized manner.