Objective To observe the fundus characteristics of acquired immune deficiency syndrome (AIDS) with human immunodeficiency virus (HIV) retinopathy. Methods Eighty eyes of 52 AIDS patients with HIV retinopathy were enrolled in this study. The patients included 42 males (67 eyes) and 10 females (13 eyes). The patients ages ranged from 16 to 78 years, with a mean age of (43plusmn;12) years. All patients' visual acuity, intraocular pressure, slit-lamp microscopy and mydriatic indirect ophthalmoscopy, fundus color photography and CD4+ T cell count was documented. Experienced ocular fundus doctors carried out fundus examinations. Retinopathy characteristics were recorded. Seventeen patients (24 eyes) were followed for a period between two days to two years, with a median of 125 days. We failed to follow up the remaining 35 patients (56 eyes) due to death or moving away. Results Among 52 patients (80 eyes), 28 patients (56 eyes, 70.0%) had bilateral HIV retinopathy and 24 patients (24 eyes, 30.0%) had unilateral HIV retinopathy. Cotton-wool spots (CWS), mostly located close to temporal peripapillary vessels, were found in 46 patients (72 eyes, 90.0%). Six patients (eight eyes, 10.0%) were found to have flaming or spotting hemorrhage located in posterior pole. Among 72 eyes with CWS, 57 eyes were found to have CWS only and 15 eyes were found to also have retinal hemorrhage, mostly located near CWS. Among 24 eyes of 17 followed-up patients, three eyes of three patients were found with no significant changes during the less than two week follow-up. In 18 eyes of 11 patients, CWS or hemorrhage disappeared after one to three months without treatment and in five eyes new CWS or hemorrhage were found in other parts of the posterior pole. Three eyes of three patients initially considered as lint plaque-like lesions were eventually detected with CMVR as lesions during one to five months follow-up. Conclusion CWS are the most common ocular lesions in HIV retinopathy.
Objective To compare quality of life for HIV infected people or AIDS patients and their family members of noninfected people in two counties (Zizhong and Zhaojue) with high AIDS morbidity and high HIV infective rates. Methods The quality of life for HIV infected people or AIDS patients and 162 of their family members and 97 people noninfected HIV/AIDS was measured by a questionnaire containing the generic quality of life inventory 74 (GQOLI-74) and the social support scale (SSS). Data were analyzed with SPSS. Results Total GQOLI-74 scores and each of the four dimensionality scores were significantly lower for HIV/AIDS people and their family members compared with noninfected people (total score for HIV/AIDS people 52.20 [9.41]; family members 60.46 [11.92]; noninfected people 66.36 [8.90] (Plt;0.01)). Scores for each of the disease status (physical function, psychological function, social function and material status) were all lower compared with noninfected people (all comparisons Plt;0.01). GQOLI-74 scores of HIV/AIDS people were significantly correlated with disease status and social support, but age, education level and substance abuse did not show significantly correlation. Conclusions The quality of life for HIV infected people or AIDS patients and their families is significantly lower than the general population, and this is particularly related to the severity of their disease and lack of social support.
Objective To explore the key influencing factors of HIV risk behavior among male who have sex with male (MSM). Methods 36 MSM subjects in a community were recruited for HIV risk behavior characteristics, social environment and the attitude of exposure of high risk sexual intercourse, using behavior scales and qualitative research methods. The collected data were orderly input and analyzed using Nvivo 8.0 software. Then, after three-level transcription, the data were further summarized and extracted based on the method of the grouding theory. Results The HIV Risk Assessment Questionnaire score of 36 subjects was 8.08±2.46, of whom, 72% scored at a medium level (5 to 10 scores) and 19% scored at a high level (more than 10 scores). The social support rating scale (SSRS) score was 32.38±5.99 in MSM population, lower than in undergraduates and floating population. The results of qualitative analysis showed that, after open coding, 11 key message and 4 categories contributed to HIV risk in MSM populaiton, including: a) low levels of fear for AIDS; b) male role and uncertain sexual orientation; c) low degree social support; and d) poor availability of condom in the setting of sexual intercourse. Conclusion The interventions against AIDS/HIV for MSM need to be further studied. Besides, we should strengthen the community intervention mode based on fear for AIDS, social support, and condom distribution methods
Objective To observe the fundus characteristics of human immunodeficiency virus with acquired immune deficiency (HIV/AIDS). Methods A total of 1041 HIV/AIDS patients were enrolled in this study. The patients included 882 males (88.70%) and 159 females (11.30%). The patientsprime; ages ranged from 12 to 73 years, with a mean age of 41 years. The median time of HIV/AIDS diagnosis was 12 months, which ranged from one month to 10 years. HIV infection was acquired through sexual contact, intravenous drug use, blood transfusion or mother-to-child transmission in 475 patients (45.63%), 508 patients (48.80%), 44 patients (4.25%) and 14 patients (1.34%), respectively. Ocular examinations (vision acuity, slit lamp microscope and fundus examination) were performed on recruited patients with HIV/AIDS. Additional exams (intraocular pressure, fundus photography and fundus fluorescein angiography) were done if abnormal ocular fundus was found. The ocular manifestations were diagnosed according to clinic reference. Results Ocular manifestations of HIV/AIDS were detected in 247 patients (23.73%). Of 247 patients, the most common ocular manifestation was HIV retinopathy, which was present in 132 patients (53.44%); cytomegalovirus retinitis (CMVR) was second place, affecting 70 participants (28.34%). Clinic findings of HIV retinopathy included retina microaneurysm, hemorrhage along the blood vessel with cotton-wool spots, while irregular dry edge, granular appearing border, were present in CMVR, and the optic nerve may be affected. Fluorescein angiogram of HIV retinopathy demonstrated that hemorrhage was shown as sheltered fluorescence, with b fluorescence without leakage in center of hemorrhage. Fluorescein angiogram of CMVR demonstrated significant hemorrhage appearing as sheltered fluorescence with leakage and/or transparent fluorescence. The optic disk and lesioned area were stained with fluorescence. Conclusions There are various HIV/AIDS related ocular manifestation. HIV retinopathy and CMVR are common ocular manifestations. The main clinical findings of HIV retinopathy are hemorrhage and/or cotton-wool spots, while irregular granular appearing edges and hemorrhage were observed in CMVR.
ObjectiveTo systematically evaluate the efficacy and safety of early initiation of antiretroviral therapy (ART) in asymptomatic HIV-infected, treatment-naive adults and adolescents. To assess the evidence for the optimal time to initiate ART. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 4, 2016), CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about early initiation and optimal time to initiate ART in asymptomatic, treatment-naive HIV-infected patients from January 1996 to April 2016. Two review authors independently assessed study eligibility, extracted data and graded methodological quality. Data extraction and methodological quality were checked by a third author who resolved differences when these arose. We meta-analysed dichotomous outcomes using the risk ratio (RR) and report the 95% confidence intervals (95% CIs) by using RevMan 5.3 software. ResultsA total of 4 RCTs involving 8 751 patients were included. The results of meta-analysis showed that initiating ART at CD4+ T-cell counts (CD4 counts) ≥350 cells/μL or 500 cells/μL, comparing to deferring initiation of ART to CD4 counts <350 cells/μL, would benefit patients more: (1) Risk of AIDS-defining illnesses which representing disease progression, reduced significantly when starting ART at higher CD4 counts (no less than 350 cells/μL) (RR=0.49, 95%CI 0.38 to 0.64, P<0.001). The reduction of risk was even more significant when initiating ART at CD4 counts of not less than 500 cells/μL (RR=0.38, 95%CI 0.24 to 0.59, P<0.001). (2) When initiating ART at CD4 counts of not less than 350 cells/μL, the risk of serious non-AIDS related events was significantly reduced by 42% (RR=0.58, 95%CI 0.40 to 0.83, P=0.003). When initiating ART at CD4 counts of not less than 500 cells/μL, according to START 2015, the risk of serious non-AIDS related events could be reduced by 39% (RR=0.61, P=0.04). (3) However, when initiating ART at CD4 counts of not less than 350 cells/μL or 500 cells/μL, comparing to deferring initiation, there were no statistically significant differences in death (RR=0.70, 95%CI 0.48 to 1.02, P=0.06) and serious adverse events (RR=0.67, 95%CI 0.38 to 1.20, P=0.18). ConclusionOur findings contribute to the evidence base for recommending initiating ART at CD4 counts of 350-500 cells/μL compared to initiating it later when CD4 counts fall below 350 cells/μL. As for patients with CD4 counts of not less than 500 cells/μL, initiation of ART is also recommended.
Objective To investigate the potential effect of glucocorticoids (referred to as 'hormones' here) on decreasing case fatality rate in patients with human immunodeficiency virus (HIV) negative Pneumocystis jirovecii pneumonia (PJP). Methods The clinical data of a cohort of 93 patients that were diagnosed with HIV-negative PJP at Jiangxi Provincial People's Hospital between April 2019 and April 2022 were retrospectively analyzed. These patients were classified into two groups based on the partial pressure of oxygen in arterial blood (PaO2), specifically PaO2 ≥70 mm Hg and PaO2 <70 mm Hg. The association between case fatality rate and various factors such as underlying diseases, hormone use, mechanical ventilation, and others was examined. Results Over a period of three years, 93 cases of HIV-negative PJP were identified. The most prevalent underlying diseases were solid organ transplantation (n=34, 36.6%), rheumatic system diseases (n=26, 28.0%), and malignant tumors (n=15, 16.1%). 51 cases had arterial PaO2 levels ≥70 mm Hg, while 42 cases had levels <70 mm Hg. Moreover, 19 patients required invasive ventilation, 39 patients were treated with non-invasive ventilation, while 50 patients received oxygenation using a nasal cannula. Out of the 93 patients, 31 died from the disease, resulting in an overall case fatality rate of 33.3%. Meanwhile, 62 patients survived. In patients with arterial PaO2 levels ≥70 mm Hg, the administration of hormones did not significantly affect the case fatality rate (P > 0.05); In patients with arterial PaO2 level <70 mm Hg, the administration of hormones did not significantly affect the case fatality rate (P > 0.05). Conclusion Hormone use did not contribute to improved survival rates in HIV-negative PJP patients, regardless of arterial PaO2 level.
ObjectiveTo translate evidence of "HIV/AIDS Clinical Nursing Practice Guideline" into clinical practice, in order to reduce the incidence and severity of symptoms of AIDS and to improve the quality of life of patients. MethodsWe integrated the best evidence into the HIV/AIDS inpatient unit of a tertiary hospital for infectious disease in Shanghai, China between September 2013 and February 2015. Based on the "Ottawa Model of Research Use", this study was divided into four stages: evaluating the status quo, building the evidence-based strategy, applying evidence-based decision-making, and evaluating results and reflecting. 148 patients were either assigned to an intervention group with HIV/AIDS-related symptom management protocol (n=74), or to a usual care group (n=74) for the duration of their antiretroviral therapy. Then Medical Outcomes Questionnaire (MOS-HIV) were applied to evaluate the life quality after intervention. ResultsMixed-effects regression indicated significant difference between groups across time in total MOS-HIV score. The intervention group increased more than the control group 2.72 points in total MOS-HIV scores per month (P<0.05). ConclusionThe evidence-translation and evidence-based decision-making of "HIV/AIDS Clinical Nursing Practice Guideline" can regulate nurse behavior, raise the quality of clinical care and improve the patients' quality of life.
Objective To evaluate the correlation between mycoplasma genitalium and HIV infection. Methods Databases including MEDLINE, ScienceDirect, EMbase, WanFang Data, and CNKI were searched from inception to March 2012, so as to identify the independent cohort studies, case-control studies and cross-sectional studies. Moreover, the references of relevant studies were also retrieved. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the methodological quality of the included studies was assessed. Then meta-analysis was performed using RevMan 4.2 and SAS 9.1.3 softwares. Results A total of 19 studies were included, including 3 430 HIV infected patients and 7 656 controlled participants. The results of meta-analyses showed that the HIV infection group was more likely to infect mycoplasma genitalium than the control group (OR=2.34, 95%CI 1.68 to 3.28, Plt;0.000 01). The same results were found in both subgroup and sensitivity analyses. Conclusion Mycoplasma genitaliuman infection is closely related to HIV infection. However, detailed pathogenesis is still unknown. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to prove the above.
ObjectiveTo investigate the ultrasonic changes of hepatic veins and splenic veins during various immune stages with different CD4+T lymphocyte count. MethodsFifty AIDS/HIV patients with chronic viral hepatitis treated between January 2010 and October 2013 were designated as the case group, and another 50 patients with simple chronic viral hepatitis were regarded as the controls. For patients in the case group, we observed their ultrasonic changes of hepatic and splenic veins during various immune stages with different CD4+T lymphocyte count. The results of observation and clinical laboratory analysis were compared. ResultsAbnormal ultrasonic changes were detected in the liver in various immune stages based on the CD4+T lymphocyte count, and the main manifestations of these changes included unclear portal and splenic vein distal direction, wide diameter, slowed blood flow velocity, and disappearance of fluctuations of blood flow spectrum; and unclear hepatic vein distal direction, low and three-phase, and negative blood flow spectrum with the disappearance of windows were also detected. There were no statistical differences between the case group and the control group when the CD4+T cell count was over 300/mm3, and a few indexes were significantly different when the CD4+T cell count was between 100 and 200/mm3. However, the differences of almost all indexes were significant when the CD4+T cell count was below 100/mm3. ConclusionPatients with HIV/AIDS combined with chronic viral hepatitis have ultrasonographic abnormalities of intrahepatic and splenic veins, which is more obvious as the CD4+T cell count declines. Overall consideration of intrahepatic vein and splenic vein ultrasonic indicators helps clinical assessment of disease development in patients with HIV/AIDS combined with chronic viral hepatitis.
Background AIDS (acquired immune deficiency syndrome) has become the most devastating disease which humankind has ever encountered. Human immune-deficiency virus (HIV) is transmitted through blood, sexual behavior and mother-to-baby, with more efficient transmission through blood transfusion. HIV risk among blood transfusion was severe due to lack of effective and correctly applied screening method and rigorous management, especially in some developing countries. Since the first HIV screening reagent was approved by FDA to screen the blood in 1985, the fourth generation test has been produced till now. Initially, HIV test was primarily used to screen the blood supply, it also became an important aspect of HIV prevention, especially screening among people donating blood. Today, HIV testing is seen as an integral part of both the nation’s prevention and treatment efforts. Objective To assess the effectiveness of any intervention tests for HIV screening among people donating blood, and find appropriate tests for HIV screening to decrease the risk of HIV transmission by blood transfusion. Search strategy MEDLINE, Cochrane Controlled Trials Register (CENTRAL/CCTR), AIDSLINE, EMBASE, CBM were be searched with the terms: "HIV", "AIDS", "screening", "test", "blood donor", "blood bank" and the detailed screening method. The websites of WHO, UNAIDS, CDC, FDA, and their related links were searched. Letters were mailed to various agencies and experts in this field to acquire unpublished reports. Inclusion criteria RCT and CCT for screening HIV among blood. donors will be included. Observational studies such as cohort studies, cased-control studies, and historical controlled studies will be used for sensitivity analysis. Method of the review According to the principles of Cochrane Review, selection of trials for inclusion, quality assessment of studies, data extraction and syntheses were conducted by reviewers.