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.
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.
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 study the distribution of HIV/AIDS high-risk population, HIV infection and the main risk factors for developing HIV/AIDS’ controllable measures and exploring appropriate health education and behavior intervention models. Methods A total of 360 commercial sex workers (CSW) joined together through convenience sampling and 360 drug users (DU) joined together through convenience sampling or snow-balling sampling whose relevant behavior factors were investigated by questionnaires. Results The general rate of knowing knowledge about AIDS was 75.2% among 360 CSW, 67.8% CSW used condom in commercial sex activities; none of 149 CSW blood samples was detected HIV or syphilis antibody positive. The general rate of knowing knowledge about AIDS was 83.7% among 360 DU who injected drugs last month, the rate of sharing needles was 47.6% and the low rate of condom used; 1 HIV antibody and 5 syphilis antibodies positive were found among 198 DU blood samples, so HIV and syphilis infection rate were 0.51%and 2.53%, respectively. Conclusion The rate of HIV infection is a very low level and there are many risk factors among CSW and DU. A good job should be done to integrate AIDS health education with behavioral intervention and the monitoring system for the AIDS/HIV high-risk population should be improved.
Objective To investigate the influence of including HIV/AIDS patients on the consolidated fund under the New Cooperative Medical System （NCMS）. Methods Designed questionnaires were used to investigate 24 HIV/AIDS patients and 1155 randomized sample of the population to compare their income, requirement for public health service, expenditure of medical care and to analyze the influence of including HIV/AIDS patients. Results We found the income of HIV/AIDS patients was lower than healthy population in 2003 （722 vs. 2 162 RMB） ; but the requirement （outpatient：2 ：1, inpatient：5 ：1 ）and expenditure of medical care was higher in HIV/AIDS patients. Including HIV/ AIDS patients into NCMS would cause an adverse-effect on consolidated fund. When more than 293 HIV/AIDS patients were included, it would be beyond what the consolidated fund can afford. Conclusions Including HIV/AIDS patients into NCMS can decrease the HIV/AIDS expenditure to some degree. But the government still needs to get involved to share risks and to establish an HIV/AIDS fund to cover that part which NCMS could not afford.
The latest global big data evidence indicated the changes of skin and venereal disease burden was huge. HIV/AIDS disease burden was the heaviest diseases among all skin and venereal diseases, and its skin manifestation was serious. The evidence of skin manifestation was searched and classified by subjects such as clinical symptoms, diagnosis & treatment, nursing, etc. The results showed, that the skin manifestation of HIV/AIDS with high incidence was serious, atypical, difficult to cure which was easy to misdiagnose or miss diagnosis. After analyzing the global HIV/AIDS guidelines, we found that many high quality guidelines with widely-covered subjects were produced by developed countries, while quite a few low quality and ones with narrowly-covered subjects were produced by developing countries. Only one guideline was for treatment of HIV/AIDS skin lesion. Based on the current evidence, we call for that all healthcare professionals to increase their awareness, update knowledge, and joint in cooperative prevention and treatment of HIV/AIDS. We also call for that we should produce high quality primary evidence for clinical diagnosis and treatment of HIV/AIDS skin manifestation, and clinical practice guidelines based on good evidence. For the increasing heavy burden of skin and venereal diseases, we should adjust and expand research directions, enrich and improve new interdisciplinary knowledge. We also should constantly train professionals and spread out knowledge in public on prevention and treatment for skin manifestation, so as to transform the evidence in time, effectively protect medical staff and susceptible population, effectively prevent and treat this disease, and improve the satisfaction of our country, hospitals and patients.