故意性途径传播艾滋病现象浅析

目的:调查故意性途径传播艾滋病现象的现状及危害,分析原因,讨论可行的解决方案。方法:通过网络与人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者、获得性免疫缺陷综合征(acquired immuno deficiency syndrome,AIDS)患者交流及查阅文献,并调查2014年湖北省大冶市新发HIV/AIDS患者婚外性行为、性伙伴数等数据佐证。结果:经故意性途径感染HIV的人群客观存在,老年和青少年尤甚,而湖北省大冶市2014年新发137例HIV/AIDS患者中100%经性途径感染,有婚外性行为者占89%,有2个及以上性伙伴者占81.8%。结论:性途径传播已经成为艾滋病主要感染方式,其中故意传播现象客观存在,加强艾滋病知识宣传,完善相关法律法规,重视故意性途径传播现状,保护易感人群,加大对故意性途径传播者的打击力度,重视受害人群心理干预、安抚受害者,避免其成为下一个传播者是重要的社会问题。     

昆明地区艾滋病患者跟骨骨量调查

<正>获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS,别称艾滋病)是由人免疫缺陷病病毒(human immunodeficiency virus,HIV)感染引起的以免疫系统结构破坏和功能缺陷为主的一种传染病。它能通过性接触、血液、母婴传播,引起感染者各种组织器官的机会性感染和肿瘤,最终导致死亡。中国自1985年发现第     

人类免疫缺陷病毒感染者抗病毒治疗服药依从性监测与管理

高效抗反转录病毒治疗大大降低了人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者的病死率,使HIV感染者可获得长期存活。服药依从性是实现病毒抑制、延缓疾病进展的关键因素之一。目前依从性的测量方法可分为间接和直接测量两种。影响依从性的因素大致可分为个体水平因素、药物治疗方案因素、人际关系问题和结构性问题4大类。可提高依从性的方法有:短消息提醒、指导治疗及制定计划、实时依从性监测和应用长效抗病毒药物制剂等。虽然已有较多相关依从性的研究,获得可推广的行之有效的依从性监测及提高手段仍存在较大挑战。     

中医药调节HIV/AIDS患者免疫功能研究现状与思考

高效抗逆转录病毒疗法实施过程中,存在着患者免疫重建不良和免疫重建炎症综合征等治疗难点。中医药调节HIV/AIDS患者免疫功能的研究主要集中在以下几个方面:(1)中医药对HIV/AIDS免疫重建作用的研究;(2)中医药治疗HIV/AIDS免疫重建不良研究;(3)中医药治疗HIV/AIDS免疫重建炎症综合征研究;(4)中医药调节HIV/AIDS免疫功能机理研究。以上研究为进一步提高中医药防治HIV/AIDS的水平提供了理论基础。     

中国艾滋病诊疗指南(2018版)

艾滋病是中国重要的公共卫生问题。2005年,中华医学会感染病学分会艾滋病学组制定了《艾滋病诊疗指南》第一版,并于2011年和2015年进行了更新。2018版指南是在第三版的基础上,根据我国艾滋病临床诊疗实践和最新研究成果进行的更新,主要体现在机会性感染和人类免疫缺陷病毒(human immunodeficiency virus,HIV)相关肿瘤的诊治、抗反转录病毒治疗、HIV暴露后预防和预防母婴传播方面的最新研究进展。2018版指南首次介绍了HIV暴露前预防、首次提出了HIV感染全程管理的概念并详细介绍了如何做好HIV感染全程管理。本指南将根据最新的临床研究证据定期进行更新。     

HAART疗法治疗不同中医体质AIDS患者临床研究

目的:总结分析48例人类免疫缺陷病毒(human immunodeficiencyvirus,HIV)/获得性免疫缺陷综合征(acquived immunodeficiency syndrome,AIDS)患者临床资料,探讨中医体质对高效抗逆转录病毒疗法(highly active antiretroviral therapy,HAART)治疗的反应性,为中医药治疗HIV/AIDS提供参考。方法:收集并分析2014年8月—2016年5月南通大学附属南通第三医院传染科门诊及病房诊治的HIV/AIDS患者病例资料,分析各体质类型患者HIV-RNA载量及CD_4~+T淋巴细胞及其亚群变化情况。结果:治疗前及治疗后虚性体质患者与实性体质患者比较,HIV-RNA载量无显著差异(P>0.05);治疗前虚性体质较实性体质CD_4~+T淋巴细胞更为低下,有着更为低下的Th1、Th17及Th22百分比,同时Th2、Treg占CD_4~+T细胞百分比更高,差异有统计学意义(P<0.05);HAART治疗1 a后虚性体质患者和实性体质患者CD_4~+T细胞、Th1、Th17、Th22所占CD_4~+T细胞百分比均不同程度升高,Th2、Treg所占CD_4~+T细胞百分比则出现不同程度下降;进一步分析发现,虚性体质与实性体质患者Th1升高值、Th2降低值、Th17升高值和Treg降低值比较,差异有统计学意义(P<0.05),而CD_4~+T淋巴细胞升高值、Th22升高值,虚性体质与实性体质患者比较,无显著差异(P>0.05)。结论:中医体质影响着HIV/AIDS病情进展,不同体质人群对HAART治疗反应性各异。     

HIV/AIDS合并深部型真菌感染研究概况

<正>艾滋病(acquired immune deficiency syndrome,AIDS)是患者由于感染人免疫缺陷病毒(humam immunodeiciency virus,HIV)引起的慢性传染病,HIV病毒主要会攻击机体的辅助性T淋巴细胞及系统,若已侵入人类机体细胞,则将与细胞整合以致终生无法消除[1-3]。此类病毒广泛存于被感染者血液和精液,及阴道分泌物和唾液,以及尿液和乳汁等体液中[4]。其     

人免疫缺陷病毒阴性者播散型马内菲青霉菌感染的诊治

<正>马内菲青霉菌(Talaromyces marneffei,TM)可寄生于细胞内,是呈温度双相型的条件致病菌。TM所致的真菌感染可分为局限型和播散型,后者在免疫抑制人群中,特别是人免疫缺陷病毒(human immunodeficiency virus,HIV)感染者中较为常见,且十分凶险,死亡率极高~([1])。TM感染的流行区主要在东南亚地区,近年来在中国南部,播散型感染者亦呈逐年快速递增趋势。Hu等~([2])对1984年至1999年近15年中     

人类免疫缺陷病毒首犯后天阳之本

人类免疫缺陷病毒(HIV)感染人体后,主要侵犯肺、脾二经,但首犯肺经。肺为后天阳之本,脾为后天阴之本。根据肺的生理功能和HIV病毒侵袭人体的特点,肺经的临床表现出现最早,出现的几率也最大。脾为后天阴之本,当肺脏卫外功能减退或不足的时候,病邪即可深入,引起脾经病变。同时HIV病毒对肺脾的侵犯具有较大的特异性,需要结合其他各期的病机进行综合分析,完整地认识病毒的发病特性。     

青蒿琥酯对猴免疫缺陷病毒感染中国恒河猴模型T淋巴细胞活化的调节作用

目的:观察注射用青蒿琥酯对猴免疫缺陷病毒(simian immunodeficiency virus,SIV)感染中国恒河猴模型免疫异常激活的改善情况,探讨青蒿琥酯对艾滋病的干预作用。方法:选用8只SIV感染平台期中国恒河猴模型,随机分为治疗组和对照组,每组各4只,治疗组按每天3 mg·kg~(-1)剂量肌肉注射青蒿琥酯注射液8周,对照组肌肉注射等剂量生理盐水。分别于给药前,给药后2周、4周、6周、8周,停药后4周、8周检测血浆病毒载量、全血细胞计数、淋巴细胞亚群及免疫活化相关标记物CD_(69)~+、CD_(25)~+、HLA-DR~+和CD_(38)~+表达情况。结果:青蒿琥酯可在4周内下调CD_8~+细胞CD_(69)~+、HLA-DR~+和CD_(38)~+表达水平(P<0.05),对CD_4~+细胞影响较小。给药第4周出现一过性嗜中性粒细胞下降,后回升至正常水平。结论:青蒿琥酯可改善SIV感染中国恒河猴细胞毒性T细胞免疫异常激活,嗜中性粒细胞下降是可逆的。     

HIV感染真的被“治愈”了吗?

人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染靶细胞需要识别细胞表面CD4分子及其辅助受体,C-C趋化因子受体5 (C-C chemokine receptor type 5,CCR5)和C-X-C趋化因子受体4 (C-X-C-motif receptor 4,CXCR4)是HIV识别靶细胞的两种重要辅助受体。CCR5Δ32基因突变使得HIV无法识别CCR5受体,从而阻止嗜CCR5的HIV病毒株入侵靶细胞。"柏林病人"和"伦敦病人"正是利用这一原理,通过移植携带纯合子CCR5Δ32突变基因的异基因骨髓,实现了停用抗病毒药物后病毒无反弹的目标,故而被誉为HIV感染"治愈"案例。然而,这一成功是否存在偶然性?事实上,人群中携带CCR5Δ32纯合子基因突变概率极低、异基因骨髓配型十分困难、骨髓移植医疗费用昂贵、移植后HIV病毒株嗜性迁移等客观因素的存在,使得通过携带纯合子CCR5Δ32基因突变异基因骨髓移植法实现HIV感染者停用抗病毒药物且保持病毒不反弹的目标困难重重。因此,"柏林病人"和"伦敦病人"的成功经验为治疗HIV感染提供了新的方向和希望,但如认为HIV感染已被"治愈"为时尚早,需进一步研究证实。     

Exposure of eyes to perfume: a double-blind, placebo-controlled experiment

Environmental perfume exposure can elicit bothersome respiratory symptoms. Symptoms are induced at exposure levels which most people find tolerable, and the mechanisms are unclear. The aim of the study was to investigate patients with eye and respiratory symptoms related to environmental perfume, by exposing the eyes to perfume in a double-blind, placebo-controlled study.Twenty-one eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex- and age-matched case-control study. The participants completed a symptom questionnaire, and underwent a double-blind, placebo-controlled exposure to perfume. Of the 42 individuals tested, 10 had more eye symptoms (irritation, itching, and tears) during perfume exposure than during placebo exposures, and eight of these individuals (P = 0.07, Fisher's exact test) belonged to the patient group. A true positive eye reaction to perfume was significantly associated with identification of perfume as an active exposure (P < 0.05). In this study, vapor of perfume elicited irritation in the eyes independently of olfaction, but the relative importance of ocular chemoperception in relation to elicitation of respiratory symptoms from common environmental exposures to perfume remains unclear. We investigated the hypothesis of an association between respiratory symptoms related to perfume and ocular perfume sensitivity by exposing the eyes to perfume in a double blind, placebo-controlled experiment. Vapors of perfume provoked symptoms in the relevant eye in some patients and healthy control persons, but under our exposure conditions, ocular chemesthesis failed to elicit respiratory symptoms.     

江西省艾滋病成年治疗患者分布及临床特征

目的了解江西省艾滋病（acquired immunodeficiency syndrome,AIDS）成年治疗患者的分布与临床特征,为制订合理的AIDS防治方案与政策提供依据。方法收集江西省2004—2012年开展的2 194例AIDS成年治疗患者的基本情况及临床状态资料,采用描述性流行病学方法分析其分布规律与临床特征。结果 2 194例AIDS成年治疗患者的分布规律为：性别以男性为主占71.4%,年龄以30~40岁为主占31.7%,婚姻状况以已婚或同居者为主占60.8%。WHO临床分期分布：Ⅰ期35.2%、Ⅱ期23.0%、Ⅲ期22.4%、Ⅳ期19.4%。感染途径以性传播为主占79.6%。临床特征为：患者机会性感染率为31.9%,不同临床分期患者的机会性感染率有所不同（P〈0.001）;其中前5位机会性感染疾病分别为持续或间断发热17.2%、皮肤损害5.7%、持续腹泻5.6%、带状疱疹5.2%、鹅口疮3.6%。有37.5%患者出现发热、咳嗽咳痰、夜间盗汗、腹泻、恶心、视力下降、皮疹、淋巴结肿大等1种或几种症状体征。7.9%最近1年患有肺结核。乙、丙肝阳性率分别为16.8%、7.5%。结论江西省AIDS成年治疗患者以男性、青壮年、性传播途径为主;机会性感染率较高,机会性感染与临床分期关联性强,特征性临床症状较多且伴随较多乙、丙肝合并感染。宜针对AIDS治疗患者的特征建立健全相关AIDS的综合防治措施,以控制AIDS的播散。     

HIV 感染者 /AIDS 病人生存质量现状调查及相关影响因素研究

目的：了解 HIV感染者/AIDS病人（people living with HIV/AIDS,PLWHAS）的生存质量现状及其影响因素。方法采用简体中文版 MOS-HIV量表评价371例 PLWHAS的生存质量现状,同时调查可能影响其生存质量的人口学特征和 HIV感染相关情况。采用t检验、方差分析和多元线性回归模型进行统计分析。结果生存质量得分：心理健康总分为（46．60±10．45）分,生理健康总分为（51．14±9．28）分。单因素分析结果显示：年龄、文化程度、职业等因素,与PLWHAS的生存质量各个领域有关（P＜0．05）。多元线性回归分析结果显示：年龄、收入、文化程度和感染途径,是影响PLWHAS生存质量的主要因素。结论年龄、收入、文化程度和感染途径等,在不同方面影响着PLWHAS的生存质量。重点关注老年、收入较低、文化程度较低者的生存质量,对提高该人群生存质量有重要意义。     

Guidelines for effective workplace HIV/AIDS intervention management by construction firms

Construction firms have an important role in combating HIV/AIDS in the South African construction industry. The HIV/AIDS intervention management practices of 12 construction firms in Cape Town are examined through interviews and documents. From thematic analysis, five themes emerged: construction firms’ perceptions of HIV/AIDS as a threat to the firm; construction firm interventions; barriers to the success of interventions; the role of service providers; and state-led interventions. A tension exists in managing HIV/AIDS interventions as firms are concerned with productivity and profit maximization, but are becoming more engaged with corporate social responsibility and a higher duty of care towards employees. Interventions should extend beyond awareness and prevention campaigns to include testing and treatment programmes. A guideline checklist for such interventions is proposed. Partnering with specialized service providers is recommended, as well as engaging closely with public sector services. Firms successfully managing their HIV/AIDS response should share their experience with others struggling to respond. Employee issues of stigma and reluctance to disclose need to be addressed. Attention should be paid to the employment structure of the construction industry and to the needs of the informal sector.     

A study of the probable transmission routes of MERS‐CoV during the first hospital outbreak in the Republic of Korea

Infections caused by the Middle East respiratory syndrome coronavirus (MERS‐CoV) are a serious health issue due to their prevalence and associated mortality. However, the transmission routes of the virus remain unclear, and thus, the current recommended control strategies are not evidence based. In this study, we investigated the transmission routes of MERS‐CoV during the first nosocomial outbreak in the Republic of Korea in May 2015 using a multi‐agent modeling framework. We identified seven hypothesized transmission modes based on the three main transmission routes (long‐range airborne, close contact, and fomite). The infection risks for each hypothesis were estimated using the multi‐agent modeling framework. Least‐squares fitting was conducted to compare the distribution of the predicted infection risk in the various scenarios with that of the reported attack rates and to identify the hypotheses with the best fit. In the scenarios in which the index patient was a super‐spreader, our model simulations suggested that MERS‐CoV probably spread via the long‐range airborne route. However, it is possible that the index patient shed an average viral load comparable to the loads reported in the literature, and that transmission occurred via a combined long‐range airborne and close contact route.     

An integrated model of HIV/AIDS testing behaviour in the construction industry

The South African construction industry is one of the economic sectors most adversely affected by the HIV/AIDS pandemic. Prevalence rates exceed those of most other sectors. Little is known about the antibody testing behaviour of construction workers, and the determinants thereof. A field-administered questionnaire survey, using an item catalogue based on similar surveys, gathered data from 512 site-based construction employees in the Western Cape, South Africa. An integrated hypothesized conceptual model of testing behaviour, derived from the literature, was proposed as a starting point for data analysis. This model comprising demographic factors, lifestyle risk and condom use, alcohol consumption, drug use, knowledge about HIV/AIDS, prejudice towards HIV+ persons, and attitudinal fear of being tested, was used to explain testing behaviour. Bivariate analysis, regression modelling, and structural equation modelling were then used to test the conceptual model. A revised model was proposed. The findings indicate that: (1) employment type, alcohol consumption, drug use, and HIV/AIDS knowledge are the terminal predictors of testing behaviour; (2) knowledge about the disease is determined by education level and ethnicity; (3) age, gender, ethnicity and education behave as significant predictors of alcohol consumption; (4) drug use is predicted by employment type, education and alcohol consumption (marginally); and (5) the interrelationship between knowledge, prejudice, and fear of being tested is nuanced and complex. In strategies for positively influencing employee testing behaviour, employers should first ensure that effective communication is established with workers in all employment categories. Interventions relating to alcohol consumption and drug use by employees need particular attention. Existing peer educator training, and awareness campaign media, should be particularly sensitive to ethnic and cultural values that are likely to influence HIV/AIDS testing behaviour.