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

艾滋病并發血小板極度低下一例

Analysis of Effectiveness and Drug Resistance in Patients with AIDS Receiving Highly Active Antiretroviral Therapy

【摘要】　目的　評價高效抗逆轉錄病毒療法（highly active antiretroviral therapy，HAART）對艾滋病患者的療效，并觀察其耐藥情況。　方法　2008年11月，對23例接受免費HAART治療1~3年的艾滋病患者的HIV-RNA病毒載量、HIV-1耐藥、CD4+T淋巴細胞絕對計數、常規生化檢測結果進行分析。　結果　23例艾滋病患者在HAART治療1~3年后有6例（26.1%）患者HIV-RNA載量在水平線以下，17例（73.9%）HIV-RNA載量未達到檢測線以下。5例患者（21.7%）的HIV-1發生了耐藥，服藥依從性良好的患者僅9例（39.1%）。　結論　HAART對艾滋病患者的療效較差、耐藥率高、服藥依從性差。【Abstract】　Objective　To evaluate the efficacy of highly active antiretroviral therapy (HAART) in treating HIV, and observe the resistance of HAART in AIDS patients.　Methods　Twenty-three HIV patients receiving free HAART for one to three years were investigated. The plasma viral load, drug resistance to HIV-1, CD4+ T cell count were tested and routine laboratory examinations were performed in our study.　Results　After one to fhnee-year HAART treatment, HIV viral load of six patients (26.1%) declined to the undetectable level, while the viral load of 17 patients (73.9%) kept at a high level. Resistance to HIV-1 occurred in five cases (21.7%). Only nine patients (39.1%) had good treatment compliance.　Conclusion　HAART has a poor therapeutic effect on patients with HIV/AIDS with a high rate of drug resistance and poor treatment compliance.

SMS intervention on improving antiretroviral treatment adherence in HIV patients: a meta-analysis

ObjectivesTo evaluate the effects of short message service (SMS) intervention for improving antiretroviral treatment adherence in HIV patients by meta-analysis.MethodsDatabases including PubMed, EMbase, CINAHL, Web of Science, ScienceDirect, The Cochrane Library, CNKI, WanFang Data, VIP and CBM were searched electronically from January 2000 to December 2018 to collect randomized controlled trials (RCTs) on the efficacy of SMS intervention on HIV patients. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 10 RCTs with 2 411 patients were included. The meta-analysis showed that SMS intervention could improve significantly treatment adherence of HIV patients (RR=1.11, 95%CI 1.03 to 1.20, P<0.01). The subgroup analysis showed that weekly texting had an effect on treatment adherence (RR=1.15, 95%CI 1.00 to 1.33, P<0.05); personal sending (RR=1.17, 95%CI 0.99 to 1.38, P=0.06) and daily sending (RR=1.02, 95%CI 0.83 to 1.26, P=0.84) of SMS had no statistical significance on treatment adherence; the intervention duration of 6 months (RR=1.11, 95%CI 1.00 to 1.23, P=0.05) could improve the treatment adherence, while the intervention duration of 12 months (RR=1.07, 95%CI 0.98 to 1.17, P=0.13) had no statistical difference on treatment adherence; there was no statistical difference in CD4+ cell count before and after treatment (WMD=4.18, 95%CI ?39.33 to 47.69, P=0.85).ConclusionsBy comparing SMS intervention with routine nursing, sending SMS weekly for 6 months to remind HIV patients to take medicine can improve treatment adherence. Due to the limitation of quantity and quality of the included studies, the above conclusions are required to be assessed by more high-quality studies.

艾滋病并發眼底病患者的護理

目的　總結艾滋病并發眼底病患者的護理要點。 方法　回顧分析2010年3月－2012年4月艾滋病并發眼底病7例患者（13只眼）的臨床資料和護理經驗。7例患者中3例放棄手術，4例實施7次手術治療。護理重點是護理人員的培訓和患者的心理護理、局部護理、全身癥狀護理和健康教育。 結果　艾滋病并發眼底病3例患者放棄手術，4例手術中接受玻璃體切割術者4例次，視網膜修復術2例次，硅油取出術1例次，硅油充填術3例；患者術后視網膜復位4例，術后視力：0.02者2例，數指5例。無1例不良事件和護理安全事件發生，出院隨訪康復和治療情況較好。 結論　艾滋病并發眼底病患者的護理重點是眼部和全身疾病的護理、患者的心理護理、隱私保護，以及醫護人員的職業防護。

鐵路旅客艾滋病知識、態度、行為及需求調查分析

目的:了解鐵路旅客的艾滋病知識、態度和行為(KAP)及需求現狀,為制訂宣傳干預方案提供參考。方法:采用整群抽樣方法,對850名鐵路旅客進行自填式問卷調查,有效問卷827份,所有數據輸入微機進行統計分析。結果: 在艾滋病預防措施方面的認知率較高;在非傳播途徑(蚊蟲叮咬及同桌吃飯)的認知水平較低;與妻子(丈夫)之外的人進行性行為使用安全套態度的問題回答愿意使用的有526人,占63.6%。鐵路站車艾滋病宣傳方式及內容方面,廣播與電視宣傳途徑及艾滋病的預防措施、艾滋病對人體的危害宣傳內容選擇率較高。結論: 鐵路旅客艾滋病相關防治知識認知水平較低,應利用鐵路車站、旅客列車的多種宣傳形式,針對鐵路旅客的人群特點,開展有針對性的宣傳教育和行為干預工作,以提高鐵路旅客艾滋病防治知識水平和防治意識。

Meta-analysis of Effect on HIV/AIDS Intervention in Floating Population

Objective　To evaluate the effect of a health education for preventing HIV/AIDS in floating population. Methods　A computerized literature search was carried out in PubMed, CBM (Chinese Biomedical Database), CNKI (Chinese National Knowledge Infrastructure), Wanfang (Chinese) and VIP (Chinese) databases to collect articles published between 1996 and 2006 concerning the effect of a HIV/AIDS education intervention in floating population. We also checked the reference lists of relevant articles. The study type was self-control intervention study. Meta-analyses were performed to assess 3 outcomes of the intervention, i.e. knowledge about HIV transmission, means of prevention and attitudes towards HIV/AIDS patients. Fixed and random effect models were employed to combine results after a heterogeneity test, with rate difference (RD) used as the indicator of intervention effect. Results　The analysis showed that the RD for knowing the sexual transmission route of HIV, the RD for knowing the effect of condoms for HIV prevention, and the RD for changing attitudes towards HIV/AIDS patients, i.e. treating them as ordinary people, were increased by 16% (0.10, 0.22), 22% (0.17, 0.28) and 19% (0.13, 0.25), respectively. Conclusion　Health education for preventing HIV/AIDS is effective in changing knowledge and attitudes in floating population.

Efficacy Analysis of Antiretroviral Therapy in 51 Cases with AIDS

目的:分析艾滋病患者抗病毒治療后的臨床療效,比較不同基線CD4+T淋巴細胞計數增長情況。方法:納入51例符合治療標準的初治患者,采用國家標準抗病毒治療一線方案和衛生部統一提供的免費藥物,通過對服藥后半月、1月、3月、6月、12月的時段進行臨床評估和實驗室檢查,并比較不同基線CD4+T淋巴細胞計數水平治療后的增長情況。結果:治療12月后,各方案組療效無差異,不同基線CD4+T淋巴細胞計數的增長有顯著差異。毒副反應為肝損傷、過敏性皮疹,消化道反應為主。結論:HAART可顯著的抑制體內HIV病毒的復制,重建機體的免疫功能,緩解患者病情,有利于存活期的延長。嚴重的毒副作用發生較少。

A Study on the Effects of Training of Prevention of Occupational Exposure to Blood-borne Pathogens for Medical Staff in High-risk Areas of AIDS

目的　了解艾滋病高發區醫務人員血源防護情況以及培訓所取得的效果。 方法　采用自行設計的問卷，對涼山州某醫院參加培訓的職工進行培訓前后調查。 結果　培訓前89人參加調查，培訓后93人參加調查；女性、護士和初級職稱者占絕大多數；培訓前調查參加者中84.3%接受過預防銳器傷培訓，79.8%工作中被銳器刺傷，38.2%報告過職業暴露，95.5%接種過乙肝疫苗；6道知識考核題培訓后答對率比培訓前均有不同程度的提高，其中4道比較具有統計學上的意義（P＜0.05）。 結論　該院醫務人員已具備一定職業防護意識，對一些知識點掌握較好，但培訓強化可提高職業暴露報告依從性和預防治療及時性，更好維護艾滋病高發區醫務人員的職業健康。

Quality evaluation of clinical guidelines and consensus for adult AIDS

Objective To evaluate the methodological and reporting quality of clinical guidelines and consensus for adult AIDS. Methods Databases including PubMed, EMbase, Web of Science, CBM, WanFang Data and CNKI were electronically searched and major guideline websites such as GIN, NICE, NGC and Yimaitong were also searched to collect guidelines and consensus for adult AIDS from inception to December 2021. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. Four reviewers evaluated the methodological and reporting quality of the included guidelines and consensus by using AGREE Ⅱ and RIGHT, respectively. Results A total of 17 adult AIDS guidelines and consensus were included. The average scores of AGREE Ⅱ in various domains were 59.48% for scope and purpose, 37.17% for stakeholder involvement, 30.76% for rigor of development, 74.75% for clarity of presentation, 35.54% for applicability, and 50.49% for editorial independence. The items with the highest reporting rate among the RIGHT evaluation items were 1a, 1b and 1c (100.00%), followed by 3 and 4 (94.12%), 13a and 13b (88.24%), 7b and 11a (76.47%), and 5 (64.71%), and the remaining items were all reported below 60%. Results of subgroup analysis showed that the clarity of presentation, applicability and editorial independence of the guidelines for adult AIDS expressed in AGREE Ⅱ and the average score of RIGHT were higher than those of the consensuses for adult AIDS; the average scores of guidelines and consensuses based on evidence-based medicine in five domains of AGREE Ⅱ (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation and applicability) and RIGHT were higher than those based on expert opinions or reviews. The foreign guidelines and consensus had higher average scores in the six domains of AGREE Ⅱ and the RIGHT score than the domestic guidelines. Conclusion The methodological quality and reporting quality of the published clinical guidelines and consensuses for adult AIDS is low; in particular, there is a certain gap between the national and international guidelines and consensuses. It is suggested that future guideline developers should refer to international standards, such as AGREE Ⅱ and RIGHT, formulate high-quality guidelines and promote their application to better regulate the diagnosis and treatment of adult AIDS.