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.
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.
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 investigate the AIDS knowledge and sexual behavior of middle school students in the key areas of HIV/AIDS epidemic in Liangshan, Sichuan Province in 2015 and 2020, so as to understand the epidemic trend and acquire possible references for future prevention. Methods A survey on AIDS knowledge and sexual behavior of middle school students was conducted in 2015 and 2020 in the key areas of HIV/AIDS epidemic in Liangshan, Sichuan Province, respectively. The prevalences of HIV/AIDS knowledge and sexual behavior were analyzed. Results The rate of AIDS education was increasing, which was 75.4% in 2015 and 89.3% in 2020, respectively. However, the awareness rate of AIDS remained low, which was 44.4% in 2015 and 53.3% in 2020, respectively. The reported rate of sexual behavior decreased, which was 12.8% in 2015 and 1.6% in 2020, respectively. The condom usage rates were still low, with 47.4% and 55.8%, respectively in 2015 and 2020. Conclusions The AIDS publicity and education work in Liangshan is effective, and the awareness rate of AIDS, the rate of sexual behavior and the usage rate of condom are improving well. However, the slow increase in the awareness rate of AIDS and the usage rate of condom require further in-depth analysis aiming at the specification of this area so that effective scientific measures can be carried out to prevent the HIV/AIDS diffusion.
Objective To explore the methods of intervention for street-based female sex workers (FSWs) by assessing the intervention process, and evaluate the effectiveness. Methods By cluster sampling procedure, many streetbased female sex workers in Yuzhong district were intervened systematically after informed consent. Before and after the intervention, questionnaire survey was conducted to understand their KAP towards AIDS and analyzed the results of the questionnaire and the effectiveness of intervention. Results The recognition rate abut AIDS knowledge was improved markedly, from the previous 28% to the later 70.5%; condom use in last act increased the previous 59% to the later 75%, consistent use in recent month changed from 4% to 26%; Peer education was trained. Conclusion systematical intervention among street-based female sex workers is critical for spread of AIDS.
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.
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.
