ABSTRACT
Objective:To investigate the clinical efficacy of ventriculo-peritoneal shunt (VPS) in acquired immunodeficiency syndrome (AIDS) patients with cryptococcal neoformans meningitis (CNM).Methods:Patients with AIDS and CNM who were hospitalized in Guangzhou Eighth People′s Hospital, Guangzhou Medical University from January 2015 to June 2020 were included and divided into VPS group and conventional treatment group.The data including symptoms and signs of meningitis, cerebrospinal fluid (CSF) pressure, CSF routine examination, ink staining, Cryptococcus culture and Cryptococcus culture negative time were obtained, and the clinical efficacy compared between the two groups after six and 48 weeks of treatment.Two independent samples t test or chi-square test was used for statistical analysis. Results:Among 66 AIDS patients with CNM, 26 cases in VPS group were (35.7±11.9) years, and 11 cases (42.3%) had CSF pressure> 330 mmH 2O (1 mmH 2O=0.009 8 kPa) at admission, 25 cases (96.2%) were positive for ink staining, and 20 cases (76.9%) had positive culture of Cryptococcus neoformans in CSF. There were 40 cases in the conventional treatment group with age of (38.9±12.9) years, 15 cases (37.5%) had CSF pressure>330 mmH 2O, 32 cases (80.0%) were positive for ink staining, and 31 cases (77.5%) were positive for culture of Cryptococcus neoformans in CSF. There were no significant differences of age, the proportion of patients with CSF pressure>330 mmH 2O, positive rate of ink staining, positive rate of Cryptococcus culture between the two groups ( t=-1.02, χ2=0.15, 3.49 and 0.00, respectively; all P>0.050). All patients were administrated with antifungal treatment, decreasing CSF pressure treatment, nutritional support and symptomatic treatment after admission. VPS was performed in patients with poor responses after medical conservative treatment in VPS group. At week six of treatment, the recovery rate of CSF pressure in VPS group was 57.7%(15/26), and the partial remission rate was 73.1%(19/26), which were both higher than those in conventional treatment group (31.0%(9/29) and 47.5%(19/40), respectively). The differences were both statistically significant ( χ2=3.96 and 4.22, respectively, both P<0.050). At week 48 of treatment, the recovery rate of CSF pressure in VPS group was 92.3%(24/26), the negative rate of Cryptococcus culture in CSF was 100.0%(20/20), and the complete remission rate was 46.2%(12/26), which were all higher than those in conventional treatment group (37.9%(11/29), 67.7%(21/31) and 20.0%(8/40), respectively). The differences were all statistically significant ( χ2=17.52, 8.03 and 5.10, respectively, all P<0.050). In VPS group, 22 cases were complete or partial remission, four cases were ineffective, and no death occurred, while there were 23 cases of complete or partial remission, 12 cases of ineffective and five cases of death in the conventional treatment group. The proportion of ineffective or death in the VPS group was 15.4%(4/26), which was lower than 42.5%(17/40) in the conventional treatment group. The difference was statistically significant ( χ2=5.34, P=0.021). Conclusions:VPS in AIDS patients with CNM could significantly improve the treatment outcomes, and reduce the rates of treatment failure and mortality.
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Objective@#To clarify the predictive power of PBMCs miR-122, as well as other clinical factors, for response to IFNα therapy in chronic HCV infected patients.@*Methods@#A total of 40 patients chronically infected with HCV genotype 1b were enrolled. All the patients received pegylated interferon alpha (PEG-IFN α) in combination with ribavirin for 48 weeks. To perform the analyses, the patients were compared in terms of achieving sustained virological response (SVR) or not (NSVR) at 24th week after antiviral treatment.@*Results@#SVR rate was 72.5% (29/40) and NSVR rate was 27.5% (11/40). SVR group experienced significantly lower HCV viral load, total bilirubin (TBIL), alpha fetal protein (AFP), fibroscan and laminin (LN) compared with NSVR group before treatment (P<0.05). PBMCs miR-122 expression level was also lower in SVR group than that in SNVR group, although the difference was not statistically significant (P>0.05). and there was no significant change of miR-122 level from baseline to the last available measurement between SVR group and NSVR group. However, no significant association was found between baseline PBMCs miR-122 and HCV viral load, body mass index (BMI), alanine transaminase (ALT), aspartate transaminase (AST), degree of liver fibrosis, respectively.@*Conclusions@#Our result suggest that PBMCs miR-122 level is not an efficient biomarker to predict response to IFN alpha therapy in chronic HCV patients. However, baseline HCV viral load, TBIL, AFP and fibroscan may serve as predictive factors.
ABSTRACT
Objective To study the impact of HIV and hepatitis C virus ( HCV ) infection on peripheral expression of antiviral protein A3G and plasma IFN-αlevels.Methods Untreated patients with chronic hepatitis C(HCV infection group, n=43), AIDS(HIV infection group, CD4 +T0.05).There was no significant correlation between plasma IFN-αlevel and A3G mRNA expression (rs =0.04, P>0.05), and the levels of A3G mRNA and IFN-αshowed no correlation with HIV RNA and HCV RNA (all P>0.05).Conclusions A3G is highly expressed in PBMCs from HIV infected patients, and it may not be affected by the infection of HCV.A3G mRNA is not closely correlated with IFN-α, and it has not significant influence on HIV RNA and HCV RNA replication.