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Objective To explore the factors affecting the duration of secondary prophylaxis for penicilliosis marneffei in patients with acquired immunodeflciency syndrome (AIDS).Methods A retrospective analysis was conducted.The study included 92 adult patients with AIDS and penicilliosis mameffei which were confirmed at the Guangxi Centers for Disease Control and Prevention/Medecins Sans Frontieres clinic.The patients were divided into two groups based on the counts of CD4+ T cells at the time of discontinuation of secondary prophylaxis with itraconazole.The patients with a CD4+ lymphocyte count ＞ or =200 × 106 cells/L at the discontinuation of secondary prophylaxis were assigned to Group Ⅰ,and those with a CD4+ lymphocyte count ranging from 100 × 106 to 200 × 106 cells/L to Group Ⅱ.The treatment duration and clinical outcome were compared between the two groups,and factors which might affect the duration of secondary prophylaxis,including organ involvement,complications,antifungal regimen,antiviral treatment timing,and so on,were assessed.The SPSS 13.0 ~ftware package was used for statistical analysis.Results All the 92 patients received highly active antiretroviral therapy (HAART).No significant difference was observed in the sex ratio,age,follow up duration,number of organs involved,occurrence of complications,composition and duration of antifungal treatment regimens between the two groups (all P ＞ 0.05).The duration of secondary prophylaxis was significantly shorter in Group Ⅱ than in Group Ⅰ (8.13 ± 5.13 vs.12.44 ± 9.51 months,P＜0.05).The commencement of HAART after the treatment of penicilliosis,coinfection with other pathogens or mycobacterium tuberculosis were associated with a longer duration of secondary prophylaxis,and the influence degree of these factors decreased in order,whereas the commencement of HAART before the treatment of penicilliosis was associated with a shorter secondary prophylaxis (P ＜ 0.05).Conclusions For AIDS/PSM patients receiving HAART,secondary prophylaxis could be discontinued 3 to 6 months after the CD4 +lymphocyte count restores to 100 × 106 cells/L or more.The duration of secondary prophylaxis may be extended by the commencement of HAART after the treatment of penicilliosis,coinfection with other pathogens or mycobacterium tuberculosis,but shortened by the commencement of HAART before the treatment of penicilliosis.
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Objective To screen the active tuberculosis patients among HIV infected patients,and investigate the diagnostic methods for active tuberculosis among TB/HIV co-infected patients.Methods From August 2006 to March 2007,660 HIV/AIDS patients were enrolled.The study was conducted at 4 authorized hospitals for AIDS in Nanning and Liuzhou.Chest X-ray(CXR),acid-fast stain test of sputum smear and fast culture were applied if CD+4 T cell counts were below 350 cells/mm3 or the patients at least have one suspected symptom.Result The CD<;+>4 T cell count in 76.1% (502/660) of the patients was less than 200 cells/mm3.TB/HIV coinfection was found in 22.9% (151/660) of the HIV patients.Among them,74.8% (113/151) of them were pulmonary TB patients.One third of them were extra-pulmonary TB patients,and 68.1% of them involved lymph node.In 264 patients with negative sputum smear test and CXR,20.1% (53/264) of them showed positive results in fast culture tests.In addition,the non-tuberculosis mycobacterium (NTM) infection accounted for 38.5% culture positive cases.Conclusions The TB/HIV coinfection rate is 22.8%.Liquid rapid culture of sputum plays an import role in diagnosing of active tuberculosis among HIV patients.There are considerable proportions of NTM or extra-pulmonary TB coinfection in HIV patients.
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Objective To evaluate the 3-year outcomes of the Medecins Sans Frontieres/Guangxi Center for Disease Control and Provention comprehensive and free of charge HIV/AIDS treatment and care project.Methods We present a detailed retrospective analysis of treatment outcomes of 432 cases who received highly active antiretroviral therapy (HAART)from December 2003 to December 2006.Results Among the adult patients who received HAART,the mortality rate was 6.5%and only 12(2.8%)patients were lost to follow up.The mean CD+4 T cell count increase was 147 cells/μl and 246 cells/μl for patients receiving HAART for 9-15 and 21-27 months respectively.An adherence assessment conducted during March to December 2006 indicated that 95.9%of the study cases reached an adherence of 95%or more of the prescribed medications.Among the 30 children patients who received HAART,4(13.3%)cases died and the mean CD4+T cell increase after 9-15 and 21-27 months of HAART was 673cells/μl and 658 cells/μlrespectively.148 of the adult patients starting HAART were current or ex-intravenous drug users(IDU)and showed global death rate and lost to follow-up rate comparable to those of non-IDU patients(Log rank test,P=0.91).Conclusions Good mid-term therapeutic outcomes with combination antiretroviral therapy have been achieved in this project.Total free of charge care and treatment and intensive patient support/counseling are crucial to program success.
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Objective To study the clinical characteristic of acquired immune deficiency syndrome (AIDS) patients younger than 15 years old and to explore the influence of human immunodeficiency virus (HIV) infection on them. Methods The clinical information, including demographic profile, clinical stages of the disease, laboratory test results and developmental status were gathered from 275 antiretroviral therapy naive patients. Results Seventy eight point nine percent patients were infected by vertical transmission. Sixteen percent were infected by receiving blood products. The average age was (7.6±3. 7) years, with 5 cases younger than 1 year old, 104 cases ranging from 1 - 5 years and 166 cases elder than 6 years. Seventy point one percent patients were classified as stage 3 or 4 according to World Health Organization definitions. The average CD4 count was ( 137 ± 159 )/μL, ( 304 ± 317 ) /μL and ( 1 246 ± 776 )/μL respectively in children elder than 6 years, ranging from 1 to 5 years and younger than 1 year. One hundred and eighty one cases suffered from anemia on different severity grading. The most common HIV related symdromes included persistent fever, skin damage, persistent diarrhea, oral candidiasis and recurrent upper respiratory tract infection. Among these infected children, 49. 6% showed height lower than x - 2s and 19. 9% showed weight lower than x - 2s. Conclusions Most survival pediatric AIDS patients are elder than 6 years. HIV infection can significantly affect the children's immune system function,growth and development.
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Objective To introduce and evaluate an improved technique of vertical mammaplasty for correction of severe breast ptosis. Methods Vertical mammaplasty that was first reported by Ma-deleine Lejour in Brussels is a technique that uses adjustable markings, an upper pedicle for the areola, and a central breast reduction with lower skin undermining. To shorten vertical scar, it was important to locate new nipple position and move up new inframammary fold. The shape of the breast was crea-ted by suturing the gland and did not rely on the skin. No scar was produced in submammary fold. Re-sults 36 cases were treated with vertical mammaplasty in our department since August 1999. The shape of the new breast was satisfactory in all patients after 3-24 months following-up. Areora necro-sis was not found in all the cases. Conclusion The vertical mammaplasty is an optical technique for correction of severe breast ptosis, Stable results are produced because the gland is strongly sutured.
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Objective To evaluate the effects of pingangmycin and dexamethasonum injected synchronously in the treatment of hemangioma in maxillofacial regions. Methods A total of 83 patients with hemangioma in maxillofacial regions between September 1996 and March 2004 were reviewed. The age of the patients was from 3 months to 50 years old. The sizes of the lesions varied from 1cm?1cm to 6cm?9cm. Injection should be accorded to size of the tumor, local appearance and patients' age. Injection might be repeated in every 5~10 days, totally 4~6 times. Results All cases were followed up from 8 to 36 months. The recovery rate was 95.18%, and the total effective rate was 100%. Conclusion This method is a simple, safe and effective therapy of hemangioma in maxillofacial regions.