ABSTRACT
CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy (HAART) and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings. This study examined the correlation between total lymphocyte count (TLC) and CD4 count of HIV-infected patients before and after HAART, and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART. A retrospective study was performed, and 665 HIV-infected patients with TLC and CD4 count from four counties (Shangcai, Queshan, Shenqiu and Weishi) were included in the study. Pearson correlation and receiver operating characteristic (ROC) were used. TLC and CD4 count after HAART was significantly increased as compared with pre-HAART (P<0.01). An overall positive correlation was noted between TLC and CD4 count (pre-HAART, r=0.73, P=0.0001; follow-up HAART, r=0.56, P=0.0001). The ROC curve between TLC and CD4 count showed that TLC ≤ 1200 cells/mm(3) could predict CD4 < 200 cells/mm(3) with a sensitivity of 71.12%, specificity of 66.35% at pre-HAART. After 12-month HAART, the optimum prediction for CD4 count < 200 cells/mm3 was a TLC ≤ 1300 cells/mm(3), with a sensitivity of 63.27%, and a specificity of 74.84%. Further finding indicated that TLC change was positively correlated to CD4 change (r=0.77, P=0.0001) at the time point of 12-month treatment, and the best prediction point of TLC change for CD4 increasing was 135 cells/mm(3). TLC and its change can be used as a surrogate marker for CD4 count and its change of HIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.
ABSTRACT
The third round of Global Fund AIDS Program carried out in the 19 counties of Henan Province has promoted a comprehensive prevention and treatment of AIDS in the whole province.The main achievement of this project includes about 23 698 medical staff training,improving the capacity of AIDS prevention and control in the areas,and attracting multidivisions to participate in the AIDS prevention and control work.As a result,1 092 government departments and grassroots organizations participated in the program and 2 832 activities,attracting 94 213 persons voluntarily to receive counseling and AIDS testing;the service of HIV Voluntary Counseling and Testing(VCT)has accounted for 99.33% of the total HIV detective samples.So VCT has become the major method of HIV detection in the population.The implementation of incentive mechanisms has promoted the intervention in high-risk behaviors,and has prevented AIDS transmission from mother to child or sexual transmission between couples.In 2008,the rate of mother to child transmission in Henan Province fell to 4.16 percent and the positive transforming rate of single-positive spouse was 1.13/100 person per year.Through the establishment of medicine supervision mechanisms to promote the anti-virus measures,the survival rate of the AIDS patients who have been treated for over 12 months has reached 89.48%.
ABSTRACT
Objective To summarize the practice of AIDS prevention and treatment in rural areas of Henan province and to explore a community-based integrated AIDS prevention and treatment model.Methods In the context of the existing 3 tier(county-township-village)rural health care systems,several approaches were adopted including scientific management of HIV-infected persons,patient tracking,laboratory testing,maternal-to-child transmission block,high-risk intervention,health education and medical treatment.Results By the end of 2008,AIDS mortality rate dropped to 4.57 %,the rate of mother-to-child transmission reduced to 4.16%,and the sero-conversion rate among HIV positive single spouses was 1.13/100 person per year;the proportion of persons who continued to receive medical care after 12 month therapy was 85.2%;the rate of HIV related knowledge among the public was 82.3%;the coverage of HIV preventive service among CSWs was as high as 96.98%;the rate of condom use among institution-based CSWs in the last sex trade was 89.54%;the proportion of CSWs who had correct understanding of sex route of HIV transmission was 81.17%,and the rate of persistent use of condom among HIV infected persons and AIDS patients reached 92.57%.Conclusion The community-based integrated AIDS prevention and control model in rural areas of Henan province has achieved remarkable outcomes and it is suggested that such a model should be employed in areas where HIV/AIDS is relatively prevalent.