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ObjectiveTo investigate the factors that influence the first CD4+T lymphocyte counts in newly reported HIV-infected cases aged 50 and above in Dehong Prefecture of Yunnan Province during 2016 to 2021， and to understand the patient immune status and disease progression so as to provide scientific basis for HIV prevention and control strategies in the future. MethodsData was collected from the national HIV/AIDS information system. Multivariate logistic regression was used for the analysis of factors affecting the first CD4+T lymphocyte counts. ResultsA total of 642 cases of HIV infection were newly reported， among them， 571 cases had CD4+T lymphocyte counts and 200 cases （35.03%） had CD4+T lymphocyte counts <200 cells·μL-1. Patients who were in the 50-59 age group， male， divorced or widowed， and less educated were more likely to have CD4+T lymphocyte counts <200 cells·μL-1. Compared with active testing consultants， forced reeducation through labor or drug rehabilitation cases were less likely to have CD4+T lymphocyte counts <200 cells·μL-1. ConclusionThere is no obvious upward trend in newly reported HIV infected persons aged 50 years and above in Dehong Prefecture during 2016 to 2021. However， the situation of CD4+T lymphocyte counts <200 cells·μL-1 is still serious. Attention should be paid to the key groups： male， Chinese nationality， farmers， Han nationality， married or divorced， junior high school education or below， and heterosexual transmission. It is necessary to strengthen the intervention in people aged 50 and above and improve the detection efficiency.
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ObjectiveTo investigate the late detection of HIV/AIDS cases in the elderly in Jilin Province and analyze its influencing factors， to provide theoretical basis for improving their life quality. MethodsThe first CD4 values of HIV/AIDS patients aged 50 years and above living in Jilin Province were used to estimate late detection， and the influencing factors of late detection in elderly cases were analyzed. ResultsThe average CD4 cell count of newly reported HIV/AIDS cases aged 50 and above in Jilin Province from 1996 to 2021 was （230.55±191.97）， the low value group accounted for the largest proportion （50.8%）， and the late detection rate was 59.3% （1397/2325）. The late detection cases were mainly from sexual transmission （46.8% for same-sex and 48.2% for heterosexual contact）. From the perspective of sample sources， most of the late detection patients were diagnosed while testing for other illnesses， followed by testing and consulting. In terms of contact history， the late detection of cases of men who have sex with men was higher. The binary logistic regression analysis showed that gender， marriage， sample source and report year were the factors affecting the late detection of AIDS. The late detection rate of males was higher， and cases of married couples were more likely to be late detection. With the increase of report year， the late detection rate decreased， and testing and counseling could effectively reduce the late detection rate of AIDS. ConclusionThe CD4 cell count in the first detection of HIV/AIDS in the elderly in Jilin Province is low， and the late detection rate of male cases is high. In recent years， the expansion of voluntary counseling and testing in Jilin Province has effectively reduced the late detection rate of HIV/AIDS. At the same time， sex education should be strengthened for the elderly， healthy marital relationships should be advocated and more attention should be paid to the mental health of the elderly.
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RESUMEN Introducción: El retraso diagnóstico de la infección por SIDA constituye un problema de gran magnitud con importantes repercusiones para los propios infectados y para la sociedad en general. Objetivos: Caracterizar a los pacientes con diagnóstico tardío de infección por VIH y su evolución a los 6 meses del diagnóstico. Material y Métodos: Se realizó un estudio longitudinal de corte prospectivo que incluyó 248 casos con diagnóstico positivo de infección por VIH durante su ingreso o en la consulta de infectología del Instituto de Medicina Tropical "Pedro Kourí" desde enero de 2015 hasta diciembre de 2016, los que se dividieron en dos grupos de comparación, según diagnóstico tardío (n=79) o no (n=169) de la enfermedad. Resultados: La edad avanzada y el sexo masculino fueron factores relacionados con el diagnóstico tardío de la infección por VIH. La fiebre (31,7%) y los síntomas respiratorios (20,3%) fueron las formas más frecuentes de presentación, mientras que la neumonía por Pneumocystis jirovecii fue la enfermedad con más incidencia en el momento del diagnóstico. La mitad de los pacientes se encontraban con inmunodepresión severa en el momento del diagnóstico. Los pacientes con diagnóstico tardío mostraron una supervivencia significativamente menor a los 6 meses del diagnóstico en comparación con los pacientes con diagnóstico precoz. La carga viral y el nivel de linfocitos CD4 fueron parámetros de laboratorio con un alto valor predictivo de mortalidad. Conclusiones: El diagnóstico tardío de infección por VIH conlleva un alto riesgo de mortalidad, mayor en aquellos con afectación de la carga viral y el nivel de linfocitos T CD4+.
ABSTRACT Introduction: Late diagnosis of HIV is a major problem with important consequences for the people infected with this virus and the society in general. Objectives: To characterize patients with late diagnosis of HIV infection and their evolution six months after diagnosis. Material and Methods: We conducted a prospective longitudinal study which included 248 cases with positive diagnosis of HIV infection during admission at the Pedro Kourí Tropical Medicine Institute between January 2015 and December 2016. They were divided into two comparison groups which included patients with late diagnosis (n=79) and those with no late diagnosis (n=169) of the disease. Results: Advanced age and male sex were factors related to the late diagnosis of HIV infection. Fever (31.7%) and respiratory symptoms (20.3%) were the most frequent forms of presentation, whereas Pneumocystis jirovecii pneumonia was the disease with the highest incidence at the time of diagnosis. Half of the patients were found to have severe immunosuppression at the time of diagnosis. Patients with late diagnosis showed a significantly diminished survival six months after being diagnosed compared with those patients with early diagnosis. Viral load and CD4+ T count were laboratory parameters with a high predictive value of mortality. Conclusions: Late diagnosis of HIV leads to a high risk of mortality, which is higher in those with affectation of the viral load and low CD4+ T cell count.
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RESUMEN Introducción: La atención de pacientes con VIH se realiza actualmente en Cuba de forma descentralizada; cada vez es mayor el número de casos ingresados en hospitales generales. Objetivo: Determinar características clínicas de pacientes con VIH ingresados en el Hospital General Docente "Enrique Cabrera". Material y Métodos: Se realizó una investigación descriptiva retrospectiva de pacientes con VIH ingresados en el Hospital General Docente "Enrique Cabrera" en el período comprendido del 1RO de enero de 2007 hasta 31 de diciembre de 2013. La muestra estuvo constituida por 86 casos. Resultados: El número de pacientes se incrementó por años, los casos masculinos constituyeron 79%, los grupos de edad más frecuentes 21 a 30 y 41 a 50 años. Las adenopatías generalizadas fue el hallazgo al examen físico más frecuente. Predominó el conteo de T CD4 menor de 200 células/mm3. Las patologías respiratorias constituyeron 25% de las causas de ingreso. Se realizó el diagnostico hospitalario en 36% de los casos de los cuales el 77% eran diagnósticos tardíos de la enfermedad. Conclusiones: Los pacientes con VIH constituyen una población joven que ingresa cada vez más a nivel secundario hospitalario, con características propias de esta enfermedad y patologías que ponen en riesgo su vida.
ABSTRACT Introduction: The care of patients with Human Immunodeficiency Virus is currently carried out in a decentralized way in Cuba. The number of patients with HIV admitted to general hospitals is increasing. Objective: To determine the clinical characteristics of patients with HIV admitted to Enrique Cabrera General Teaching Hospital. Material and Methods: A descriptive retrospective study was carried out in patients with HIV admitted to Enrique Cabrera General Teaching Hospital from January 1st, 2007 to December 31st, 2013. The sample consisted of 86 cases. Results: The number of patients increased per year, male cases constituted 79 %, the most frequent age groups were from 21 to 30 years and from 41 to 50 years. Generalized adenopathies were the most frequent findings on physical examination. CD4 T- cell counts below 200 cells/mm3 predominated in the study. Respiratory pathologies constituted 25 % of the causes of admission. Hospital diagnosis was carried out in 36 % of the cases, 77 % of which had late diagnoses of HIV. Conclusions: HIV patients constitute a young population that is admitted more and more to secondary level hospitals. They present own characteristics of the disease and pathologies that put their lives at risk.
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Background & objectives: Ocular manifestations in HIV/AIDS patients range from adnexal disorders to the posterior segment disease. This study was aimed to evaluate the ocular manifestations, including vision-threatening manifestations in HIV-positive patients attending an antiretroviral therapy centre (ART) of a tertiary care hospital in north India and its association with the CD4+ cell count. Methods: This cross-sectional study was conducted in the department of Ophthalmology in collaboration with the ART centre. An equal number of patients were selected from each year i.e., 30 patients each from those registered in the year 2010 till 2015. These patients were selected randomly from the register using systematic randomization. Hence, a total of 150 patients were examined for ocular manifestations. All the patients included in this study were on highly active ART. Results: Of the 150 patients examined, 53 per cent were females and 47 per cent were males. Heterosexual transmission was the most common mode of transmission in 126 (84%) patients. Maximum number of patients was in the age group of 31-40 yr. Ocular manifestations were present in 53 [35.3%; 95% confidence interval (CI): 28-43%] patients. Twelve (8%; 95% CI: 4-12%) patients had lid and adnexal manifestations. Anterior-segment manifestations were present in 20 (13.3%; 95% CI: 8-19%) patients. Posterior-segment manifestations were present in 21 (14%; 95% CI: 8-20%) and vision-threatening posterior-segment ocular lesions were present in 14 per cent of the patients. Univariate logistic regression showed a significant (P<0.001) inverse association of CD4+T-cell count with the vision-threatening posterior-segment ocular lesions. Interpretation & conclusions: Routine ocular examination may be done in all the HIV/AIDS patients to detect and treat vision-threatening ocular lesions at the earliest.
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Objective@#To analyze first follow-up and CD4+ T (CD4) cell count test of newly reported students HIV cases in China from 2013 to 2017.@*Methods@#Data were collected from both Case Reporting Cards and Follow-up Cards from China Information System for HIV/AIDS Control and Prevention between 1st January 2013 and 31st December 2017. The inclusion criteria are 15-24 years old students who were newly diagnosed with HIV infection. Logistic regression model was used to analyze relevant factors of the first CD4 test results less than 200 CD4 cells/μl.@*Results@#There were 12 037 newly diagnosed students HIV cases from 2013 to 2017. Most cases were male (97.7%), 19-22 years old (65.1%) and Han ethnicity (90.5%). At the time of diagnosis, the route of HIV infection was most frequently homosexual contact (82.2%). The majority of cases (46.9%) were diagnosed at HIV voluntary counseling and testing (VCT) location. About 2 465 (20.6%) students had unprotected intercourse in the past 3 months, of which 1 387 (56.8%) had 1 sexual partner, 610 (25.0%) with 2 sexual partners, 273 (11.2%) with 3 partners and 170 (7.0%) with more than 4 partners. 11.0% and 28.9% of cases had initial CD4 counts less than 200 cells/μl and 200-349 cells/μl. Compared to the male, younger than 18 years old and diagnosed at VCT location, female (OR=2.09, 95%CI: 1.51-2.89), aged 21 to 22 years (OR=1.25, 95%CI: 1.06-1.47), diagnosed in hospital settings (OR=2.20, 95%CI: 1.89-2.57) and preoperative testing (OR=1.36, 95%CI: 1.07-1.73) had greater proportion of the first CD4 test result less than 200 CD4 cells/μl.@*Conclusion@#The number of newly diagnosed students HIV cases significantly increased in past 5 years, and the proportion of late diagnosis was high. Female, aged 21 to 22 years, diagnosed in hospital settings and preoperative testing were related to the first CD4 test result less than 200 CD4 cells/μl.
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Objective To investigate the effect of baseline CD4+T cell count (CD4) on drop-out of antiretroviral therapy (ART) in HIV infected persons.Methods Retrospective cohort was conducted in this study.HIV infected persons aged≥ 18 years and receiving free ART for the first time in Guangxi Zhuang Autonomous Region (Guangxi) from 2008 to 2015 were selected from the antiretroviral treatment database of National Comprehensive HIV/AIDS Information System,with follow-up conducted till May 30,2016.Cause-specific Cox proportional hazard models were used to evaluate effect of different CD4 on the drop-out of ART in the HIV infected persons.Results A total of 58 502 eligible study participants were included in this retrospective cohort study.The average drop-out ratio was 4.8/100 person-years.After controlling the following baseline covariates:age,sex,marital status,route of HIV infection,WHO clinical stage before ART,initial/current ART regiment,ART regiment adjustment,and year of initiating ART for potential confounding,the adjusted HR of drop-out for HIV infected persons with 200-cells/μl,351-cells/μl and ≥500 cells/μl were 1.110 (95％CI:1.053-1.171,P＜0.001),1.391 (95％CI:1.278-1.514,P＜0.001) and 1.695 (95％CI:1.497-1.918,P＜ 0.001),respectively,in risk for drop-out compared with those with baseline CD4 ＜200 cells/μ 1.Among the HIV infected persons,56.0％ (1 601/2 861) of drug withdrawal was due to poor compliance with medication.Conclusions With the increase of baseline CD4 when initiating ART,the risk for the drop-out in HIV infected persons increased significantly.To further reduce the drop-out of ART,it is important to take CD4 into account in initiating ART and to strengthen the health education on treatment compliancy and training for healthcare providers.
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Objective To analyze the mobility,status of follow-up and CD4+T cell testing (CD4 testing) programs among people living with HIV (PLHIV) between 2011 and 2015 and to improve the prevention program on HIV secondary transmission.Methods Data were collected from both Case Reporting Cards and Follow-up Cards through the National HIV/AIDS Comprehensive Control and Prevention data system.Changes of residence among the newly reported cases and survival cases between 2011 and 2015 were analyzed by SPSS 24.0 software.Results The number of newly reported inter-provincial mobile PLHIV had been increasing,with proportions of the total reported cases from 10.0％ (5 576/55 805) in 2011 to 13.3 ％ (15 348/115 231) in 2015.After adjusting for related confounders,percentages of follow-up and CD4 testing were lower in inter-provincial and inter-prefectural mobile cases than those without.Conclusion Service regarding the follow-up and CD4 testing programs was affected by mobility of people living with HIV/AIDS.Programs on communication and personal contact should be strengthened in the follow-up management services for PLHIV.Information on potential mobility of PLH1V should be gathered timely by health workers during the subsequent follow-up period to avoid the loss of follow-up and CD4 testing on patients.
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Objective To investigate the effect of baseline CD4+T cell count (CD4) on drop-out of antiretroviral therapy (ART) in HIV infected persons.Methods Retrospective cohort was conducted in this study.HIV infected persons aged≥ 18 years and receiving free ART for the first time in Guangxi Zhuang Autonomous Region (Guangxi) from 2008 to 2015 were selected from the antiretroviral treatment database of National Comprehensive HIV/AIDS Information System,with follow-up conducted till May 30,2016.Cause-specific Cox proportional hazard models were used to evaluate effect of different CD4 on the drop-out of ART in the HIV infected persons.Results A total of 58 502 eligible study participants were included in this retrospective cohort study.The average drop-out ratio was 4.8/100 person-years.After controlling the following baseline covariates:age,sex,marital status,route of HIV infection,WHO clinical stage before ART,initial/current ART regiment,ART regiment adjustment,and year of initiating ART for potential confounding,the adjusted HR of drop-out for HIV infected persons with 200-cells/μl,351-cells/μl and ≥500 cells/μl were 1.110 (95％CI:1.053-1.171,P＜0.001),1.391 (95％CI:1.278-1.514,P＜0.001) and 1.695 (95％CI:1.497-1.918,P＜ 0.001),respectively,in risk for drop-out compared with those with baseline CD4 ＜200 cells/μ 1.Among the HIV infected persons,56.0％ (1 601/2 861) of drug withdrawal was due to poor compliance with medication.Conclusions With the increase of baseline CD4 when initiating ART,the risk for the drop-out in HIV infected persons increased significantly.To further reduce the drop-out of ART,it is important to take CD4 into account in initiating ART and to strengthen the health education on treatment compliancy and training for healthcare providers.
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Objective To analyze the mobility,status of follow-up and CD4+T cell testing (CD4 testing) programs among people living with HIV (PLHIV) between 2011 and 2015 and to improve the prevention program on HIV secondary transmission.Methods Data were collected from both Case Reporting Cards and Follow-up Cards through the National HIV/AIDS Comprehensive Control and Prevention data system.Changes of residence among the newly reported cases and survival cases between 2011 and 2015 were analyzed by SPSS 24.0 software.Results The number of newly reported inter-provincial mobile PLHIV had been increasing,with proportions of the total reported cases from 10.0％ (5 576/55 805) in 2011 to 13.3 ％ (15 348/115 231) in 2015.After adjusting for related confounders,percentages of follow-up and CD4 testing were lower in inter-provincial and inter-prefectural mobile cases than those without.Conclusion Service regarding the follow-up and CD4 testing programs was affected by mobility of people living with HIV/AIDS.Programs on communication and personal contact should be strengthened in the follow-up management services for PLHIV.Information on potential mobility of PLH1V should be gathered timely by health workers during the subsequent follow-up period to avoid the loss of follow-up and CD4 testing on patients.
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Background: Tuberculosis remains a disease of major public health importance worldwide including Nigeria. Endocrine abnormalities have been reported among Tuberculosis patients with the thyroid inclusive. Aims of Study: The present study was designed to evaluate the thyroid hormones changes and CD4+ T-cell count during menstrual cycle in women infected with Pulmonary Tuberculosis in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south east Nigeria. Materials and Methods: The study comprised 90 premenopausal females aged 15-45 years randomly recruited at Direct Observed Therapy (DOT) Clinic at NAUTH, Nnewi from 2013-2014. 30 participants were Symptomatic TB infected females who were not yet on drugs at the time of sample collection while 30 were Symptomatic TB infected females on Anti tuberculosis therapy. The remaining 30 were apparently healthy hospital staff with regular menstrual cycle. After due consent, a detailed medical history was obtained and routine investigations of pulmonary tuberculosis and confirmation using Ziehl Neelsen and sputum culture techniques for AFB and chest x-ray were done. Blood samples were collected at follicular and luteal phases of their menstrual cycle for analysis of Thyroid hormones (T3, T4 and TSH) using Enzyme Linked Immunosorbent Assay (ELISA) method. CD4 T-cell counts was determined using cyflow SL Green Cytometer. Results: Result showed significantly lower T3 and CD4 T-cells with normal TSH values in Symptomatic TB compared with control females at both phases of menstrual cycle (P=.05 respectively). TSH value was significantly lowered in Symptomatic TB than Symptomatic TB on ATT while T3 and CD4 T-cell count were significantly higher in Symptomatic TB on ATT compared to Symptomatic TB at both phases of menstrual cycle (P=.05). Conclusion: Euthyroid sick syndrome was observed among Symptomatic TB females which showed some level of improvements with administration of ATT. A new national strategic plan for TB control is advocated to include routine thyroid function check with special attention paid to the reproductive function.
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Objective: To describe the serum level of urea and creatinine, and as well as CD4+ T cell count of blood among HIV positive patients before and after initiation of HAART in St. Paulo’s general specialized hospital. Methods: A retrospective follow up study was conducted among HIV infected individuals who take HAART drug combination regimens such as (TDF/3TC/EFV), (TDF/3TC/NVP), (AZT/3TC/NVP), (D4T/3TC/EFV) and (D4T/3TC/NVP) and visit St. Paulo’s generalized hospital laboratory for renal function testing from 2007-2009G.C. Results: A total of 2026 HIV positive patients started HAART between 2007-2009G.C in St. Paulo’s ART clinic. Among them 380 HIV patients, with two and three visits for CD4+ and renal function test (creatinine & urea), were recruited to the study. Of whom 240 (63.2%) were female and 140(36.8%) male. Out of 380 patients, 104(27.4%) were taking 1b30, 94(24.7%) were using 1a30, 77(20.3%) were taking 1d, 57(15%) 1c, 14(3.7%) tdf/3tc/efv, 12(3.2%) use tdf/3tc/nvp and 22(5.7%) were taking other drug types. The statuses of CD4+ T cell count of patients become improved as they are using HAART drug through visit. These were 115, 266 and 298 out of 380 have greater than 200 CD4+ T cell count on 6th, 12th, 18th months time difference respectively. But the numbers of patients who have renal dysfunction were increased as they were using HAART drug as treatment through visits. These might indicate that, use of HAART drug combination may improve the immune status HIV positive patients even though some renal side effects are there. Therefore, patients (HAART drug user) should have a follow up on renal function to monitor side effects of drug. Conclusion: HAART resulted in improved Immune status of HIV patients with remarkable increase in CD4 T lymphocyte count but at the same time there was an increase in Azotemia after the introduction part of HAART which suggests the impact of drug in renal function. This is especially true for TDF containing drug regimens (TDF/3TC/NVP) which dramatically improve CD4 T lymphocyte count and show significant Azotemia over times.
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BACKGROUND: In spite of active HIV/AIDS control and managements, UNAIDS estimate that 40 million people were living worldwide with HIV at the end of 2001. In Korea, The member of HIV- infected adults are continuously growing. For improvement of HIV screening and prevention, we analyzed over times the relationship between the changes in initial CD4+ T cell counts of newly HIV- diagnosed adults, sex, and exposure route. METHODS: We selected 1011 newly HIV-diagnosed adults whose initial CD4+ T cell count was determined within 6 months of HIV diagnosis between 1990 and June, 2002. Based on CD4+ T cell counts, the selected people were grouped into 4 as follows: 700 cells/mm3. The relationship between initial CD4+ T cell counts, age, sex, and HIV risk category were studied by regression statistic methods. RESULTS: The median initial CD4+ T cell counts decreased over times (P<0.001). In each major group, over 50% of initial CD4+ T cell counts were below 350 cells/mm3. For homosexually infected adults, the median age did not statistically increase (P=0.062). However, in heterosexually infected adults, the median age increased throughout the time period examined (P<0.001) with an exception of female group (P=0.427). The multi-regression analyses revealed that older age (P<0.001) and male sex (P<0.001) were independently associated with lower initial CD4+ T cell counts, but not exposure group (P=0.483). For each year cohort of newly diagnosed adults, the median initial CD4+ T cell counts in subsequent years decreased until 1998 and then increased thereafter. CONCLUSION: These results show that a large proportion of HIV-infected adults are being diagnosed late in the course of HIV infection, particularly heterosexually infected male group. Therefore, we should continuously enforce screening, prevention and prompt diagnosis of high risk groups.
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Adult , Female , Humans , Male , Cell Count , Cohort Studies , Diagnosis , HIV , HIV Infections , Homosexuality , Korea , Mass ScreeningABSTRACT
BACKGROUND: In spite of active HIV/AIDS control and managements, UNAIDS estimate that 40 million people were living worldwide with HIV at the end of 2001. In Korea, The member of HIV- infected adults are continuously growing. For improvement of HIV screening and prevention, we analyzed over times the relationship between the changes in initial CD4+ T cell counts of newly HIV- diagnosed adults, sex, and exposure route. METHODS: We selected 1011 newly HIV-diagnosed adults whose initial CD4+ T cell count was determined within 6 months of HIV diagnosis between 1990 and June, 2002. Based on CD4+ T cell counts, the selected people were grouped into 4 as follows: 700 cells/mm3. The relationship between initial CD4+ T cell counts, age, sex, and HIV risk category were studied by regression statistic methods. RESULTS: The median initial CD4+ T cell counts decreased over times (P<0.001). In each major group, over 50% of initial CD4+ T cell counts were below 350 cells/mm3. For homosexually infected adults, the median age did not statistically increase (P=0.062). However, in heterosexually infected adults, the median age increased throughout the time period examined (P<0.001) with an exception of female group (P=0.427). The multi-regression analyses revealed that older age (P<0.001) and male sex (P<0.001) were independently associated with lower initial CD4+ T cell counts, but not exposure group (P=0.483). For each year cohort of newly diagnosed adults, the median initial CD4+ T cell counts in subsequent years decreased until 1998 and then increased thereafter. CONCLUSION: These results show that a large proportion of HIV-infected adults are being diagnosed late in the course of HIV infection, particularly heterosexually infected male group. Therefore, we should continuously enforce screening, prevention and prompt diagnosis of high risk groups.