Expert consensus on antiviral therapy of COVID-19 / 中华临床感染病杂志

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.

An epidemiological investigation of oral lesions in HIV infected subjects aged 50 years and older in Yunnan China / 实用口腔医学杂志

Objective: To investigate the characteristics of oral lesions in HIV infected patients aged 50 years or older in Yunnan.Methods: 315 HIV infected patients aged 50 years and older from January 2013 to December 2016 were included in a cross-sectional survey at the Third People's Hospital of Kunming. The characteristics of oral mucosal lesions and the relationship between the oral lesions and CD4 count level were analyzed. Results: 13 kinds of oral mucosal lesion in 185 out of the 315 cases (58. 73％) were observed. 122 cases were with candidiasis (38. 73％), including 68 (21. 59％) of pseudomembranous type, 52 (16. 51％) of erythema and 18 (5. 71％) of stomatitis; 25 (7. 94％) were with Hairy leukoplakia, 20 (6. 35％) with recurrent oral ulcer, 17 (5. 40％) with fissured tongue, 11 (3. 49％) with herpes simplex. 2 and 3 lesions were detected in 41 cases (13. 02％) and 1 case (0. 32％), respectively. The rate of simultaneous detection of more than 2 lesions and the detection rate of oral candidiasis were related to the CD4 count level. Conclusion: Oral mucosal lesions are common in elderly patients with HIV infection, and oral candidiasis is the main type.

An antiretroviral regimen containing 6 months of stavudine followed by long-term zidovudine for first-line HIV therapy is optimal in resource-limited settings: a prospective, multicenter study in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>An zidovudine (AZT)-substitution regimen containing 24-week stavudine (d4T) followed by long-term AZT for HIV therapy is potential to trade off short-term AZT-related anemia and long-term risks associated with d4T in resource-limited settings. However, evidence is scarce. This study aims to assess the efficacy and safety of AZT-substitution regimen, aiming to find a regimen with better efficacy, less adverse events, and more affordability in resource-limited settings.</p><p><b>METHODS</b>This prospective, multicenter study enrolled 499 (190 on d4T regimen, 172 on AZT regimen, and 137 on AZT-substitution regimen) HIV-1-infected subjects who initiated combined antiretroviral therapy and attended follow-up visits over 96 weeks from 2009 to 2011. Lamivudine (3TC) and either nevirapine (NVP) or efavirenz (EFV) were the other two drugs in the antiretroviral regimens. Virologic and immunologic responses and adverse events were monitored at baseline and at weeks 4, 12, 24, 36, 48, 60, 72, 84, and 96.</p><p><b>RESULTS</b>In terms of hematological adverse effects, AZT-substitution group had similar safety profiles to d4T group and was superior to AZT group. In comparison with AZT-substitution group, AZT group was associated with higher risk of developing anemia (adjusted hazard ratio (aHR) for anemia ≥ grade II, 8.44, 95% CI 1.81-39.46) and neutropenia (aHR for neutropenia ≥ grade II, 1.86, 95% CI 1.19-2.93). The prevalence of lipodystrophy in d4T group was 19.5%, while that in AZT-substitution group was zero. As to antiretroviral efficacy, these three groups showed no differences.</p><p><b>CONCLUSION</b>AZT-substitution regimen provides a relatively safe and effective first-line antiretroviral strategy in resource-limited settings.</p>

Nested-PCR detection of cytomegalovirus and herpesviruses 6,7 and 8 in saliva from human immunodeficiency virus-infected subjects / 实用口腔医学杂志

CMV,HHV-6,HHV-7 and HHV-8 DNA in unstimulated whole saliva from 245 HIV-infected subjects and 30 healthy controls were examined by nested-PCR assays.Prevalence of CMV,HHV-6,HHV-7 and HHV-8 in saliva of HIV-infected subjects was 34.7%, 83.3%,70.2% and 14.3% respectively,that of the controls 10.0%,56.7%,70.0% and 0% respectively(between 2 groups,P 0.05).Multi-infection was observed in all subject.

Pathogenic Bacteria Distribution and Drug Resistance Analysis in HIV/AIDS Patients with Lower Respiratory Tract Infection in Yunnan Province / 昆明医科大学学报

Objective To study the pathogenic bacteria distribution and drug resistance characteristics in HIV/AIDS patients with lower respiratory tract infection in Yunnan province, so as to guide the clinical medication. Methods We collected 278 cases of hospitalized patients with sputum,alveolar lavage specimen smear, culture, positive specimens from HIV/AIDS patients with lower respiratory infection in The Third People’s Hospital of Kunming from January 2008 to December 2012. Then we retrospectively analyzed the collected data. Results From 278 cases of sputum and alveolar lavage fluid specimens,we isolated a total of 127 strains of bacteria (45.7%), 53 strains of fungus (19.1%),50 strains of white candida,3 strains of aspergillus,49 strains of mycobacterium, 44 strains of mycobacterium tuberculosis,and the rest of atypical mycobacteria. Gram negative bacilli accounted for 64.6%,followed by pneumonia klebsiella bacteria, pseudomonas aeruginosa,e. coli,acinetobacter,sewer,e. coli, gram-positive bacteria accounted for 15.4%. Fungi accounted for 19.1%, and candida albicans was the common fungus. Mycobacterium tuberculosis accounted for 17.6%. Gram-negative bacilli were sensitive to imipenem, ptilinum ketone/sulbactam and amikacin,gram-positive bacilli were sensitive to vancomycin, nitrofurantoin and imipenem. Conclusions The major pathogenic bacteria are gram-negative bacilli in HIV/AIDS patients with lower respiratory tract infection in Yunnan province,but fungal infection ratio is increasing year by year, and conditional pathogenic bacteria are the major pathogen,which have antimicrobial resistance with different degree,TB infection rate is high and multi-drug resistant TB appears. Antimicrobial agents should be rationally used to delay the appearance of pathogen resistance.

The incidence of oral candidiasis in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome from Yunnan, China / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To assess the incidence of oral candidiasis and its influencing factors in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS).</p><p><b>METHODS</b>An oral examination was conducted in the 1 566 HIV/AIDS patients in the Third Hospital of Kunming from March 2008 to September 2012 (M/F: 1 062/504, age range: 0.2 to 84.0 years old). The HIV viral load (HIV- RNA) and peripheral blood CD4 count were respectively analyzed by Bayer Q340 fluorescence signal surveying instrument (bDNA method) and flow cytometry analysis. The information on usage of highly active anti-retroviral (HAART) drugs and transmission of HIV were obtained through questionnaires. The incidence of oral candidiasis in patients with different HIV-RNA levels and CD4 count and the use of HAART was analyzed and compared.</p><p><b>RESULTS</b>The total incidence of oral candidosis was 31.0% (486/1 566) and there was no difference in sex. The oral lesions were presented by three types, psudomembranous candidosis (PC), erythematous candidosis (EC) and angular cheilitis (AC), and the morbidity was 13.9% (217/1 566), 17.0% (267/1 566) and 4.9% (77/1 566), respectively. The average level of CD4 count in psudomembranous candidosis, erythematous candidosis and angular cheilitis [81.0 (146.0), 74.0 (152.0) and 69.0 (121.5) cell/µl] showed no significant difference (P > 0.05). The incidence of oral candidiasis in non-HAART and HAART subjects were 36.3% (402/1 107) and 18.3% (84/459), respectively (P = 0.000). The CD4 count and absolute counts of HIV viral load in oral candidiasis patients and non-oral candidiasis patients had significant difference (Z = -10.261, P = 0.000 and Z = -4.762, P = 0.000).</p><p><b>CONCLUSIONS</b>The morbidity of oral candidiasis in HIV/AIDS patients in Yunnan Province was high, including PC, EC and AC and hyperplastic candidosis was not detected. The incidence was related to the degree of immune suppression and HIV viral load.</p>

Effect of enteral nutrition on T lymphocytes-mediated immune function in patients with acquired immune deficiency syndrome / 中华临床营养杂志

Objective To investigate the effect of enteral nutrition (EN) on the T lymphocytes-mediated immune function in patients with acquired immune deficiency syndrome (AIDS). Methods Totally 79 AIDS patients were randomly divided into enteral nutrition ( EN ) group ( supported with EN daily in addition to conventional treatment; n = 46) and control group (underwent conventional treatment only; n = 33 ). T lymphocytes including CD3, CD4, and CD8 cells as well as blood biochemical parameters including alanine aminotransferase ( ALT), aspartate aminotransferase (AST), glucose ( Glu ), total protein (TP), albumin ( ALB ), blood urea nitrogen (BUN) , Cr, and prealbumin (PA) were determined immediately before management (T0) and on the 30th day(T1). Results ALT, AST, Glu, TP, ALB, BUN, Cr, and PA showed no significant differences between these two groups before management ( all P ＞ 0. 05 ). The levels of TP ( P = 0. 015), ALB ( P = 0. 007 ), and PA ( P =0. 022 ) were significantly higher in EN group than those in control group at T1. The cell counts of CD3, CD4, and CD8 were not significantly different at T0, while the cell count of CD4 was significantly higher in EN group than that in control group at T1 ( P ＜ 0. 05 ). Conclusion EN can improve the nutritional status and T lymphocytesmediated immune function in AIDS patients.