Proportion and related influencing factors of HIV-infected individuals that rejecting the antiretroviral therapy among all the HIV infections, Dehong prefecture, Yunnan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine the proportion and influencing factors on HIV-infected individuals who rejecting the antiretroviral therapy among all the HIV positives, in Dehong prefecture, Yunnan province.</p><p><b>METHODS</b>A cross-sectional analysis was conducted on all the local HIV-infected survivals aged over 16 year old who refused to receive antiretroviral therapy (ART) by the end of 2013 in Dehong prefecture.</p><p><b>RESULTS</b>The proportion of those rejecting the ART among HIV-infected survivals and aged over 16 years old in Dehong prefecture, was 7.4% (605/8 136). Factors related to the 'rejection' among the 605 refusals would include: being male (72.9%), aged 31-45 years (57.2%), peasants (75.4%), married (52.2%), with minor ethnicity (41.3%), illiterate or only having primary school education (58.7%), infected through sexual contacts (61.2%), and with CD4(+)T cell counts >350 cells/mm(3) (66.6%). Data from the multiple logistic regression analysis indicated that rejecting the ART was significantly associated with areas, gender, age, ethnicity and CD4(+)T cell counts of the HIV patients. Those who were from Yingjiang county, female, aged 31-45 years old had lower proportions of ART refusals than those who were from Ruili city, male, aged ≤30 year old. Those who were of Dai minority and had no records on CD4(+)T cell counts, had higher proportions of ART refusals than those who were of Han ethnicity and had CD4(+)T cell counts ≤350 cells/mm(3). Reasons for the 605 HIV-infected patients with rejection to the ART would include fear of disclosure of HIV infection status (84, 13.9%), misunderstandings of the effectiveness and side effects of ART (111, 18.3%), self-realized wellness(340, 56.2%) and others (70, 11.6%). Of them, reasons for the 181 patients with CD4(+)T cell counts ≤350 cells/mm(3) that rejecting ART would include fearfulness on the disclosure of HIV infection status(40, 22.1%), misunderstandings of the effectiveness and side effects of ART (36, 19.9%), self-realized wellness (84, 46.4%) and others (21, 11.6%). Among those who rejected ART, reasons for that would vary by areas, gender, age, marital status and routes of HIV transmission, according to the results from Chi-squared tests.</p><p><b>CONCLUSION</b>A substantial proportion of HIV-infected individuals rejected ART in Dehong prefecture of Yunnan province. It was urgently needed to enhance health education programs of ART tailored for those HIV-infected patients, according to different characteristics and reasons for rejection, so as to promote the ART in this prefecture.</p>

Observation of nutritional risks in 200 cirrhotic inpatients using Nutritional Risk Screening 2002 / 中华临床营养杂志

Objective To screen the prevalence of nutritional risk in cirrhotic inpatients by Nutritional Risk Screening 2002 (NRS 2002) and explore the relationship between nutritional risks and outcomes.Methods NRS 2002 was used to identify the nutritional risk of 200 cirrhotic inpatients between May 2010 and May 2011.The Child-Turcotte-Pugh (CTP) grade,fatality,complications,and length of stay within 6 months were followed up to explore the relationship between nutritional risks and outcomes.Results The prevalence of nutritional risk screened by NRS 2002 was 53.5％ in cirrhotic patients.The prevalence of nutritional risk was 39.0％,59.4％,and 60.0％ respectively in patients with CTP grade A,B,and C (P =0.029).Compared with those without nutritional risks,patients with nutritional risks had significantly higher incidences of complications and fatality (P =0.000 and 0.013) and longer hospital stay (P =0.001).Conclusion The nutritional risk increases along with the CTP grade.Patients with nutritional risks tend to have poorer outcomes.The influence of nutrition support on the outcome of patients with liver diseases needs further research.