[Clinical impacts of highly active antiretroviral therapy on patients of hemophilia combined with acquired immunodeficiency syndrome: 6-year follow-up of 39 cases].

OBJECTIVE: To evaluate the impact of highly active antiretroviral therapy (HAART) on the haemorrhage status, joint function, and physical ability of the patients of hemophilia combined with acquired immunodeficiency syndrome (AIDS). METHODS: Thirty-nine hemophilia A/AIDS patients, all male, aged (40+/-13), underwent HAART and followed up for 6 years from 2002 to 2008 to observe the yearly hospital visit time, bleeding time, transfusion times, amount of factor VIII transfusion, VIII: C level, physical ability, and joint function. Flow cytometry was used to count the CD4+ T cells, and bDNA assay was used to examine the HIV virus load. RESULTS: The average hospital visit time, bleeding time, transfusion time, and amount of factor VIII transfusion, hemoglobin, white blood cell count, and platelet count before HAART were not significantly different from those after treatment (all P>0.05); only one case showed moderate decrease in VIII: C level, and another one case showed slight decline in physical ability and joint function. The serum HIV RNA load decreased from (4.8+/-1.0) log copies/ml before HAART to (2.4+/-1.0) log copies/ml (P<0.05) and the CD4+ T cell count raised from 183+/-97/mm3 to 456+/-157/mm3 (P<0.05) after HAART. CONCLUSION: HAART has no obvious impact on the haemorrhage status, joint function, and physical ability in hemophilia A/AIDS patients, however, it is effective to inhibit HIV replication and raise CD4+ T cell number which indicates that HAART therapy is positive for immune recovery.

[Peg-interferon alfa-2a and highly active antiretroviral drug therapy on hepatitis C patients with AIDS].

OBJECTIVE: To evaluate the clinical effect and side-effect of peg-interferon alfa-2a (PEG-IFN alfa-2a) and highly active antiretroviral therapy (HAART) for patients infected with hepatitis C virus (HCV) and co-infected with human immunodeficiency virus (HIV). METHODS: Twenty-two patients with HCV/HIV co-infection received highly active antiretroviral therapy initially; after their CD4 lymphocyte counts rose to over 0.20x10(9)/L, they were separated into two groups: one group with CD4 lymphocytes over 0.35x10(9)/L (high group) and one group with CD4 lymphocytes below 0.35x10(9)/L (low group). Both groups were given 180 microg of PEG-IFN alfa-2a every week intramuscularly. HCV RNA and HIV RNA loads, blood cell and CD4 lymphocyte counts, and liver functions were routinely examined. RESULTS: After 12, 24 and 48 weeks of PEG-IFN alfa-2a therapy, mean HCV RNA loads reduced 2.0650 log10 copies/ml (t=3.8733), 2.9146 log10 copies/ml (t=7.6741) and 2.4315 log10 copies/ml (t=5.8202) from the baseline at week 0 in the 13 patients in the high group, and reduced 1.1522 log10 copies/ml (t = 2.8937), 1.4189 log10 copies/ml (t=2.4422) and 1.1167 log10 (t=1.1261) in the 8 patients of the low group. However, there was no significant difference between the early viral response rate (EVR) and the end of treatment viral response rate (ETVR) of the two groups. In the high group, the white blood cell count was lower at 24 weeks than the base line (t=2.4700), and the blood platelet count was lower both at 24 and 48 weeks than the base line (t=2.3273 and t=3.6149). CONCLUSIONS: PEG-IFN alfa-2a can effectively reduce HCV RNA loads in patients with HCV-/HIV co-infection, and the inhibition rate in patients with higher CD4 lymphocyte counts is better. The EVR and ETVR of the two groups of patients show similar results after the treatment. PEG-IFN alfa-2a can reduce the white blood cell counts and the blood platelet counts in the peripheral blood.

Invasive fungal infections among inpatients with acquired immune deficiency syndrome at a Chinese university hospital.

Invasive fungal infections (IFIs) have become a major cause of morbidity and mortality among people with acquired immune deficiency syndrome (AIDS), however, little is known about the clinical features and prognosis of IFI in AIDS in China. This study aimed to characterise the clinical features and prognosis of IFI in AIDS patients in China. We retrospectively reviewed the records of all HIV-infected patients at a Chinese university hospital between December 2004 and May 2006. We identified 35 patients with IFI. IFIs included thrush, oesophageal candidiasis, fungal pneumonia, cryptococcosis, penicilliosis and fungaemia, 44.4% of IFIs occurred in the digestive tract, 71.8% of IFIs occurred in patients with CD4(+)T-lymphocyte counts <100 cells mm(-3). Candida albicans accounted for 57.4% of fungal pathogens isolated. All the patients received both antiretroviral and antifungal therapy; 27 patients were cured and eight died. IFI is one of the most common opportunistic infections in AIDS patients in China. IFIs mainly occur in patients with low CD4(+)T-lymphocyte counts. The majority of IFIs occur in the digestive tract. The most common pathogen causing IFI is C. albicans. The mortality rate remains high although antiretroviral therapy and many newer antifungals are available in China.

[A cross-sectional case study of human immunodeficiency virus and tuberculosis co-infection in mainland China].

OBJECTIVE: In order to take an insight into the profile of HIV/AIDS and tuberculosis (TB) co-infection, we made a statistic survey in 9 hospitals in mainland China. With the purpose of guiding the prevention and treatment, 241 cases with such co-infection were enrolled and the data with respect to clinical manifestations, laboratory tests, therapy and prognosis were analysed. METHODS: All indices were collected with unified questionary. RESULTS: Young men (75.9%) took constituted the majority. HIV was transmitted mainly by intravenous drug use (IDU) in Xinjiang and Yunnan provinces, by blood transfusion or blood products in Shanghai, Henan and Wenxi county of Shanxi, and by sexual transmission in Fuzhou, Shanghai, Shenzhen and Dehong prefecture of Yunnan province. In this survey, pulmonary TB accounted for 59.3%, extra-pulmonary TB for 21.2%, and both for 19.5% of the patients. As for laboratory tests, only 9.5% was positive in sputum for acid-fast bacillus (AFB) and 2.9% in culture, 10.8% of the patients had AFB in pleural fluid or cerebrospinal fluid. Besides, PPD was negative or weakly positive in most of the cases. Overall, 76.8% of the 241 cases had a CD(4) cell count < 200/microl, and 58.5% < 100/microl. 80.5% of the patients was treated with anti-tuberculous medications and 69.7% with highly active antiretroviral therapy (HAART). 203 (84.2%) were still alive and 38 (15.8%) died. CONCLUSIONS: (1) The clinical manifestations of the 241 cases were varied because of prevailing pulmonary TB. (2) The immune function was depressed with reducing CD(4) counts in most of the patients. (3) Positivity rate of examination relevant to TB was too low to help the diagnosis. (4) The mortality (15.8%) was high even with HAART and/or chemotherapy.

Significance of blood analysis in hemophiliacs co-infected with human immunodeficiency virus and hepatitis viruses.

AIM: To study the effect of hepatitis virus infection on cirrhosis and liver function markers in HIV-infected hemophiliacs. METHODS: We have analyzed the immunological, liver function and cirrhosis markers in a cohort of hemophiliacs co-infected with human immunodeficiency virus (HIV) and hepatitis viruses. RESULTS: There was no difference in immunological markers among co-infected patients and patients infected with HIV only and those co-infected with one or more hepatitis virus. Although liver function and cirrhosis markers remained within a normal range, there was a worsening trend in all patients co-infected with hepatitis virus C (HCV), which was further exacerbated in the presence of additional infection with hepatitis virus B (HBV). CONCLUSION: Co-infection with HIV, HBV and HCV leads to worsening of hyaluronic acid and liver function markers. Increases in serum hyaluronic acid may be suggestive of a predisposition to liver diseases.