Qualidade do acesso percebida por usuários de serviços especializados em HIV/AIDS da Bahia, Brasil / Quality of access perceived by users of HIV/AIDS specialized services in Bahia, Brazil / Calidad de acceso percibida por los usuarios de servicios especializados en VIH/SIDA en Bahía, Brasil

Este artigo descreve o acesso e a percepção do acesso de usuários a serviços especializados no tratamento do vírus da imunodeficiência humana e da Síndrome da Imunodeficiência Humana (HIV/AIDS) em municípios baianos por meio de um recorte epidemiológico descritivo-analítico, com abordagem quantitativa de dados primários de estudo realizado em cinco serviços localizados na capital e oito no interior do estado da Bahia, Brasil. Participaram deste estudo 475 usuários, de 21 municípios baianos, predominantemente do sexo feminino, com faixa etária entre 25 e 44 anos, negros, cristãos, desempregados, com escolaridade compreendendo o ensino fundamental, renda de até três salários mínimos, heterossexual e cisgênero. O acesso à testagem para HIV e outras Infecções Sexualmente Transmissíveis (IST), profilaxias de pós-exposição e pré-exposição e outros insumos de prevenção não constituíram motivação de inserção no serviço. O tratamento específico e a assistência médica para HIV e outras IST foi motivação para que a maioria dos participantes se direcionassem ao serviço especializado. O deslocamento até o serviço de referência é realizado principalmente por transportes coletivos, e o trajeto casa-serviço tem duração de pelo menos uma hora. O horário de funcionamento da unidade atende às necessidades da maior parte dos participantes, mas parcela dos usuários mencionaram o desejo de funcionamento em horários alternativos. A marcação de consultas é realizada principalmente de forma presencial e por telefone, com possibilidade de agendamento diário, assim a maioria dos usuários avaliaram a organização do serviço para marcação de consultas como boa ou muito boa. O tempo de espera, entre marcação e consulta, mais comum é de uma semana a um mês.

This article describes user access and perception of access to specialized HIV/AIDS services in Bahia municipalities by applying a qualitative epidemiological, descriptive-analytical approach to primary data from research conducted in five services located in the capital and eight in the countryside. A total of 475 users from 21 municipalities in Bahia participated in this study. Most were female, between 25 and 44 years old, Black, Christian, unemployed, with complete primary education, income of up to 3 minimum wages, heterosexual and cisgender. Access to HIV testing and other STIs, post-exposure and pre-exposure prophylaxis and other prevention inputs did not constitute motivation for procuring the service. Specific treatment and medical care for HIV and other STIs motivated most participants to turn to specialized services. Commuting to the reference service is made mainly by public transport and the home-service journey takes at least one hour. The unit's opening hours meet the needs of most participants, but some mentioned the desire for alternative operating times. Appointments are booked mainly in person and over the phone, with the possibility of daily scheduling, so most users rated the service organization for scheduling appointments as good or very good. The most common waiting time between booking and consultation is one week to one month.

Este artículo describe el acceso y la percepción de acceso de los usuarios a servicios especializados en el tratamiento del virus de inmunodeficiencia humana y síndrome de inmunodeficiencia humana (VIH/sida) en municipios de Bahía (Brasil) mediante un enfoque epidemiológico, descriptivo-analítico, y un enfoque cuantitativo de datos primarios de un estudio realizado en cinco servicios ubicados en la capital y ocho en el interior del estado de Bahía. Participaron en este estudio 475 usuarios, de 21 municipios de Bahía, con mayor predominio femenino, con edades de entre 25 y 44 años, negros, cristianos, desempleados, con educación primaria, ingresos de hasta tres salarios mínimos, heterosexuales y cisgénero. El acceso a pruebas de VIH y otras infecciones de transmisión sexual (ITS), profilaxis posexposición y preexposición, y otros insumos de prevención no constituyeron una motivación para ingresar al servicio. El tratamiento específico y la asistencia médica para el VIH y otras ITS fueron la razón para que la mayoría de los participantes buscaran servicios especializados. El desplazamiento al servicio de referencia se realiza principalmente en transporte público, y el trayecto desde el domicilio al servicio tiene una duración mínima de una hora. El horario de atención de la unidad satisface las necesidades de la mayoría de los participantes, pero algunos usuarios mencionaron el deseo de que operase en horarios alternativos. Las citas se realizan principalmente de forma presencial y telefónica, con posibilidad de concertación diaria, por lo que la mayoría de los usuarios valoran como buena o muy buena la organización del servicio de citas. El tiempo de espera más habitual entre la reserva y la consulta es de una semana a un mes.

Criptococosis Meníngea en pacientes viviendo con HIV experiencia en cuidados intensivos / Meningeal cryptococcosis in patients living with HIV. Experience in intensive care

Resumen Introducción : La criptococosis meníngea (CM) es una causa frecuente de meningoencefalitis en personas que viven con HIV (PVHIV) y produce una importante morbi-mortalidad (20-55%). Se describen las características clínicas, la letalidad y las variables de mal pronóstico en PVHIV con CM, en unidades de cuidados intensivos (UCI). Métodos : Estudio observacional y retrospectivo. Pe ríodo 21/11/2006 a 24/05/2023. Población evaluada: 154 PVHIV adultos, admitidos en UCI con diagnóstico de CM. Los porcentajes y valores absolutos, fueron comparados mediante Chi-Cuadrado o test de Fisher y las medianas mediante test de Mann-Whitney. La asociación con mortalidad se evaluó por regresión logística. Se utilizó el programa SPSS 23.0. Un valor p<0.05 fue considerado significativo. Resultados : Los pacientes que fallecieron y los que so brevivieron fueron comparables en edad y sexo (p>0.05). El análisis univariado, observó que un estado funcional y nutricional alterado, falta de tratamiento antirretroviral previo (TARV), CD4 <100 células/μl, APACHE II ≥13 y un score pronóstico de PVHIV ≥8 puntos, requerir ventilación mecánica (VM), sufrir insuficiencia respiratoria, renal, disfunción neurológica o sepsis, podrían estar asociados (p<0.05) con mortalidad. La regresión logística estableció que un estado funcional y nutricional alterado, un score pronóstico PVHIV ≥8, necesitar VM y sufrir sepsis serían variables independientes asociadas a mortalidad. Conclusión : Los resultados indican que el estado funcional y nutricional alterado, un score pronóstico PVHIV ≥8 puntos, requerir VM y sufrir sepsis al ingreso a UCI podrían servir como variables independientes para predecir un mayor riesgo de mortalidad.

Abstract Introduction : Meningeal cryptococcosis (MC) is a frequent cause of meningoencephalitis in people living with HIV (PLHIV), leading to substantial morbidity (20- 55%). Clinical characteristics, lethality and adverse prog nostic factors in PLHIV with MC admitted to intensive care units (ICUs) are described. Methods : A retrospective observational study. Period from 11/21/2006 to 05/24/2023. It involved 154 adult PLHIV diagnosed with MC and admitted to ICUs. Percen tages and absolute values were compared by Chi-Square or Fisher's test and medians by Mann-Whitney test. The association with mortality was assessed by logistic re gression. SPSS 23.0 software was used. A p-value <0.05 was considered significant. Results : Patients who died and those who survived were comparable in age and sex (p>0.05). Univariate analysis showed that impaired functional and nutritio nal status, lack of previous highly active antiretroviral therapy, CD4 <100 cells, APACHE II ≥13 and a PLHIV prognostic score ≥8 points, requiring mechanical venti lation (MV), respiratory failure, renal failure, neurological dysfunction or sepsis could be associated (p<0.05) with mortality. Logistic regression established that impaired functional and nutritional status, a PLHIV prognostic score ≥8, need for MV and presence of sepsis would be independent variables associated with mortality. Conclusion : The results indicate that altered functio nal and nutritional status, a PLHIV prognostic score ≥ 8 points, requiring MV and suffering sepsis on admission to the ICU are more frequent in deceased patients, and they could therefore serve as independent variables to predict a higher risk of mortality.

Tecnologias relacionais e atuação psicológica em HIV/Aids: contribuições da psicologia socioconstrucionista / Relational technologies and psychological action in HIV/AIDS: contributions from socioconstructionist psychology / Tecnologías relacionales y acción psicológica en VIH/SIDA: aportes desde la psicología socioconstruccionista

OBJETIVO: Discutir como se estabelece a indicação de tecnologias relacionais off-line e on-line como recurso de cuidado a Pessoas Vivendo com HIV/Aids (PVHA) por psicólogas/os atuantes em serviços especializados. MÉTODO: Trata-se de uma pesquisa de abordagem qualitativa e exploratória. Utilizamos a perspectiva da psicologia social construcionista, além das noções de tecnologias dura, leve-dura e leve e seu encontro com a perspectiva de tecnologias (materiais e não materiais) como mediadoras inventivas. Realizamos entrevistas semiestruturadas e submetemos os dados à análise categorial temática. RESULTADOS: Foram elaboradas duas categorias: tecnologias relacionais off-line e on-line. Tratam-se dos sentidos construídos em torno de estratégias para o cuidado de PVHA, que não são típicas da clínica psicológica clássica. CONCLUSÃO: Concluímos que o uso de tecnologias relacionais off-line e on-line no acompanhamento de PVHA sugere uma ampliação do repertório profissional das/dos psicólogas/os que trabalham em serviços especializados em HIV/Aids, porém, isso não demonstrou ocorrer de forma tão articulada no campo de atuação psicológica, em comparação às práticas psicológicas clássicas.

OBJECTIVE: To discuss how offline and online relational technologies are recommended as a care resource for People Living with HIV/Aids (PLWHA) by psychologists working in specialized services. METHOD: This is research with a qualitative and exploratory approach. We use the perspective of constructionist social psychology, in addition to the notions of hard, soft-hard and soft technologies and their encounter with the perspective of technologies (material and non-material) as inventive mediators. We carried out semi-structured interviews and submitted the data to thematic categorical analysis. RESULTS: Two categories were created: offline and online relational technologies. These are the meanings constructed around strategies for caring for PLWHA, which are not typical of classical psychological clinics. CONCLUSION: We conclude that the use of offline and online relational technologies in monitoring PLWHA suggests an expansion of the professional repertoire of psychologists working in specialized HIV/AIDS services, however, this has not been demonstrated to occur in a so articulated, in the field of psychological action, in comparison to classical psychological practices.

OBJETIVO: Discutir cómo las tecnologías relacionales offline y online son recomendadas como recurso de atención a las Personas que Viven con VIH/SIDA (PVVS) por parte de psicólogos que trabajan en servicios especializados. MÉTODO: Se trata de una investigación con un enfoque cualitativo y exploratorio. Utilizamos la perspectiva de la psicología social construccionista, además de las nociones de tecnologías duras, blandas-duras y blandas y su encuentro con la perspectiva de las tecnologías (materiales y no materiales) como mediadoras inventivas. Realizamos entrevistas semiestructuradas y sometimos los datos a análisis temático categórico. RESULTADOS: Se crearon dos categorías: tecnologías relacionales en línea y fuera de línea. Estos son los significados construidos en torno a estrategias de atención a las PVVS, que no son propias de las clínicas psicológicas clásicas. CONCLUSIÓN: Concluimos que el uso de tecnologías relacionales en línea y fuera de línea en el seguimiento de las PVVS sugiere una expansión del repertorio profesional de los psicólogos que trabajan en servicios especializados en VIH/SIDA, sin embargo, no se ha demostrado que esto ocurra de manera tan articulada en el campo de acción psicológica, en comparación con las prácticas psicológicas clásicas.

Linfoma de células B primario de mama en una paciente con sida. Presentación de un caso y revisión de la literatura / Primary B-cell lymphoma of the breast in an AIDS patient. Case report and literature review

Los LNH constituyen la segunda neoplasia más frecuente en pacientes con VIH. Estas neoplasias están ligadas a la inmunodeficiencia, suelen ser de período de latencia prolongado y más frecuentes en hombres. Más del 95% de estas neoplasias son de fenotipo B, de alto grado de malignidad, extranodales y representan la causa de muerte en un 12% al 16% de los casos. El linfoma no Hodgkin primitivo de mama (LPM) es una entidad infrecuente, que representa el 2,2% de todos los linfomas extranodales y el 0,5% de todas las neoplasias malignas de la mama. Se presenta una mujer con sida y linfoma primario de mama. (AU)

NHL is the second most common neoplasm in patients with HIV. It is linked to immunodeficiency, tends to have a long latency period and is more common in men. More than 95% of these neoplasms are of phenotype B, high-grade, extranodal and are the cause of death in 12% to 16% of cases. Primitive non-Hodgkin lymphoma of the breast is a rare entity, accounting for 2.2% of all extranodal lymphomas and 0.5% of all breast malignancies. A woman with AIDS and primary breast lymphoma is presented. (AU)

Mortality trend due to HIV/AIDS among women in Porto Alegre/RS from 2007 to 2017 / Tendência de mortalidade por HIV/AIDS entre mulheres em Porto Alegre/RS de 2007 a 2017 / Tendencia de mortalidad por VIH/SIDA entre mujeres en Porto Alegre/RS de 2007 a 2017

Background and Objectives: Porto Alegre is among the state capitals of Brazil with the highest magnitude of epidemiological indicators in relation to people living with HIV/AIDS, impacting the mortality indicators of this population. This study aimed to analyze the temporal trend of deaths from HIV/AIDS in women residents of the city of Porto Alegre, Rio Grande do Sul, Brazil, from 2007 to 2017, considering age groups, skin color and education. Method: this is an ecological time series study on the trend of HIV/AIDS mortality rates among women living with HIV residents in the city of Porto Alegre, RS. Unadjusted and standardized mortality rates were calculated according to age group, skin color and education. For trend analysis, Prais-Winsten generalized linear regression was used. Results: 1,603 deaths related to HIV/AIDS were identified in women living in the city during the study period. Mortality coefficients were higher in white, less educated women, with an increasing trend among those over 60 years of age (95%CI 0.044; 0.029) with a decline for those in the age group between 20 and 29 (95%CI - 0.566; - 0.120). Conclusion: changes in the epidemiological scenario of HIV/AIDS draw attention to the care of people over 60 years of age and with less education, requiring efforts from healthcare networks to prevent deaths.(AU)

Jutificativa e Objetivos: Porto Alegre está entre as capitais estaduais do Brasil com maior magnitude de indicadores epidemiológicos em relação às pessoas vivendo com HIV/AIDS, impactando os indicadores de mortalidade dessa população. Este estudo teve como objetivo analisar a tendência temporal de mortes por HIV/AIDS em mulheres residentes na cidade de Porto Alegre, Rio Grande do Sul, Brasil, de 2007 a 2017, considerando grupos etários, cor da pele e educação. Método: trata-se de um estudo de série temporal ecológica sobre a tendência das taxas de mortalidade por HIV/AIDS entre mulheres vivendo com HIV residentes na cidade de Porto Alegre, RS. As taxas de mortalidade não ajustadas e padronizadas foram calculadas de acordo com grupo etário, cor da pele e educação. Para análise de tendência, foi utilizada regressão linear generalizada de Prais-Winsten. Resultados: Foram identificadas 1.603 mortes relacionadas ao HIV/AIDS em mulheres residentes na cidade durante o período do estudo. Os coeficientes de mortalidade foram mais altos em mulheres brancas, menos escolarizadas, com uma tendência crescente entre aquelas com mais de 60 anos de idade (IC95% 0,044; 0,029) com declínio para aquelas na faixa etária entre 20 e 29 anos (IC95% -0,566; -0,120). Conclusão: Mudanças no cenário epidemiológico do HIV/AIDS chamam a atenção para o cuidado de pessoas com mais de 60 anos de idade e com menor escolaridade, exigindo esforços das redes de saúde para prevenir mortes.(AU)

Antecedentes y Objetivos: Porto Alegre está entre las capitales estatales de Brasil con la mayor magnitud de indicadores epidemiológicos en relación a las personas que viven con VIH/SIDA, impactando los indicadores de mortalidad de esta población. Este estudio tuvo como objetivo analizar la tendencia temporal de muertes por VIH/SIDA en mujeres residentes en la ciudad de Porto Alegre, Rio Grande do Sul, Brasil, de 2007 a 2017, considerando grupos de edad, color de piel y educación. Método: se trata de un estudio de serie temporal ecológica sobre la tendencia de las tasas de mortalidad por VIH/SIDA entre mujeres que viven con VIH residentes en la ciudad de Porto Alegre, RS. Se calcularon tasas de mortalidad no ajustadas y estandarizadas según grupo de edad, color de piel y educación. Para el análisis de tendencia, se utilizó la regresión lineal generalizada de Prais-Winsten. Resultados: Se identificaron 1.603 muertes relacionadas con el VIH/SIDA en mujeres residentes en la ciudad durante el período de estudio. Los coeficientes de mortalidad fueron más altos en mujeres blancas, menos educadas, con una tendencia creciente entre aquellas con más de 60 años de edad (IC95% 0,044; 0,029) con un declive para aquellas en el grupo de edad entre 20 y 29 años (IC95% -0,566; -0,120). Conclusión: Los cambios en el escenario epidemiológico del VIH/SIDA llaman la atención sobre el cuidado de las personas mayores de 60 años y con menor educación, requiriendo esfuerzos de las redes de salud para prevenir muertes.(AU)

Pharmaceutical care for a case of tumor patient with interstitial lung disease due to EGFR-TKI and AIDS opportunistic infection / 中国药房

OBJECTIVE To provide a reference for drug treatment and pharmaceutical care in AIDS patients with tumor. METHODS For a case of AIDS complicated with pulmonary adenocarcinoma， interstitial lung disease occurred repeatedly in the course of targeted therapy， and bacterial and fungal infections could not be ruled out. Clinical pharmacists provided pharmaceutical care such as medication monitoring， drug reconciliation， and adverse reaction monitoring for the patient. RESULTS The patient’s use of Amivantamab is “highly likely related” to adverse reactions such as interstitial lung disease， and it is recommended by the clinical pharmacist that the targeted therapy drugs should be suspended， and hormone medication monitoring plans should be formulated. For the possible pathogens of AIDS opportunistic infection， it was recommended to stop ertapenem and foscarnet sodium， monitor voriconazole concentration in blood and follow up on the safety and antifungal course of voriconazole. According to the drug-drug interaction and the patient’s condition， the anti-AIDS drug was adjusted to bictegravir sodium， emtricitabine and tenofovir alafenamide. For the possibility of Pneumocystis carinii pneumonia， thrombosis and gastric mucosal injury， preventive drugs such as Compound sulfamethoxazole， nadroparin calcium and esomeprazole were recommended. Physicians followed the advice of the clinical pharmacists. The patient made a good outcome after drug treatment without any significant adverse reactions or drug-drug interactions， and was discharged smoothly. CONCLUSIONS AIDS patients with tumor have complex disease condition and use many therapeutic drugs. Clinical pharmacists should conduct drug treatment management as drug reconciliation and medication monitoring and provide individual pharmaceutical care for these patients to guarantee the safety of drug use.

Analysis of Depression and Influencing Factors in HIV/AIDS Patients Receiving Antiviral Therapy / 中山大学学报(医学科学版)

ObjectiveTo investigate the depression status and its influencing factors in HIV/AIDS patients receiving antiviral therapy. MethodsFrom July 2022 to September 2022， successive sampling method was used to recruit HIV/AIDS patients receiving antiviral therapy from antiviral treatment institutions in Nanjing， and they were instructed to fill out anonymous questionnaires. The questionnaire collected the basic information of patients， and depression， HIV stigma score and social support level were investigated by Patient Health Questionnaire-9 （PHQ-9）， Berger HIV stigma scale （BHSS） and Multidimensional Scale of Perceived Social Support （MSPSS）. Multivariate Logistic regression was used to analyze the influencing factors of depression. ResultsA total of 1879 valid questionnaires were collected in this study， and the detection rate of depression was 50.1%. The results of multivariate logistic analysis showed that compared with patients with middle school or below， the risk of depression was lower for those with postgraduate or above ［OR=0.534， 95%CI （0.341， 0.835）， P=0.006］. Compared with antiviral therapy duration<1 year， antiviral therapy duration for 1 to 5 years ［OR=0.729， 95%CI （0.536， 0.991）］， >5 to 10 years ［OR=0.516， 95%CI （0.379， 0.702）］， >10 years ［OR=0.603， 95%CI （0.375， 0.969）］ was associated with a lower risk of depression. High level of social support was a protective factor for depression in HIV/AIDS patients compared with middle and low level of social support ［OR=0.430， 95% CI（0.349， 0.530）， P < 0.001］. There was a higher risk of depression with side effects than without side effects ［OR=2.260， 95%CI （1.833， 2.786）， P < 0.001］. The higher the score on the HIV stigma scale， the higher the possibility of depression was. ConclusionThe detection rate of depression of patients receiving antiviral therapy in Nanjing is high. After starting antiviral therapy， we should strengthen the monitoring of side effects and psychological status of patients， carry out psychological intervention， alleviate psychological problems， and improve the quality of life of patients receiving antiviral therapy.

The epidemiology and risk factors of delayed diagnosis in newly reported HIV/AIDS cases in Xuhui District， Shanghai， 2018‒2022 / 上海预防医学

ObjectiveTo investigate the trends and significant determinants of delayed HIV diagnosis （DHD） among newly reported HIV/AIDS cases in Xuhui District， Shanghai between 2018 and 2022. MethodsIn the newly reported HIV/AIDS cases， patients died within one year without accident， HIV/AIDS cases with CD4 cell count <200 cells·μL-1， and AIDS cases with a CD4 cell count between 200 to 499 cells·μL-1 were defined as delayed diagnosis. Univariate and multivariate logistic analysis were employed to explore the influencing factors of DHD. ResultsAmong the 862 newly reported HIV/AIDS cases， The DHD rate was 39.79% without statistically significant difference by year（χ2=4.508， P=0.342）. Patients with CD4 cell count <200 cells·μL-1 contributed the largest proportion of DHD. During 2018‒2022， the DHD rate declined among HIV/AIDS patients who were younger than 35 years old or 45‒65 years old， never married， original diagnosis from tertiary specialized hospitals. Patients who were 65 years or older， married or divorced， with heterosexual transmitted HIV/AIDS， and original diagnosis from other types of testing and tertiary metropolitan hospital， had sustainably higher DHD rates. The number of HIV screening and diagnosed from voluntary counseling and testing （VCT） decreased during the COVID-19 epidemic， while the DHD rate increased sharply. Multivariate logistic regression analysis suggested the DHD rates were higher among older age， other types of testing（OR=3.805， 95%CI： 2.260‒6.406）and pre-operative testing（OR=2.411， 95%CI： 1.424‒4.081）. Patients who received CD4 test in 15 days had a higher DHD rate compared to the cases received CD4 test exceeding 90 days （OR=0.336， 95%CI： 0.216‒0.522）. ConclusionThere is no significant decrease of delayed HIV diagnosis rate in Xuhui District in recent years， and the number of HIV tests has decreased in 2022. Monitoring of newly reported HIV/AIDS should be conducted continuously. Expansion of HIV antibody screening should be conducted in non-infectious departments and inpatient departments in healthcare institutions， particularly metropolitan hospitals. Assistance should be provided to clinicians and elderly patients for improving their ability to recognize and perceive the risk of HIV/AIDS， in order to enhance early diagnosis and subsequent treatment.

Application value of ultrasonic measurement of optic nerve sheath diameter and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococcal meningitis / 重庆医学

Objective To explore the application value of ultrasonic measurement of optic nerve sheath diameter(ONSD)and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococ-cal meningitis.Methods A total of 27 patients with cryptococcal meningitis diagnosed by Chongqing Public Health Medical Center from February to July,2022 were included.All patients were examined with ultrasound measurement of ONSD and ultrasound measurement of cerebral blood flow of intracranial middle cerebral ar-tery(MCA),including peak systolic velocity(PSV),end diastolic velocity(EDV),peak systolic velocity/end diastolic velocity(S/D)and resistance index(RI),and then lumbar puncture was performed and intracranial pressure(ICP)was recorded.The ICP≥200 mmH2O was defined as the ICP increased group,ICP＜200 mmH2O was defined as the ICP normal group,and 17 AIDS patients without complications were selected as the control group.The baseline data,ONSD and MCA cerebral blood flow parameters of the three groups were compared,and the statistically significant indexes were correlated with ICP,and the receiver operating charac-teristic(ROC)curve of the subjects was drawn to analyze the diagnostic efficacy of ONSD value in predicting intracranial hypertension caused by AIDS cryptococcal meningitis.Results There were no significant differ-ences in gender,age,systolic blood pressure or diastolic blood pressure among the ICP increased group,the ICP normal group and the control group(P＞0.05).There were no significant differences in PSV,EDV,S/D and RI among the three groups of MCA(P＞0.05),but there was significant difference in ONSD among the three groups(P＜0.05).There was a positive correlation between ICP and ONSD in the patients with AIDS cryptococcal meningitis(P＜0.01,r=0.736).The ROC curve analysis showed that when the ONSD cutoff value was 3.965 mm,it predicted the highest efficacy of intracranial high pressure in the patients with AIDS cryptococcal meningitis.The area under the ROC curve was 0.90(95％CI:0.714-1.000,P=0.001),the sensitivity was 90％,and the specificity was 100％.Conclusion Ultrasonic measurement of ONSD can effec-tively predict ICP in patients with AIDS cryptococcal meningitis and guide clinical decompression measures in time,which is worthy of clinical application.

Impact analysis of emergency intervention on 120 ambulance dispatchers in Chongqing city with regression discontinuity designs / 中华急诊医学杂志

Objective:To explore the impact of emergency response to public health emergencies on the efficiency of pre-hospital emergency work, and study the degree of impact on 120 ambulance dispatchers in Chongqing city during pre-periods and post-periods of the emergency intervention.Methods:Taking 120 phone answering and ambulance operation efficiency as the research subjects, we collected pre-hospital emergency case data from a city's emergency medical center, covering the period from November 10, 2021 to January 6, 2023. The cases were divided into groups according to the time periods of emergency response. A regression discontinuity design method was employed to compare the response of emergency intervention to the predictions (virtual cases) without the emergency intervention, obtaining the average intervention effect.Results:During the study period of 27 days, the number of 120 calls picked up within 10 seconds increased from 11 000 to 19 000, but the answering rate slightly decreased within 10 seconds. The vacancy rate of 120 ambulances during emergency response decreased from 0.39% to 0.20%, but the completion rate within 18 minutes decreased from 72% to 30%. In this particular emergency response period, the number of patient complaints (such as high fever and difficulty breathing) increased compared to the pre-period of emergency response.Conclusion:Emergency response significantly impacts pre-hospital emergency work such as emergency phone answering and ambulance operation efficiency. This study provides empirical research results and decision-making support for urban emergency medical services to respond to public health emergencies.

The Investigation and Analysis of the Situation of COVID-19 Vaccination and Vaccination Willingness in HIV/AIDS Population in Yunnan Province / 昆明医科大学学报

Objective To investigate the vaccination status and vaccination willingness of novel coronavirus in HIV/AIDS population in Yunnan.Methods From October 2021 to June 2022,a questionnaire survey was conducted among 2180 HIV/AIDS patients in Kunming,Qujing,Yuxi,Zhaotong,Puer,Baoshan,Lincang,Honghe,Wenshan,Xishuangbanna,Dali,Dehong and Nujiang prefectures.The questionnaire included age,sex,education,nationality,education level,vaccination,adverse reactions within 7 days after the vaccination,safety of COVID-19 vaccine,awareness of effectiveness,vaccination willingness and so on.Results Among the subjects,2109 completed 3 injections,accounting for 96.74%,and 71 were not vaccinated,accounting for 3.26% .Within 7 days of inoculation,local adverse reactions occurred in 116 cases,accounting for 5.50%,and systemic adverse reactions occurred in 56 cases,accounting for 2.66% .Injection site pain,fatigue and muscle pain accounted for the highest proportion of adverse symptoms in different sex,age and the Han nationality,while the proportion of minority adverse reactions was very low,and there was no difference among the different sex and age(P>0.05).The main reasons for the reluctance of HIV/AIDS population to be vaccinated were(recommended by doctors)that HIV/AIDS patients could not be vaccinated(67.61%)and may have serious adverse reactions after the vaccination(19.72%).The factors affecting the vaccination were found by logistic regression analysis,whether they were worried about infecting novel coronavirus(OR = 0.121,95% CI = 0.083～0.640,P<0.001)and how much they knew about COVID-19 vaccine(OR = 28.932,95% CI = 15.469～54.115,P<0.001),safety of vaccination(OR = 13.953,95% CI = 4.819～40.404,P<0.001)and belief in the preventive effect of vaccine(OR = 14.017,95% CI = 4.752～41.348,P<0.001)were significant factors affecting vaccination.Among the 13 prefectures and cities,Dehong(20),Zhaotong(21)and Lincang(14)had the largest number of unvaccinated people.Conclusion After the mass vaccination,the rate of adverse reaction in HIV/AIDS population is low,the symptoms are mild,the correct and scientific advice and guidance from doctors and the full understanding of the harmfulness of the disease,the safety,prevention and effectiveness of the vaccine are the key to complete vaccination and put an end to vaccine hesitancy.

Analysis of AHFtest-based HIV antibody self-testing data / 预防医学

Objective@#To investigate the characteristics of AHFtest-based HIV antibody self-testing among male adolescents at ages of 15 to 24 years, so as to provide insights into the promotion of HIV antibody self-testing.@*Methods@#Data were collected from male adolescents at ages of 15 to 24 years that applied for HIV antibody self-testing in the AHFtest platform from 2019 to 2021, with mailing address showing as Zhejiang Province, and demographics, applying cause and testing results were analyzed.@*Results@#A total of 268 male adolescents were enrolled, with a median age of 22.00 (interquartile range, 3.00) years. There were 160 cases with an educational level of junior college/bachelor (59.70%), 147 students (54.85%), 175 men who had sex with men (65.30%), and 126 cases with a history of previous HIV antibody self-testing (47.01%). The main causes for applying for HIV antibody self-testing through AHFtest were "easy to operate" (259 cases, 96.64%) and "privacy protect" (102 cases, 38.06%). There were 203 subjects that applied once HIV antibody self-testing (75.75%), and 65 subjects that applied multiple self-testing (24.25%). There were 123 subjects that uploaded their test results (45.90%), including 3 cases with HIV antibody positive, and 125 subjects that did not tell others the self-testing results (46.64%).@*Conclusions@#Among male applicants at ages of 15 to 24 years in Zhejiang Province from 2019 to 2021, students are predominant occupation. Easy to operate and privacy protect are the main cause for the application, but the proportion of detection results uploading is relatively low.

Epidemiological investigation of an incident of suspected intentional transmission of AIDS / 预防医学

Abstract@#On 18 May 2021, the Center for Disease Control and Prevention (CDC) of X District in P City, Z Province received a co-investigation of a suspected case of intentional HIV transmission from the public security branch, and conducted epidemiological investigations on Zhao and Wang (both males). Wang was confirmed HIV-positive in 2019. Zhao had unprotected sexual encounters several times with Wang in March 2021 without being informed of Wang's HIV infection. Zhao developed fever, sore throat and other symptoms of acute infection phase on 28 March, and were confirmed HIV positive by the CDC of P City on 11 May. Zhao did not have sex with anyone else before or after having sex with Wang. In addition, Zhao had no history of surgery, blood transfusions, drug use or any other history of HIV exposure. Laboratory tests conducted by the CDC of Z Province showed that the HIV nucleic acid sequences between the samples of Zhao and Wang had a high degree of homology. Combined with the epidemiological investigation, laboratory testing and the evidence from the public security branch, it was concluded that Wang intentionally transmitted HIV to Zhao through unprotected anal sex without disclosing his HIV infection status.

Late identification and its influencing factors of newly reported HIV/AIDS cases in Shangcheng District from 2013 to 2022 / 预防医学

Objective@#To investigate the late identification and its influencing factors of newly reported HIV/AIDS cases in Shangcheng District, Hangzhou City, so as to provide insights into the development of strategies for early detection and identification of HIV/AIDS cases.@*Methods@#Basic information, identification routes and CD4+T lymphocyte counts among newly reported HIV/AIDS cases in Shangcheng District from 2013 to 2022 were collected through the Chinese Disease Prevention and Control Information System. The proportion of late identification of newly reported HIV/AIDS cases was analyzed, and factors affecting late identification was analyzed by a multivariable logistic regression model.@*Results@#Totally 1 052 HIV/AIDS cases were newly reported in Shangcheng District from 2013 to 2022, including 1 011 males (96.10%), and had a mean age of (32.90±12.39) years. There were 333 cases with late identification, accounting for 31.65%. The proportions of late identification have no significant changing trend from 2013 to 2022 (P>0.05). Multivariable logistic regression analysis showed that HIV/AIDS cases aged 25 years and older (25 to 49 years, OR=1.894, 95%CI: 1.350-2.658; 50 years and older, OR=3.010, 95%CI: 1.838-4.928) had a higher risk of late identification, while HIV/AIDS cases with college degree and above (OR=0.655, 95%CI: 0.459-0.936) and identified by voluntary counseling and testing (OR=0.542, 95%CI: 0.380-0.772) had a lower risk of late identification.@*Conclusions@#The proportion of late identification of newly reported HIV/AIDS cases in Shangcheng District from 2013 to 2022 was 31.65%. Age, educational level and identification route were important factors affecting late identification of HIV/AIDS cases in Shangcheng District.

Factors affecting immune reconstitution in HIV/AIDS patients after antiretroviral therapy / 预防医学

Objective@#To investigate the immune reconstitution of HIV/AIDS patients and its influencing factors after receiving antiviral therapy (ART) in Hangzhou City, so as to provide insights into improving the treatment effects and quality of life in HIV/AIDS patients.@*Methods@#A retrospective cohort of HIV/AIDS patients who began antiviral treatment between January 1, 2016 and August 31, 2021 and had a baseline CD4+T lymphocyte (CD4) counts of less than 500 cells/μL or a baseline CD4/CD8+T lymphocyte (CD8) ratio of less than 0.8 in Hangzhou City was followed up until August 31, 2023. Demographic information, antiviral therapy in formation, CD4 counts, and CD4/CD8 were collected from the Chinese Disease Prevention and Control Information System. A good immune reconstitution was defined as having CD4≥500 cells/μL and CD4/CD8≥0.8. The immune reconstitution status of HIV/AIDS patients were analyzed, and factors affecting immune reconstitution were identified using a multivariable Cox proportional risk regression model.@*Results@#A total of 3 349 HIV/AIDS patients were enrolled, with a median age at ART of 31 (interquartile range, 20) years. There were 3 075 males (91.82%), 1 600 cases with college education and above (47.78%) and 2 455 cases at WHO clinical stage Ⅰ-Ⅱ(73.31%). There were 1 368 cases with good immune reconstitution, accounting for 40.85%, and the proportion of HIV/AIDS patients with good immune reconstitution that began ART in 2016 was the highest, reaching 51.90%. Multivariable Cox proportional risk regression model identified WHO clinical stage (Ⅰ-Ⅱ, HR=2.529, 95%CI: 2.023-3.162), timely ART (HR=1.196, 95%CI: 1.027-1.394), initial treatment regimen (TDF+3TC+NVP/EFV, HR=2.185, 95%CI: 1.891-2.524; integrase inhibitors, HR=8.509, 95%CI: 6.706-10.795), baseline CD4/CD8 (≥0.1, HR: 1.600-4.515, 95%CI: 1.061-6.661), baseline hemoglobin (<90 mg/dL, HR=0.327, 95%CI: 0.121-0.880), hepatitis B infection (HR=0.619, 95%CI: 0.457-0.840) and hepatitis C infection (HR=0.308, 95%CI: 0.099-0.956) as factors affecting immune reconstitution in HIV/AIDS patients.@*Conclusion@#The immune reconstitution in HIV/AIDS patients after ART is associated with WHO clinical stage, timely ART, initial treatment regimen, baseline CD4/CD8, baseline hemoglobin and hepatitis B or C infection.

Marriage intention among HIV-infected men who have sex with men / 预防医学

Objective@#To investigate the marriage intention and its influencing factors among HIV-infected men who have sex with men (MSM), so as to provide the reference for formulating high-risk behavior intervention strategies and reducing the risk of HIV transmission among this population.@*Methods@#Unmarried HIV-infected MSM were sampled from newly reported HIV/AIDS patients in Gongshu District of Hangzhou City from 2020 to 2022. Participants' sociodemographic information, family status and marriage intention were collected using questionnaire surveys. Factors affecting marriage intention were identified using a multivariable logistic regression model.@*Results@#A total of 430 questionnaires were allocated and 400 valid questionnaires were recovered, with an effective recovery rate of 93.02%. The respondents had a mean age of (28.90±4.67) years, and included 271 cases with registered residence outside Hangzhou City (67.75%). There were 82 cases indicating that they would probably or definitely get married, accounting for 20.50%, including 46 cases (56.10%) aged 30 years and older, 67 cases (81.71%) engaged in commercial services/freelance work/worker and 53 cases (64.63%) being the only children. Multivariable logistic regression analysis showed that unmarried HIV-infected MSM who were aged 30 years and older (OR=2.751, 95%CI: 1.230-6.154), had a monthly income of <10 000 Yuan (5 000 to <10 000 Yuan, OR=7.010, 95%CI: 2.049-23.981; <5 000 Yuan, OR=5.229, 95%CI: 1.803-15.165), had a high school education and below (OR=5.935, 95%CI: 1.775-19.844), were the only children (OR=3.407, 95%CI: 1.468-7.910), came from families with economic conditions above the average level (OR=8.906, 95%CI: 2.070-38.308), did not disclose their sexual orientation (OR=3.298, 95%CI: 1.118-9.727), held a positive attitude towards government policies (OR=70.544, 95%CI: 14.583-341.237), had no homosexual intercourse in the past six months (OR=3.583, 95%CI: 1.278-10.044), and had not informed their sexual partners of their HIV status (OR=2.910, 95%CI: 1.228-6.897) were more willing to get married.@*Conclusion@#A certain proportion of unmarried HIV-infected MSM in Gongshu District are willing to get married, and their marriage intention is affected by age, educational level, family economic conditions, the only children or not, disclosing sexual orientation or not, having homosexual intercourse in the past six months or not, informing sexual partners of HIV status or not, and the attitude towards government policies.

Characteristics of newly reported HIV/AIDS cases aged 15 years and older in Shangcheng District from 2006 to 2022 / 预防医学

Objective@#To investigate the characteristics of newly reported HIV/AIDS cases aged 15 years and older in Shangcheng District, Hangzhou City from 2006 to 2022, so as to provide the basis for improving AIDS prevention and control strategies.@*Methods@#Data of newly reported HIV/AIDS cases aged 15 years and older in Shangcheng District from 2006 to 2022 were collected through HIV/AIDS Comprehensive Control System of Chinese Disease Prevention and Control Information System. Population distribution and transmission routes were analyzed, and changing trends in case number were analyzed using average annual percent change (AAPC) and annual percent change (APC).@*Results@#A total of 4 409 HIV/AIDS cases aged 15 years and older were newly reported in Shangcheng District from 2006 to 2022, including 3 932 males (89.18%). There were 3 447 cases (78.18%) under 50 years old and 962 cases (21.82%) being 50 years and older. Sexual contact was a predominant transmission route, with 4 326 cases accounting for 98.12%, including 2 626 cases (59.56%) with homosexual contact and 1 700 cases (38.56%) with heterosexual contact. The number of HIV/AIDS cases showed an overall upward trend from 2006 to 2022 (AAPC=13.038%, P<0.05), with an upward trend from 2006 to 2015 (APC=42.578%, P<0.05) and a downward trend from 2015 to 2022 (APC=-19.713%, P<0.05). The increase in the number of cases aged 50 years and older group was faster than that of cases aged under 50 years (AAPC=22.641% vs. 11.162%, both P<0.05). The increase in the number of cases with homosexual contact transmission was faster than that of cases with heterosexual contact transmission (AAPC=20.417% vs. 7.455%, both P<0.05).@*Conclusions@#The number of newly reported HIV/AIDS cases aged 15 years and older in Shangcheng District performed an overall upward trend from 2006 to 2022. The cases aged 50 years and older and transmitted through homosexual contact increased rapidly, which should be taken seriously.

HIV-1 subtype and drug resistance in HIV/AIDS patients who failed in antiretroviral therapy in Jinhua City / 预防医学

Objective@#To investigate HIV-1 subtypes and drug resistance in HIV/AIDS patients who failed in antiretroviral therapy in Jinhua City, Zhejiang Province, so as to provide the basis for improving antiretroviral therapy strategy.@*Methods@#Totally 128 plasma samples of HIV/AIDS patients who failed in antiretroviral therapy (treatment for more than 6 months and viral load ≥1 000 copies/mL) from January 1 to November 30, 2023 were collected. After nucleic acid extraction and amplification, the sequences of HIV-1 pol genes were determined using first generation sequencing method, then submitted to HIV resistance database of Stanford University in the United States, and the subtypes, drug resistance mutations and drug resistance status of HIV-1 were analyzed.@*Results@#A total of 118 sequences of HIV/AIDS patients were obtained, including 94 males and 24 females (male to female ratio, 3.9︰1). There were 53 cases aged between 40 to 59 years, accounting for 44.92%. The main infection routes was heterosexual contact, with 92 cases accounting for 77.97%. The main HIV-1 gene subtypes were CRF07_BC and CRF01_AE, with 45 and 39 cases accounting for 38.14% and 33.05%, respectively. There were 75 cases found to have drug-resistant site mutations, with a mutation rate of 63.56%. The most common mutation sites were M184 and K103, with mutation rates of 29.66% and 28.81%, respectively. There were 58 cases with resistance to more than one drug, with a rate of 49.15%. The rates of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleotide reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI) were 50.00%, 33.90% and 4.24%, respectively.@*Conclusion@#The HIV-1 gene subtypes of HIV/AIDS patients who failed in antiretroviral therapy in Jinhua City are mainly CRF07_BC and CRF01_AE, which are mainly resistant to NNRTI and NRTI.

Analysis and model prediction of the burden of HIV/AIDS among the population aged 10-49 in four different SDI countries in 1990 - 2019 / 公共卫生与预防医学

Objective To understand the HIV/AIDS burden and the disease burden attributed to various risk factors in four countries with different socio-demographic index (SDI) (China, United States, Russia, and Afghanistan) from 1990 to 2019, and to predict the HIV/AIDS attributable disease burden from 2020 to 2029. Methods The 2019 Global Burden of Disease Study data was used to describe and compare the incidence, prevalence, death, and DALYs of HIV/AIDS in the four countries. The standardized DALYs attributed to various risk factors in different age groups of HIV/AIDS in the four countries in 1990 and 2019 were compared. R4.3.0 was used to construct an autoregressive moving average mixed model to predict the attributable disease burden in each country over the next decade. Results Compared with 1990, in 2019, the standardized incidence rate, standardized prevalence rate, standardized mortality rate, and standardized DALYs rate in China and the other two countries, except the United States, showed an increase. People aged 10 to 49 years old were a key group for disease burden, and the main risk factors for disease burden varied among different countries and age groups. The autoregressive moving average mixed model predicted that the main risk factor for Russia in the next decade would be injecting drugs, while unsafe sexual behavior would occur in the other three countries. Conclusion There are differences in disease burden and risk factors among different genders and age groups globally and in the four different SDI countries. Therefore, differences should be fully considered to determine the focus of HIV/AIDS prevention and control and rationally allocate health resources.

Changes of laboratory biochemical indicators in HIV / AIDS patients treated with different antiviral regimens / 公共卫生与预防医学

Objective To analyze the changes of liver and kidney function, blood glucose and lipid metabolism at different follow-up time points of different treatment regimens, and to provide reference for clinical optimization and adjustment of medication in HIV/AIDS patients. Methods The changes of liver and kidney function, blood glucose and lipid metabolism at seven follow-up time points were analyzed retrospectively. The baseline blood collection time of HIV /AIDS patients was set as the starting point, and the final follow-up time was set as the end point. The seven follow-up points were 0, 3, 6, 9, 12, 18 and 24 months respectively. Results There were statistically significant differences in the distribution of sex, age, education, marital status, WHO staging, infection route, and baseline CD4+T lymphocyte count among 605 enrolled patients based on different treatment regimens. Liver function: The level of T-Bil in group E was higher than that of baseline at 9M, 12M, 18M and 24M after treatment (P<0.01); In group F, the level of T-Bil was higher than that of baseline at 9M after treatment (P=0.001); The levels of ALT in group C at the six follow-up points after treatment were higher than the baseline (P<0.001); The level of AST in group C was higher than that of baseline after 3M and 6M treatment (P<0.05). Renal function: The level of UREA in group C was higher than that in baseline after 6M treatment (P=0.007); The level of UREA in group F was higher than that in the baseline after 12M treatment (P<0.001); The level of UA in group F was higher than that of baseline after 3M, 6M and 12M treatment (P<0.05). Blood lipid and blood glucose: The levels of Glu at some follow-up points after ART treatment in group A and group C were higher than that at baseline (P<0.05); The levels of TG at some follow-up points in group A, group E and group F after ART treatment were higher than those at baseline (P<0.05); The levels of TC at some follow-up points in group A, group B, group C, group E and group F after ART treatment were all higher than the baseline (P<0.05). Conclusion Regular monitoring of changes in laboratory indicators of different treatment regimens during ART is of great importance to the prognosis of patients. Different laboratory indicators should be monitored according to different treatment regimens to effectively prevent adverse reactions caused by different treatment regimens.