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Background:This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus (HIV) patients in whom antiretroviral therapy (ART) was unsuccessful.Methods:In this retrospective study,a total of 9,418 HIV patients who failed in ART during 2004-2016 were included and divided into two treatment groups-Group 1 (treatment time ≤ 3 years,n1 =5,218) and Group 2 (treatment time ＞ 3 years,n2 =4,200).Patient follow-up data,including age,cluster of differentiation 4 (CD4) count,and viral load,glucose,creatinine,and triglyceride levels,were extracted from electronic health record databases.Covariance analysis for repeated measures was used to analyze the biochemical indicators,and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time.Results:The median initial CD4 count was 175.0 cells/μl (interquartile range,77.0-282.0),while the initial CD4 counts for Group 1 were lower than those for Group 2 (P ＜ 0.05).A significant interaction between group and time effects was observed (P ＜ 0.05) in total cholesterol (TC).Changes in hemoglobin level among HIV patients were also significantly associated with treatment time (P =0.001).The initial CD4 count (odds ratio [OR] =0.756),female sex (OR =0.713),Zerit (d4T) (OR =1.443),TC (OR =1.285),and aspartate aminotransferase level (OR =1.002) were significantly associated with the survival time of dead patients with HIV (P ＜ 0.05).Additionally,the initial CD4 count (OR =1.456),age (OR =1.022),time interval (OR =0.903),patient's living status (OR =0.597),d4T (OR =2.256),and triglyceride (OR =0.930) and hemoglobin levels (OR =0.997) were significantly associated with the treatment time of HIV patients with drug withdrawal (P ＜ 0.05).Conclusion:The initial biochemical parameters can affect the survival and treatment time of HIV patients.With a comprehensive understanding of the physiological and biochemical indicators of patients,we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.
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Background: The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy (HAART). However, the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern. The aim of this study was to determine factors influencing antiretroviral regimen changes among people living with HIV/AIDS in China. Methods: This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART, and gathered relevant information from infectious disease hospitals. The following information were collected: social-demographic characteristics, antiretroviral therapies, CD4 cell counts, virus loads, reasons for changing medication and other related data. Mean and percentages were used to describe the frequency of regimen change among patients, and binary logistic regression was employed to test the factors influencing regimen change. Results: 1,123 people who had experienced regimen change were included in the analysis. On average, patients remained on HAART for 10.2 months before changing regimen, and the average CD4 cell count and viral load (VL) were 383.1 cells/μl and 28,132.4 copies/mL respectively when changing regimen. The reasons for modification were determined as treatment failure (52.5％), adverse reactions (32.3％), and other reasons including pregnancy (15.2％). There are significant differences in regimen change among people with different genders (P<0.001), modes of transmission (P<0.001), duration of HAART (P<0.001) and initial CD4 cell counts (P=0.0024). Males, drug users, people taking long-term medication, and those with lower initial CD4 counts when starting HAART tend to change regimen. Conclusion: Treatment failure was the main reason for the change of HAART regimen. Males, drug users, people on long-term medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.
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@#Objective To analyze the status, trends and issues of professionals in rehabilitation institutions in China, and provide policy recommendations on rehabilitation professional development.Methods The data from database and statistical bulletin of CDPF has been analyzed using descriptive analysis and deviation analysis.Results The quantity of professionals of rehabilitation institutions increased 24,900 (12.62%) in 2016. Average professionals per institution had been decreased from 33.89 in 2012 to 28.33 in 2016. In regard to the structure of distribution, the rehabilitation professionals at provincial level had been decreased 21.95% in 2015 than that of in 2012. Both training programs and the number of trainees from rehabilitation institutions had decreased.Conclusion There were big gap between services provision and needs of professionals. The distribution of professionals at provincial, city and county level was under optimization. The on-job training for rehabilitation professionals should be improved. It is recommendated to develop national plan for professionals development to meet the needs of rehabilitation services, advance the on-job training for professionals, develop the higher education of rehabilitation and improve attractiveness of rehabilitation to retain and recruit more professionals.
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Objective To compare the phenylalanine(Phe)concentration in the sample of dried blood spot,measured by four different methods:fluorescence assay,tandem mass spectrometry(MS/MS), including MS/MS Derivatized,MS/MS Non-Derivatized and MS/MS-Standard Curve.Methods A total of 204 dried blood spot(DBS)samples of phenylketonuria(PKU)patients from Shanghai Xinhua Hospital were collected in this study.Phe concentration in DBS was measured by fluorescence assay and MS /MS assay,including MS/MS Derivatized, MS/MS Non-Derivatized and MS/MS-Standard Curve.The samples were divided into low, middle and high concentration groups according to Phe concentration, which were under the 360 μmol/L,between 360 and 600 μmol/L,and over 600 μmol/L respectively.The differences among the groups were analyzed by consistency check and non-parametric test.Results The within-day and between-day precisions of MS/MS-Standard Curve assay were 4.0%-7.2%,the recoveries were 93.2%-97.3%.Consistency check showed that less than 8.1%of Phe value were out of the 95%limit of agreement among these four methods.In the low and middle concentration groups,the quartile of Phe value measured by fluorescence assay,MS/MS Standard Curve and MS/MS Derivatized were 176(118,251)μmol/L,174 (94,273)μmol/L,153(94,242)μmol/L; and 540(478,578)μmol/L,485(414,529)μmol/L,466(402,513)μmol/L,respectively.Phe value measured by fluorescence assay was significantly higher than that by MS/MS Standard Curve,the difference was 4.8%-9.0%,(Z=-3.787 to -2.674,P<0.01). Phe value obtained from MS/MS Non-Derivatized was less than that by MS/MS-Standard Curve, the difference was 3.9%-5.2%,(Z=-7.474 to -5.747,P<0.01).In the high concentration group,the quartile of Phe value measured by MS/MS-Standard Curve, MS/MS Derivatized, MS/MS Non-Derivatized and fluorescence assay were 807(695,924)μmol/L,700(575,785)μmol/L,680(623,771)μmol/L and 711(674, 794)μmol/L, respectively.Phe value obtained from MS/MS Standard Curve was significantly higher than those from the other methods and the difference was 10.9% -16.2%,(Z=-4.458 to-4.356,P<0.01).Conclusions The MS/MS Standard Curve assay showed good specificity and accuracy.These four assays displayed good agreement.Although there was difference in measuring the Phe concentration among these methods, they could be used in blood Phe concentration monitoring for PKU patients.