4.HIV-Associated Neurocognitive Disorders--An issue of Growing Importance.
Lai Gwen CHAN ; Chen Seong WONG
Annals of the Academy of Medicine, Singapore 2013;42(10):527-534
INTRODUCTIONHIV-associated neurocognitive disorders (HAND) comprise a wide spectrum of cognitive, motor, and mood abnormalities prevalent in people living with HIV and AIDS (PLWHAs). This field of HIV medicine has gained renewed prominence in recent years with evidence contending that anti-retroviral agents with increased central nervous system (CNS) penetration may improve neurocognitive outcomes in those affected. This review aims at evaluating the available evidence and postulating further study direction in Singapore.
MATERIALS AND METHODSA PubMed search was carried out for original articles and systematic reviews on the subject of HIV-associated neurocognitive disorders, and the results reviewed by the authors.
RESULTSThere is a growing body of evidence that HAND is not uncommon, and the advent of highly active anti-retroviral therapy has increased its prevalence by improving the prognosis of HIV infection, and hence increasing the likelihood of diagnosing of this neurocognitive condition. Screening and diagnosing HAND is important, and requires clinical suspicion as well as validated test batteries for optimal accuracy. The authors recommend strategies for detection in the local context involving stepwise targeted screening. Anti-retroviral agents with good CNS penetration and activity, as well as adjunctive neuro-rehabilitative interventions, may improve the impairments experienced by affected individuals.
CONCLUSIONIncreased awareness of HAND, with earlier diagnosis and targeted, multi-disciplinary management of this challenging condition, may lead to better all-round outcomes for people living with HIV and AIDS in Singapore.
AIDS Dementia Complex ; Anti-HIV Agents ; therapeutic use ; Anti-Retroviral Agents ; therapeutic use ; Antiretroviral Therapy, Highly Active ; HIV Infections ; drug therapy ; Humans ; Neurocognitive Disorders ; Prevalence
6.Effects of Differential First-Line Antiretroviral Therapy (ART) Regimens on Mortality among HIV/AIDS Children in Southwest China: A 15-year Retrospective Cohort Study.
Qiu Li CHEN ; Yan Yan LIAO ; Shan Fang QIN ; Chun Yan LU ; Pei Jiang PAN ; Hai Long WANG ; Jun Jun JIANG ; Zhi Gang ZHENG ; Feng Xiang QIN ; Wen HONG ; Chuan Yi NING ; Li YE ; Hao LIANG
Biomedical and Environmental Sciences 2023;36(11):1079-1083
7.Key quality indicators of the China Comprehensive AIDS Response 2008 - 2011 Program.
Di WU ; Heng ZHANG ; Xin-lei YAO ; Yan CUI
Chinese Journal of Preventive Medicine 2012;46(12):1095-1098
OBJECTIVETo analyze the key indicators of China Comprehensive AIDS Response Program (China CARES) and the effects of this program during 2008 and 2011.
METHODSData were obtained from National AIDS Comprehensive Prevention and Control Information System. The general population HIV test rate and spouse of people living with HIV or AIDS (PLWHA) HIV test rate were chosen as the indicators for HIV testing expansion; anti-retroviral therapy (ART) coverage and PLWHA CD4 test rate during the past 6 months as the indicators for treatment expansion; femal sex worker (FSW) intervention coverage and injection drug users (IDU) intervention coverage as the Indicators for behavior intervention expansion. The Key working quality indicators of 309 program sites were calculated and the results were compared.
RESULTSDuring 2008 and 2011, for China CARES, the Median of general population HIV test rate were 1.8%, 2.5%, 3.2% and 5.5%, the Median of spouse of PLWHA HIV test rate were 80.9%, 85.7%, 91.8% and 100.0%, the Median of ART coverage were 60.0%, 66.7%, 76.1% and 92.0%, the Median of PLWHA CD4 test rate during the past 6 months were 27.7%, 45.4%, 58.6% and 75.3%, the Median of FSW intervention coverage were 43.8%, 67.8%, 73.3% and 90.9%, the Median of IDU intervention coverage were 18.2%, 24.0%, 34.0% and 72.4%. The indicators of China CARES increased steadily from 2008 to 2011 in HIV testing expansion, treatment expansion and behavior intervention expansion; Compared to 2008, the percentage of the China CARES which had great progress of the 6 indicators were 98.4% (304/309), 98.3% (286/291), 94.0% (281/299), 93.5% (288/308), 91.8% (279/304) and 90.0% (223/247). in 2008, 3 indicators which were ART coverage, PLWHA CD4 test rate during the past 6 months and FSW intervention coverage were lower than national average (6.9%, 17.9% and 30.9%), the general population HIV test rate, spouse of PLWHA HIV test rate and IDU intervention coverage were higher than national average (3.4%, 64.3% and 22.8%), with the China CARES project going on, in 2011, key indicators which were general population HIV test rate, spouse of PLWHA HIV test rate, ART coverage, PLWHA CD4 test rate during the past 6 months, FSW intervention coverage and IDU intervention coverage were all higher than national average (6.5%, 80.6%, 81.9% and 55.9%).the proportions of China CARES sites whose 6 indicators were higher than national average in 2008 were 32.7% (101/309), 60.6% (149/246), 37.4% (99/265), 61.1% (181/296), 64.0% (174/270) and 45.3% (73/161), and the proportions increase annually to 2011 were 44.0% (136/309), 89.3% (260/291), 76.6% (229/299), 77.9% (240/308), 91.4% (278/304) and 64.8% (160/247).
CONCLUSIONAn obvious achievements have been made in the areas of HIV/AIDS prevention and control among China CARES sites during 2008 and 2011 than the national average.
Acquired Immunodeficiency Syndrome ; drug therapy ; epidemiology ; prevention & control ; Anti-Retroviral Agents ; therapeutic use ; China ; epidemiology ; Humans ; Quality Indicators, Health Care
8.Overview of antiretroviral treatment in China: advancement and challenges.
Chinese Medical Journal 2011;124(3):440-444
As the severity of the HIV epidemic in China grew, National Free Antiretroviral Treatment (ART) Program was announced since 2003. Even though there still were many difficulties, China had obtained great achievements in fighting against HIV. Over 52 000 adult patients had received first-line HAART thus far and the mortality of AIDS in China decreased significantly. This paper presents an overview of the HIV/AIDS epidemic in China; the status of national free ART program, the difficulties suffered and the achievements made since the initiation of program and the challenges ahead for continued progress for China. This paper also provides suggestions to overcome these challenges.
Anti-Retroviral Agents
;
adverse effects
;
therapeutic use
;
China
;
epidemiology
;
HIV Infections
;
drug therapy
;
epidemiology
;
Humans
;
Lipodystrophy
;
chemically induced
9.Thirty years of the human immunodeficiency virus epidemic and beyond.
International Journal of Oral Science 2013;5(4):191-199
After more than 30 years of battling a global epidemic, the prospect of eliminating human immunodeficiency virus (HIV) as the most challenging infectious disease of the modern era is within our reach. Major scientific discoveries about the virus responsible for this immunodeficiency disease state, including its pathogenesis, transmission patterns and clinical course, have led to the development of potent antiretroviral drugs that offer great hopes in HIV treatment and prevention. Although these agents and many others still in development and testing are capable of effectively suppressing viral replication and survival, the medical management of HIV infection at the individual and the population levels remains challenging. Timely initiation of antiretroviral drugs, adherence to the appropriate therapeutic regimens, effective use of these agents in the pre and post-exposure prophylaxis contexts, treatment of comorbid conditions and addressing social and psychological factors involved in the care of individuals continue to be important considerations.
Anti-Retroviral Agents
;
therapeutic use
;
Antiretroviral Therapy, Highly Active
;
HIV
;
pathogenicity
;
HIV Infections
;
drug therapy
;
prevention & control
;
transmission
;
Humans
10.Study on drop-out from antiretroviral therapy among adult HIV-infected individuals in Dehong prefecture, Yunnan province.
Shitang YAO ; Yun SHI ; Pinyin LI ; Yuanwu XU ; Wenqin YANG ; Yindi ZHANG ; Chunying YIN ; Liuqing CUN ; Zhijian ZHAI ; Na HE ; Email: NHE@SHMU.EDU.CN. ; Song DUAN ; Email: DHDUANSONG@SINA.COM.CN.
Chinese Journal of Epidemiology 2015;36(7):667-671
OBJECTIVETo examine the proportion and reasons of drop-out from antiretroviral therapy (ART) among 8 367 adult HIV-infected individuals in Dehong prefecture, Yunnan province.
METHODSAll adult HIV-infected patients receiving ART before September 30 of 2014 were examined for the situation of drop-out from ART.
RESULTSThe proportion of drop-out from ART among adult HIV-infected patients in Dehong prefecture was 14.4% (1 202/8 367). Results from the univariate logistic regression analyses indicated that drop-out from ART was significantly correlated with factors as: living area, gender, age, marital status, HIV transmission route, baseline CD4⁺ T cell counts and initial treatment regimen of the patients. After adjusted for potential confounding variables by multiple logistic regression model, drop-out from ART was significantly correlated with residential area, marital status, HIV transmission route, baseline CD4⁺ T cell count and initial treatment regimen of the patients. HIV-infected patients who were living in Mangshi city, Lianghe county or Yingjiang County, being married or living with partner, HIV infection through sexual contact, with baseline CD4⁺ T cell counts ≤ 200 cells/mm³, and ART included in the initial treatment regimen etc., were less likely to drop out from ART. The proportion of drop out from ART was significantly decreasing along with the increasing time of ART. Data from specific investigation revealed that among the 1 202 patients who dropped out from ART, 704 (58.6%) were lost to follow-up, 303 (25.2%) did not adhere to treatment, 74 (6.2%) moved out the region, 64 (5.3%) were Burmese that had returned to Burma, 29 (2.4%) stopped the treatment according to doctors' advice, 18 (1.5%) were incarcerated and 10 (0.8%) were under other reasons. Reasons for the drop-out varied, according to the situation of patients.
CONCLUSIONThe proportion of drop-out from ART varied significantly according to the characteristics of HIV-infected patients in Dehong prefecture that underscoring the needs for tailored responses to reduce drop-out of ART. Focus should be targeted on reducing the loss to follow-up and improving the treatment adherence.
Adult ; Anti-Retroviral Agents ; therapeutic use ; China ; HIV Infections ; drug therapy ; Humans ; Patient Dropouts ; statistics & numerical data