Objective To explore the operative safety of HIV-infected patients with colorectal cancer in different degrees of immunodeficiency. Methods A total of 56 patients, including 26 cases of HIV positive (HIV-positive group) and 28 cases of HIV negative (HIV-negative group), who underwent radical operation for colorectal cancer between January 2012 and December 2015, were enrolled in our study. We divided HIV-positive patients into three groups according to CD4+ T cells count in peripheral venous blood before 1 day (D0) of the surgery (HIV-positive Ⅰgroup with CD4+ T cells count >500/μL, HIV-positive Ⅱgroup with CD 4+ T cells count among 200–500/μL, and HIV-positive Ⅲ group with CD4+ T cells count <200/μL). Non-infective patients were enrolled in HIV-negative group. Leukocyte count, neutrophil percentage, lymphocyte percentage, CD 4+ T cells subsets count, and CD8+ T cells subsets count of the 4 groups in different time points were tested. In addition, we compared postoperative complications, carcinoembryonic antigen (CEA), and postoperative survival rate between the HIV-positive group and the HIV-negative group. Results In 56 cases, there were 26 cases of HIV-positive patients (including 10 cases of HIV-positive Ⅰ group, 8 cases of HIV-positive Ⅱ group and 10 cases of HIV-positive Ⅲ group). Variance results about repeated measurement data showed that, variation of leukocyte count, neutrophil percentage, lymphocyte percentage, and CD8+ T cells count among 4 groups after surgery had no statistical significance (P>0.05), in addition there was no significant on time effect and interactive effect of time and group (P>0.05). CD4+ T cells count in the 4 groups showed a trend from decline to rising with time going, and the time effect had statistical significance (P<0.05). The speed and amplitude of decline and recovery of CD4+ T cells count were different among groups, and the group effect had statistical significance (P<0.05). CEA showed a trend of decline after surgery in both HIV-positive group and HIV-negative group, and the time effect had statistical significance (P<0.05), but the group effect and interactive effect of time and group had no statistical significance (P>0.05). No statistically significant differences in amount of blood loss, duration of surgery, postoperative stay, nor complication rate (including incision infection, pulmonary infection, and opportunistic infections after surgery) were found between the HIV-positive group and the HIV-negative group (P>0.05). The overall survival situation of the HIV-positive group and the HIV-negative group had no statistical significance (P>0.05). Conclusions Radical operation for HIV-infected patients with colorectal cancer has an impact of " first inhibition and recovery” on cellular immunity over a period of time. Incidence of postoperative complications and survival rates are similar in HIV-positive patients and HIV-negative patients. In a word, it’s safe to have radical operation for colorectal cancer in HIV-positive patients under the proper perioperative treatment.
Objective To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment of avascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection. Methods The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treated with cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips) without HIV infection, who were treated with cementless THA during the same period, were collected as control (negative group). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between 2 groups (P<0.05). There was no significant difference in the Ficat stage of ANFH between 2 groups (P>0.05). The operation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization time were recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the position of the prosthesis. Results The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25 months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than that of positive group (t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate of blood transfusion, and hospitalization time between 2 groups (P>0.05). There was no significant difference in Harris score between 2 groups before operation and at 1, 3, 6, and 12 months after operation (P>0.05). There were 2 cases of superficial infection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficial infection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening and sinking of the prosthesis occurred in both groups during follow-up. Conclusion Cementless THA is a safe and effective method for ANFH in patients with HIV infection.
Patients with acute human immunodeficiency virus (HIV) infection are the critical source of infection due to high viral load and strong transmission ability. The vast majority of patients in the acute infection stage have no or only mild clinical symptoms, and their screening and diagnosis often rely on laboratory tests. However, there are still some difficulties in early screening and detection for HIV infection due to the detection window period. In recent years, laboratory testing for acute HIV infection has made great progress. This article reviews the progress in laboratory testing of acute HIV infection, in order to provide a reference for follow-up related research.
Objective To evaluate the relation of human immunodeficiency virus (HIV)-1 ribonucleic acid (RNA) loads in cerebrospinal fluid with central neurological diseases. Methods The inpatients with HIV-1 infection diagnosed by Public Health Clinical Center of Chengdu between January 1st, 2015 and March 1st, 2018 were retrospectively included. The included patients were divided into central neurological disease group and non-central neurological disease group, and high viral load group and low viral load group. The demographic data, CD4+ T lymphocyte count, routine detection of cerebrospinal fluid, HIV RNA load in cerebrospinal fluid and plasma of patients with and without central neurological diseases were observed and compared.Multiple logistic regression analysis was used to identify risk factors for central neurological diseases. Results A total of 367 patients were included. In the central neurological disease group, 210 cases (57.22%) were complicated with central neurological diseases, and cryptococcus infection was the most. Compared with the non-central neurological disease group, the increase rate of cerebrospinal fluid cell counts, cerebrospinal fluid cell counts, cerebrospinal fluid HIV RNA positivity and cerebrospinal fluid HIV RNA load were higher in the central neurological disease group (P<0.05). Logistic regression analysis showed that HIV RNA load in cerebrospinal fluid≥100 000 copies/mL and CD4+ T lymphocyte count<200 cells/mm3 were risk factors for central neurological diseases. Conclusion Cerebrospinal fluid HIV RNA load≥100 000 copies/mL is an independent risk factor for HIV/AIDS patients with central neurological diseases and clinical treatment should take this factor into consideration to reasonably optimize the selection of antiretroviral therapy.
Objective To explore the clinical characteristics, diagnosis and treatment plan of pulmonary lymphomatoid granulomatosis in order to deepen the understanding of this disease. MethodsA case of pulmonary lymphomatoid granulomatosis complicated with tuberculosis and human immunodeficiency virus (HIV) infection was reported. Literature reviews were searched in PubMed database with "pulmonary, lung, lymphomatoid granulomatosis" as the key words, and in China Knowledge Network and Wanfang database with "lung, lymphomatoid granulomatosis" as the key words. The search time was from January 1, 2017 to December 31, 2021. ResultsThe patient was diagnosed as pulmonary tuberculosis at the beginning of the disease, and the lesion was obviously absorbed and improved after regular anti-tuberculosis treatment. Six months after anti-tuberculosis treatment, chest CT examination showed multiple new circular nodules in both lungs. Intensive anti-tuberculosis treatment did not improve, further lung biopsy, pathology revealed lymphomatoid granulomatosis, grade 2; During the period, HIV infection was proven, and the patient underwent anti-viral infection and re-examination of chest CT lung lesions significantly improved absorption. Literature reviews found 47 same patients, therefore totally 48 patients were analyzed, in which this former case was included. Among the 48 patients, 26 were male (54.2%) and 22 were female (45.8%), with a median age of 60 years old (4 to 87 years old). The most common symptoms were cough, fever and shortness of breath, some of them may be accompanied with fatigue, weight loss, night sweats and loss of appetite. 20.9% of the patients had rashes, mainly manifested as erythema or papules. 39.6% of the patients were accompanied by immune system related diseases or immunosuppressants; The most common manifestations of chest CT were multiple nodules or masses involving both lungs. The main way of diagnosis was surgical lung biopsy, or CT-guided lung puncture biopsy. The positive rate of bronchoscopy biopsy was low. The pathological grade was mainly grade 3 (56.3%). The treatment plan was mainly R-CHOP, with an effective rate of 71.4%. For patients considered drug-induced disease, it was necessary to stop using induced drugs first, and then combined chemotherapy if there was no improvement. For HIV-infected patients, highly active antiretroviral therapy should be given first, if there was no improvement, then took combined chemotherapy; Of the 48 patients, 41 patients had clear follow-up results with a median follow-up time of 12 months, of which 14 patients were dead (34.1%), and the others got better in different degrees. Conclusions Pulmonary lymphomatoid granulomatosis is a rare disease. Clinicians should improve their understanding of it in order to identify the disease early, and choose the appropriate treatment scheme to improve its prognosis.
Objective To analyze the clinical data of monkeypox (mpox) cases in Chengdu, to investigate the clinical characteristics of patients with mpox complicated with human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS), and provide reference for clinical diagnosis and treatment. Methods Mpox patients admitted to Public Health Clinical Center of Chengdu between June 29 and August 8, 2023 were continuously included. Patients were divided into an observation group and a control group based on whether they were complicated with HIV/AIDS. The clinical characteristics of two groups of patients were observed and compared. Results A total of 56 patients were included, all of whom were male; Age range from 19 to 51 years old, with an average of (31.6±5.9) years old; There were 23 cases in the observation group and 33 cases in the control group. Except for age, perianal lesions with infection, number of rashes, diarrhea, CD4+ lymphocyte count, CD4/CD8 ratio, syphilis, chest CT abnormalities, rash duration, and length of hospital stay (P<0.05), there was no statistically significant difference in epidemiological data, clinical features, auxiliary examinations, treatment, and intensive care unit admission between the two groups of patients (P>0.05). There was a statistically significant difference between the Ct values of throat swab nucleic acid and blister fluid nucleic acid in the total population [(30.1±4.4) vs. (23.4±3.8); t=5.462, P<0.001]. Conclusions Mpox patients complicated with HIV/AIDS are prone to persistent, diverse, and severe lesions due to relatively lower CD4+ lymphocyte counts. Therefore, it is necessary to actively provide symptomatic treatment and prevent complications for patients.
Human immunodeficiency virus (HIV) infection mainly attacks the human immune system, causing a variety of opportunistic infections and tumors, among which neoplastic diseases are serious and life-threatening. In recent years, with the popularization of highly effective anti-retroviral virus, the disease spectrum of HIV infected people has changed greatly, the incidence of non-acquired immune deficiency syndrome (AIDS) related tumors has increased significantly, and the diagnosis rate of esophageal cancer patients with HIV/AIDS has also increased. However, there is no consensus on how to standardize the diagnosis and treatment of esophageal cancer patients with HIV/AIDS. This article reviews the epidemiological characteristics, diagnosis and treatment of esophageal cancer patients with HIV/AIDS.