Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei (PM) infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results (1) The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture.All the 12 cases (100％) had irregular fever (38-41 ℃) and enlarged lymph nodes, 8 cases (66％) had skin rashes; 8 cases (66％) had hepatomegaly; 9 cases (75％) had splenomegaly while 8 cases (66％) had anemia. (2) Imaging manifestation: Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 zases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung,and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS (CD4T lymphocytes ＜50/μ L) with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver,spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of "cakes".

中国艾滋病诊疗指南(2018年版)

Acquired immunodeficiency syndrome (AIDS) is an important public health problem in China. In 2005, the first edition of the guidelines for the diagnosis and treatment of AIDS was formulated by the AIDS Professional Group of Society of Infectious Diseases of Chinese Medical Association, which was updated twice in 2011 and 2015. The fourth edition of the guidelines in 2018 is revised on the basis of national clinical practice and the latest research studies. The new research progress in opportunistic infections and human immunodeficency virus(HIV) associated cancers, antiretroviral therapy, HIV post-exposure prophylaxis, and prevention of mother to child transmission were updated in these guidelines. In the 2018 edition, pre-exposure prophylaxis is mentioned for the first time. The strategy of whole course management of HIV infection is put forward in the current version, which needs the participation of multidisciplinary team in prophylaxis, early diagnosis, individualized treatment and humanistic care.

Current human immunodeficiency virus epidemic and its response in China

The first patient with acquired immunodeficiency syndrome (AIDS) was identified in 1985; since then, as of October 31, 2010, a total accumulative number of 370 000 patients with human immunodeficiency virus (HIV)/AIDS have been reported. The estimated number of patients living with HIV (PLHIV) in China was 740 000 in 2009. Although China is still a low-HIV prevalence region (rate of 0.057%), the epidemic has spread more widely from the high-risk groups to the general population. This paper covers five topics of importance, i.e., current trends of the HIV epidemic; HIV-1 subtype diversity; emergence of HIV drug resistance (HIVDR); the country's response to the disease; and future challenges and additional actions needed. This paper emphasizes sexual transmission as the predominant route of transmission and it being spread more frequently among men who have sex with men; the epidemic being concentrated over particular areas in China. We also discuss the fact that diverse HIV-1 subtypes have been found throughout the entire country and that recombinant subtypes became predominant. We also explore other topics such as the possibility of HIVDR, including primary and secondary resistance, with the use of free highly active anti-retroviral therapy (HAART); the integrated strategy of HIVDR surveillance and individual clinical HIVDR testing as a new attempt in China. For many years both policy-makers and professionals (including non-governmental organizations) have expressed strong commitment to prevention, control, and care of HIV/sexual transmission infection (STI), promoted the research and conducted different actions to slow the rising trend of the HIV epidemics. Although China is facing many challenges, its citizens need to be persistent on continuing the campaign of the State Council titled "Information of Strengthening Work on Prevention and Control of AIDS".

人类免疫缺陷病毒感染者不同疾病阶段中自然杀伤细胞和γδT细胞的改变

目的 了解NK细胞和.γδT细胞在HIV/AIDS患者不同疾病阶段中的改变特点,探讨其在AIDS发病机制中的作用.方法 以311例未接受过抗HIV治疗的HIV/AIDS患者为研究对象,经流式细胞仪检测患者外周血CD4+T淋巴细胞、NK细胞和γδT细胞比例及计数,根据CD4+T淋巴细胞<0.20×109L、(0.20～0.35)×109L及>0.35×109/L.将病例分为低、中、高CD4+T淋巴细胞组,进行组间比较.Mann-WhitneyU检验和Kruskal-Wallis检验进行两组和多组独立样本秩和检验,Spearman和Pearson检验进行相关性分析.结果 HIV/AIDS患者外周血NK细胞比例及计数的中位数分别为8.4%和103×106L,γδT细胞比例及计数中位数分别为3.4%和41×106L,均明显低于健康对照组(Z=-5.029,Z=-7.723,Z=-2.437,Z=-6.063;均P<0.01).低、中、高CD4+T淋巴细胞组CD4+T淋巴细胞计数中位数分别为0.062×109L、0.276×109L、0.482×109L,NK细胞计数分别为89×106L、97×106L、146×106L,低、中CD4+T淋巴细胞组间的NK细胞计数差异无统计学意义,但均显著低于高CD4+T淋巴细胞组(Z=-3.392,P=0.001;Z=-4.849,P<0.01).低、中、高CD4+T淋巴细胞组γδT细胞计数中位数分别为29×106L、43×106L、59×106L,两两之间比较均差异有统计学意义(P<0.05).结论 HIV感染后外周血NK细胞和γδT细胞数量降低程度存在差异.