Study On People Living With HIV/AIDS In Rural Area Of Shanxi Province: A Prospective Cohort Study

1.Clinical response and adverse effects of Antiretroviral Therapy among HIV/AIDS patients in rural area:a prospective cohort study[Objective]The study aims to understand the effectiveness and toxicities of free antiretroviral therapy program for adult HIV-Infected people in China,so as to provide scientific evidence for better administering antiretroviral therapy(ART) and for future researches on ART.[Methods]All adult HIV-infected patients in Wenxi county of Shanxi province who started antiretroviral treatment(ART) between 01 July 2001 and 30 November 2008 and aged above 18 years were included in our cohort study.First,all patients underwent epidemiological investigation and laboratory tests at the initiation of the ART.Then,patients were followed up at months 0.5,1,2,3,6,9...after the initiation of ART,mainly to recognize adherence to the regimens,efficacy(CD4 cell counts) and drug toxicities.Data entry was using EpiData software and data analyses were performed using SPSS 11.0 software.[Results]From 01 July 2004 to 30 November 2008,a total of 188 HIV/AIDS patients were enrolled in our study.The average age of these patients was 43.9 years. Among them,61.7%were males and 38.3%females.Most of the patients were married(92.6%),under 8 years' education level(96.3%) and farmers(99.5%).The major routes of HIV transmission were commercial blood in the middle 90th.From the initiation of ART to the end of the study,the median follow-up time period was 38.0 months(IQR:19.0—43.0months).Over the duration of the follow-up, self-reported adherence was good in 97.8%of patients(adherence rate＞90%),53.9% patients reported never missing administering any antiretroviral drug dose.The results of the generalized estimating equation showed that after adjusting other factors, patients without clinical symptoms at baseline had an lower hazard of missing drugs than those with clinical symptoms at baseline,the odds ratio(OR) was 0.18(95%CI:0.06—0.56):patients with CD4 cell count＜50cells/ul at baseline had an lower hazard of missing drugs than those with CD4 cell count＞=50cells/ul at baseline, the odds ratio(OR) was 0.59(95%CI:0.35—0.99):Patients treated with EFV/IDV had a lower hazard of missing drugs than those with NVP,the odds ratio(OR) was 0.19(95%CI:0.08-0.46).Treatment was effective in most of the patients,the CD4 cell count of patients increased after the initiation of ART.Significant increases in the median CD4 cell count were found at all time points after treatment initiation(p＜0.001).And also the percentage of patients with CD4 cell count＜200cells/μl at all time points after treatment decreased significantly(p＜0.001).According to the results of the generalized estimating equation about the short-term effect,after adjusting the other factors,CD4 cell count had an average increase of 13.55cells/ul every three months; patients＜=40 years old had an average increase of 30.17cells/ul on CD4 cell count than those＞40years old;patients treated with EFV/IDV had an average increase of 33.81 cells/ul on CD4 cell count than those with NVP;CD4 cell count at baseline had a increase of 1 cells/ul,the treated patients had an average increase of 0.68cells/ul.Until the endpoint of our study,eleven patients had stopped the treatment during the follow-up,one patient lost to follow-up,twenty-five patients died of AIDS-related diseases,one hundreds-fifty-one patients still on treatment.The product-limit estimate of survival at3,12,24 and 54 months were0.90,0.88,0.87 and0.84,respectively. According to a mutivariate Cox's proportional hazard model,the hazard of death was significantly different with the CD4 cell count at baseline(＞=50cells/μl versus＜50cells/μl) and the type of initial regimens(NVP versus EFV/IDV).Patients with a CD4 cell count＞=50cells/μl at baseline had a lower hazard of death than those with＜50cells/μl at baseline,the HR was 0.27(95%CI:0.17-0.63).Patients treated with EFV/IDV had a lower hazard of death than those with NVP,the hazard ratio(HR) was 0.17(95%CI:0.04-0.72).Until the endpoint of our study,88.3%of patients presented with clinical and laboratory adverse events probably or definitely were attributed to antiretroviral treatment.The common adverse effects were nausea and vomiting(37.2%),poor appetite(35.6%)),fatigue(30.9%),skin rash(24.5%),peripheral neurotoxicity (21.8%),anemia(53.2%),hepatoxity(17.0%),and so on.87.2%of adverse effects were moderate,however there were 12.8%patients changed the initial regimens owing to adverse effects.According to the results of the generalized estimating equation,after adjusting the other factors,the incidence of nausea and vomiting,poor appetite and shin rash decreased over time;patients with clinical symptoms at baseline had higher incidence of poor appetite,shin rash and headache;female patients had higher incidence of nausea and vomiting;patients infected through commercial blood had higher incidence of fatigue;Patients with a CD4 cell count＞=50cells/μl at baseline had higher incidence of fatigue and headache.[Conclusions]ART is effective for HIV-infected adult people in Wenxi county despite initiation of treatment during the advanced stage of disease;Adverse effects are common with ART in HIV-infected people,including some drug-specific adverse effects,and thus regular monitoring is required according to the special time regularity of adverse effects.2.Study of the life status and quality of life among people living with HIV/AIDS in a rural area of Shanxi province[Objective]The study aims to understand the life status and quality of life(QOL) among people living with HIV/AIDS in a rural area of Shanxi province,so as to provide scientific evidence for promulgate the "Four Free and One Care" policy and better the quality of life and for future researches on QOL.[Methods]A cross-sectional study was conducted.All patients were HIV-positive and aged above 18 years.MOS-HIV scale,CES-D scale and ADL scale were used to ascertain quality of life,depression,activity of daily living and so on among PLWHAs.Data entry was using Epidata software and data analyses were performed using SPSS 11.0 software.[Results]A total of 195 PLWHAs were interviewed.The mean age was 45.6 years (25-64 years).Among them,119(61.0%) were male and 76(39.0%) were female. 152(77.9%) were married,and the majority of them(82.6%) were infected with HIV through commercial blood/plasma donation.Their main economic source were farm (62.6%) and working outside(33.3%).about 58.5%had the monthly incoming under 400 yuan.47.2%lived at the poor house.After they knew their status,71.8%received life aids,58.9%reduced school and miscellaneous expense of Compulsory education.Among those who were married,132 reported sex during the past six months and 87.1%consistently used condoms.Among those where were not married.4 reported sex during the past six months and 3(75%) of them consistently used condoms.For the last sexual act,condom use was reported by 92.3%of those who were married and 75%of those who were not married.146(74.9%) were on treatment.among them,90.4%used first line regiments, 94.5%did not forget taking medicine,the taking time and Medicine to diet request, 67.1%were Directly Observed Treatment by their family members and 97.9% examined their health regularly.163(83.6%) had different clinical symptoms and the depression rate were 66.4%.At dimensions involving Mental Health Summary Scores,General Health Perceptions,Energy,Quality of Life,Mental Health and Health Transition,men have got higher scores than women;At dimensions including Physical Functioning,Energy and Physical Health Summary Scores,younger groups have higher scores;At dimensions containing General Health Perceptions,Quality of Life,Mental Health, Physical Functioning and Role Functioning,higher incoming groups have higher scores;at all dimensions,patients with depression had lower scores than those without depression.[Conclusions]the majority of HIV/AIDS patients had poor economic status and suffered severe stigma;The proportion of condom use was high among PLWHAs, however there were still 7.7%-25.0%with risky sexual behaviors;the adherence rate were high but they still presented more clinical and depression symptoms;The MOS-HIV scale was suitable among PLWHAs in a rural area;Paying more attentions to Feminine,older,low incoming PLWHAs and patients with depression,will be helpful in enhancing quality of life on the population.