Syndromes Of The Patients With HIV/AIDS Before And After ART Treatment And Incomplete Immune Reconstruction

BackgroundSince the invention of antiretroviral therapy (ART), the death rate of HIV/AIDS declines and the survival period of HIV/AIDS have been extended significantly. However, there are still many problems, such as drug resistance, drug side effects, immune reconstruction incompletely, and so forth.The Traditional Chinese Medicine (TCM) has involved in HIV/AIDS treatments since the early eighties. The etiology and pathogenesis of the disease and syndrome characteristic have been partially clarified. However, few works have been focused on the etiology and pathogenesis as well as the syndrome before and after ART, especially for the patients with clinical immune reconstruction incompletely. In this case, we shed light on the patients with HIV/AIDS before and after ART in syndromes and those with the immune disorders of reconstruction, which aims to provide some reference for the clinical intervention by TCM, suggesting its clinical medicine significance.PurposeProviding some reference for the clinical intervention of Chinese Medicine (CM) to the HIV/AIDS patients, based on the investigation on the clinical symptoms, signs and syndromes of 486 cases before and after ART, and 63 cases of immune reconstruction incompletely,ObjectAll 486 patients with HIV/AIDS are from Beijing Youan hospital out-patients, which meet the disease diagnosis and inclusion criteria.ContentWe have carried out systematically the comparison analysis of the clinical improvements and changes of the syndromes before and after Antiretroviral Treatment (ART) of the patients with HIV/AIDS, which provides the theories for TCM treatment for the patients with HIV/AIDS in different periods. The syndrome classification has also been performed based on the 63 cases with immune function reconstruction incompletely to understand their TCM characteristic.Results(1) The ages of the patient are dominant by young adults. The proportion of those aged in the range from 20 to 40 is 79.01%. Career distribution shows nearly no obvious tendency. However, as compared to those in the past, the incidence of the students exhibit upward trend, accounted for 11.52%. Among the high education groups, those with college and higher degrees account for more than 40%. The route of transmission is mainly through the sexual way, in which the ones via MSM and opposite sex are 62%and 19.9%, respectively.(2)The overall treatment time of the patients shifts to an earlier time. The patients began to be treated often in less than a year infection time, which reaches more than a half (57%). The patients treated by both TCM and ART is obviously higher and higher (accounting for 25.51%). It seems that the number of underweight patients could be significantly reduced for nearly one times, and the proportion of the patients after the ART treatment decreased from 17.90% to 8.85%.(3)The statistic of the common clinical symptoms and signs before ART by frequency from high to low are:fatigue, lazy words, shortness of breath, joint pain, drowsiness, weight loss, bad breath, depression, sweat, easy to get cold, dry mouth, night sweats, and cold limbs, numbness, heavy body, pain, nasal congestion, tinnitus, eye pain, itchy skin, hair loss, swollen lymph nodes, difficulty swallowing, lymph node pain, body tremors. After one year ART, the clinical symptoms and signs, such as lethargy, depression, dry mouth, hair loss, swollen lymph nodes and lymph node pain, have not been improved yet.Before ART, the major symptoms of the patients with cerebrovascular system include dizziness, insomnia, forgetfulness. After ART, most of the symptoms have been improved. However, the proportion of the dyspnea patients reached up to 28%. Before ART, the lung system symptoms is often observed such as easy exogenous and bad cough, in which more than 20% of the patients often suffered from the cough. After ART, the lung system symptoms have been improved significantly.Before ART, the symptoms of spleen and stomach system are common. The incidence of anorexia, abdominal distension and swallow acid are always up to 70%,30%, and close to 40%, respectively. After ART, a part of the patients with nausea and stay are still existed.Before ART, the depressed and side-rib pain patients are ～90% and 30%. After one year ART, these symptoms have been improved significantly.Before ART, the cases with waist/knee pain, loss of libido and increased nocturia are more than 50%,～23% and 50%, respectively. After ART, those with waist/knee pain and increased nocturia are reduced to ～35% and ～30%, respectively.Before ART, the HIV-related rash incidence is up to 20%. After ART, it has been improved down to 9.26% with an abnormal fat distribution increased up to ～7.41%.(4) Before ART, the cases with white tongue coating, yellow tongue coating, greasy tongue coating, deep-red tongue, tooth-marked tongue, pale tongue, red tongue and plump tongue are 57.20%,28.4%,26.75%,14.81%,12.76%,13.99%,11.93%, and 7.82%, respectively. After one year ART, the cases with yellow tongue coating, thick tongue coating, greasy tongue coating and deep-red tongue are 16.05%,8.85%, 12.96% and 6.58%, respectively, suggesting a significant decrease.(5)Before ART, the deep pulse (48.77%), thready pulse (27.78%), wiry pulse (43.12%) and slippery pulse (37.45%) are often observed among the patients. After one year ART, the wiry pulse (30.04%), slippery pulse (24.69%), deep pulse (23.40%) and thready pulse (21.81%) are common.(6) Before ART, the top five syndromes are Liver-Kidney Yin deficiency(LKYD) (15.84%), deficiency of both heart and spleen (14.20%), lung-spleen qi deficiency (11.93%), stagnation of QI due to depression of the liver (7.82%), liver depression and spleen deficiency (9.26%). after ART, the top five syndromes are changed to the deficiency of both heart and spleen (15.43%), lung-spleen qi deficiency (13.79%), Stagnation of QI due to depression of the liver (13.58%), liver and kidney yin deficiency (9.47%), liver depression and spleen deficiency (8.23%).(7) Before ART, the levels of CD4+T cells are generally low. Among the 486 patients, 203 cases are <200/ul, accounting for 41.77%; 359 cases are< 350/μl, accounting for 73.87%; 448 cases are< 500/μl, accounted for 92.18%, respectively. After one year ART,68 cases are higher than 500/μl. The ones higher than 200/μlreach up to 340, accounting for 69.96%. However, there are still a few cases with invisible increase, in which the CD4+T cell counts of 58 cases are still less than 100/μl. After one year antiviral treatment, the viral load levels of most patients (87.24%) become below the detection limit.(8)As for the patients of immune reconstruction incompletely, the syndrome classifications are dominated by the deficiency of both heart and spleen (26.98%), spleen and kidney yang deficiency (19.05%), deficiency of kidney essence (14.29%), liver and kidney yin deficiency (11.11%), which account for more than 70% of the cases.Conclusions(1) The main population of HIV/AIDS patients is young adults currently, which shows an increasing trend. The infection transmission is dominated by the sexual way.(2) The treatment of the HIV/AIDS patients exhibits an advanced time than the past. More than a half of the patients begin to be received treatment within one year after infection.(3) Before and after ART, a variety of clinical symptoms and physical signs involved in each body system and organs could be often observed for the HIV/AIDS patients, which include fatigue, shortness of breath, less gas lazy words, joint pain, drowsiness, weight loss, and so on. After one year ART, most of the symptoms have been improved in various degrees. Meanwhile, the patients are suffered from different degrees of damage of cerebrovascular system, liver, spleen and stomach, and et al.(4) The common tongue image of the HIV/AIDS patients are white coating, yellow coating, thick and greasy fur. The main pulse characteristics are deep, thready, wiry and slippery.(5) Before ART, the common syndromes are Liver-Kidney Yin deficiency (LKYD), deficiency of both heart and spleen, lung-spleen qi deficiency, stagnation of QI due to depression of the liver, liver depression and spleen deficiency. After ART, the common syndromes are dominated by the deficiency of both heart and spleen, lung-spleen qi deficiency, stagnation of QI due to depression of the liver.(6) As for the patients of immune reconstruction incompletely, their common syndromes are deficiency of both heart and spleen, spleen and kidney yang deficiency, deficiency of kidney essence, liver and kidney yin deficiency.