Study On Epidemiological Characteristics Of HIV/AIDS And Follow-up Management In Shanghai

At the end of October 2007,the cumulative reported HIV-infector and AIDS patients was 223,501,AIDS patients were 62,838,22,205 cases reported death.The estimated number of persons living with HIV in China at the end of 2007 was about 700,000(550,000 to 850,000),estimates of HIV prevalence was 0.05%(0.04%-0.07%). Including 85,000 AIDS patients(80,000 to 90,000 people);In 2007,the newly infected with HIV was 50,000(40,000 to 60,000 people).The existing 700,000 HIV-infectors who,with heterosexual contact was reported by 40.6%.Since 1987 Shanghai first found HIV infector,at the end of 2007 the cumulative reported HIV /AIDS was 3011, of which AIDS patients 311,125 patients died.The epidemic is still in an upward trend,the 2007 report of a 257.95 percent rise in 2003.The study was designed to Shanghai from 1987-2006 through the report of the HIV/AIDS epidemic data analysis,to understand HIV/AIDS prevalence and the main infection way of shanghai during nearly 20 years,to offer the policy and strategies of HIV/AIDS surveillance and control.The study also passed on some long-term follow-up of HIV infectors and AIDS patients with CD4+,CD8+T lymphocytes, describing CD4+,CD8+ T lymphocytes of people infected with HIV/AIDS in the initial discovery,observing CD4+ T lymphocytes in the dynamic changes after Anti-retroviral treatment,combining with the epidemiological investigation,to understand the immune cells changes of HIV/AIDS in different stages.Through in-depth interviews with individual methods,the study also learned about the evidence,awareness,experience and understanding of follow up HIV/AIDS on both sides as well as health services needs of HIV/AIDS patients,to find the impact factors of HIV/AIDS follow-up,to improve the management of policy and recommendations of HIV/AIDS,to promote the HIV/AIDS prevention,management and treatment.PartⅠAn analysis of epidemic of HIV/AIDS in Shanghai from 1987 to 2006Objective:To analyze the characteristics and trend of HIV/AIDS in shanghai from 1987-2006 in order to provide scientific evidences for HIV/AIDS prevention and control.Methods:To Analyze national HIV epidemic reporting information and epidemiological case investigation.Results:In 1987-2006,the HIV/AIDS surveillance number in shanghai was 2313 cases,of which 1,899 cases of men,women 414 cases. The age distribution ranged from 1 years to 83 years,the mean age being 33.08 years. The number of HIV infections of residents and of migrants living in Shanghai was 523 and 1790,respectively.Epidemiological survey showed the existence of different routes of transmission of HIV including drug injection 1032(44.62%),sexual contacts 492 (21.27%),contaminated blood/blood products transfusion 212(9.17%),mother to child 10(0.43%) and the unknown infections 462(19.97%).the routes of transmission of HIV in the HIV-infected residents including sexual contacts 50.10%,blood products transfusion 15.68%and drug injection 9.20%,mother to child 0.80%.The routes of transmission of HIV in the HIV-infected migrants living in Shanghai including drug injection 54.97%,sexual contacts 18.72%,contaminated blood/blood products transfusion 4.69%,mother to child 0.30%.In all the 2313 reports of cases,the cases of 2005 and 2006 reported was 50.28%of the total number,1,163 cases.Nearly two years,the main routeof transmission in the residents was sexual transmission(56.44%); migrants population in Shanghai was drug injection(56.18%).Conclusion: Surveillance of HIV/AIDS in Shanghai has been remarkably improved in recent years. The main HIV infectors in Shanghai was the young and middle-aged male migrants, main route of transmission is drug injection.Transmission of residence of Shanghai population was sexual transmission.The characteristics of transmission in Shanghai was diversity and complexity.PartⅡStudy of CD4+,CD8+ T Lymphocyte in HIV/AIDSObjective:To analyze the immunity level of HIV/AIDS in Shanghai and the relationship between CD4+,CDS+ T lymphocyte with AIDS progress,investigate the immunity development of AIDS after highly active antiretroviral therapy(HAART), thus provide the basis of HAART and effect evaluation.Methods: To study some of the follow-up HIV infectors and AIDS patients in Shanghai,analyze the CD4,CD8 cell count testing among HIV/AIDS,compare the first and last CD4 cell count in HIV/AIDS and the dynamic changes of CD4 cell count at different stages of HAART treatment(baseline,3,6,9,12,18months following ).Results:A total of 185 HIV/AIDS conducted CD4,CD8 counting,the mean value of CD4 was 297.21 /μl, CD8 was 976.13,CD4/CD8 was 0.3566,there is a remarkable difference in CD4,CD8 and CD4/CD8 between HIV/AIDS and normal values.The CD4 cell count and CD4/CD8 of HIV infectors were higher than AIDS(P＜0.01).Compare with the first and last detecting of the same HIV/AIDS in CD4 count,the first is higher than the last(P＜0.01).45 cases were received HAART,there was a rising trend in cumulative CD4 cell count rates,compared with the baseline values,the CD4 at 3,6,9,12,18 months increased significantly and the differences were statistics significant.This increase were particularly apparent in the first 3 months after treatment with 29.44/month,and tend to slow over time.Conclusion:The CD4 cell count and CD4/CD8 of HIV infected individuals were lower than the normal value,but CD8 cell count is higher than.CD4 and CD4/CD8 were obviously relevant with HIV infected time,which were getting down along with the time.CD4 and CD4/CD8 can be used as the sign of the progress of AIDS.CD4+ T lymphocyte response of AIDS patients can be effectively reconstituted by HAART.PartⅢQualitative study of Shanghai HIV/AIDS follow-up managementObjective:Qualitative study of Shanghai HIV/AIDS follow-up management set about suppliers and demanders(provide AIDS follow-up and prevention and treatment service for different types of population and HIV infectors and patients),to understand their knowledge,experiences and realization,describe their health service demand, explore existing important problems neglected through in-depth talking,seek probable factors impacting patients prevention and treatment effects,put forward proposals for the policy-making and promote HIV prevention,management and treatment.Methods: Through in-depth talking,we collected related information from suppliers and demanders,content analysis was applied to sort and coordinate,form different topics and classification.Results:Policies providers and medical workers of different levels delivered their viewpoints mostly about challenges and problems of Shanghai HIV prevention and control(low rate of HIV infectors,lack of necessary ensuring mechanism,joint efforts from multi sections,health promotion).HIV infectors and patients lack of related knowledge and policy understanding.Attitudes of scarce and discrimination to AIDS will influence the finding,follow-up.Diagnosis,and treatment need costly expenses and health education was not suitable to the conditions. Conclusions:discrimination is of the most important impeditive causes of acquiring follow-up and influencing life quality.Government should enforce ensuring measurements and policies of enough follow-up and treatments.Law and policies should be early implemented.We should immediately establish basic information database,closely observe and summarize the development rule and variety of disease spectrum,and improve scientific research.