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“PUMCH mode” brings better life to HIV carriers
CopyFrom: PUMCH UpdateTime: 2016-01-26 Hits: 101 Font Size: SmallBig

Man’s fight against the HIV virus has lasted 34 years since the report of the world’s first case by the United States in 1981. Thanks to the invention of cocktail therapy, the AIDS fatality rate in China has dropped from 22.6% in 2003 to 3.1% in 2012, a decrease of 86% in ten years.

“After solving the problem of ‘staying alive’, medical workers should focus more on bringing better life to HIV carriers and AIDS patients.” Prof. Li Taisheng from the AIDS Treatment Center, PUMCH, leading his team and working together with the hospital’s departments of cardiology, endocrinology, radiology, nephrology, hematology, clinical laboratory as well as CACT, carried out MDT and large-sample, prospective cohort studies, and cracked a series of clinical problems, many of which provided convincing evidence for revising the AIDS strategies of China and even Asia.

■Revealing drug contraindications for AIDS patients
Many HIV carriers have hepatitis B or hepatitis C. Will their liver functions be further damaged in cocktail therapy? Which drug is safer for them?
Prof. Li’s team was the world first to report that the rate for Chinese AIDS patients and HIV carriers to have hepatitis B is 14.6%, but also discovered that such infection does not affect the efficacy of domestically made first-line drugs at that time, or increase liver function damage. But the study also found that AIDS patients in active period of hepatitis C are more prone to skin eruption and liver damage after taking Nevirapine. 
“Before 2012, Nevirapine had been a must in non-nucleoside drugs in China’s triple medication of cocktail therapy. This discovery warns doctors that no Nevirapine should be given to AIDS patients in active period of hepatitis C,” said Li.
After 2012, Viread, a nucleoside drug, entered China’s cocktail therapy. Prof. Li, together with PUMCH’s Department of Nephrology, was the first to report that 16.1% of China’s HIV carriers had CKD before treatment, and after a year taking Viread, their creatinine level rose rapidly, indicating kidney function damage, while their creatinine clearance rate, indicating capability of expelling toxin, dropped obviously.  Therefore researchers warned doctors that attention should be paid to kidney functions before using anti-virus drugs on AIDS patients, and Viread must be used with caution for those of abnormal indicators.

■ Addressing side effects of anti-HIV drugs
HIV carriers are originally of lower bone mineral density than normal people. Prof. Li, in collaboration with departments of endocrinology and radiology, researched into the effect of Viread on the occurrence of osteoporosis among HIV carriers. Preliminary results showed at after taking Viread for one year the bone mineral density at spine, collum femoris and hip joint of patients dropped significantly.
“We found that patients’ age and weight are important factors in bone loss. In follow-up treatment we strengthened the monitoring of weight and for patients of substandard bone mineral density we gave timely instructions of physical exercise, diet and supplement of calcium,” said Li.
AIDS patients will see dramatic changes in their looks when lipids disorder occurs, which will affect their confidence and drug compliance. Prof. Li’s research revealed the difference between Chinese patients and European/American patients in lipids order expression. While western patients usually suffer from facial and limb fat transfer, resulting in buffalo bump and big belly, Chinese patients show the decrease or total loss of the entire amount of fat. Research has found out that Zidovudine or Stavudine, two nucleoside drugs, may cause lipids disorder, and, the longer of drug taking, the much bigger chance of facial and limb fat loss.
“For patients of lipids disorder, we had consultation with the nutrition department. We gave instructions on diet and changed drugs when necessary. Their lipids disorder was obviously checked and reached a level acceptable to themselves. The results were satisfactory. So far, among PUMCH patients, there is no serious bone loss or fracture related to anti-virus treatment, and there is no impact on drug compliance due to lipids disorder,” said Li.

■ Screening high-risk patients
AIDS patients, though gaining obviously extended life thanks to anti-virus treatment, face faster aging compared with ordinary people and will confront in an earlier time a string of problems regarding heart, blood sugar, neurocognitie (dementia) and depression.
The research team, based on two-year observation data by several research centers on 415 patients aged between 18-65, for the first time figured out that the occurrence of diabetes mellitus among Chinese AIDS patients is 2.62%, with an impaired fasting glucose at 35.64%, both higher than normal groups. Researchers also found that three factors highly contribute to the impaired fasting glucose—older age, concurrent infection of hepatitis B and high blood sugar upon first-time test—of which concurrent infection of hepatitis B was first reported in the world.
“These clinical expressions are highly visible and can help doctors pick out patients especially prone to diabetes mellitus, so as to achieve early diagnosis and treatment, avoid diabetes mellitus and its complications,” said Li.
So far, world studies on AIDS dementia complex have been very limited. PUMCH’s AIDS Treatment Center, together with its Department of Neurology, used the Montreal Cognitive Assessment (MoCA) to assess the cognition of AIDS patients. They found that cognitive problems were mainly shown in a decline of the brain’s execution capability, including cognition, memory, thinking, language and physical movement, which seriously affected their medicine taking and life quality. Nurses in the Center, according to assessment results and expert opinions, gave patients rehabilitation trainings based on different modules and taught their families the methods. Effective intervention has kept the medication compliance of patients with cognitive problems above 95%.

■Benefiting patients across the country
“The progress of our research depends on the platform of PUMCH: supported by the complete patient data bank and highly professional departments, we are able to research into MDT and translational medicine in an orderly, effective manner, and can realize full-course, individualized management and treatment from patients’ entering hospital, seeing doctors, consultation, follow-up treatment, risk assessment and comprehensive intervention,” said Li. Apart from the departments mentioned above, the research team also worked with the Department of Thoracic Surgery to perform lung cancer operations, with the Department of Radiology to perform CT-guided renal cyst aspiration, with the Department of Orthopedics for joint replacement, with the Department of Ophthalmology for eye operations, with the Department of Neurosurgery for decompressive craniotomy, and with the Department of Hematology for chemotherapy of lymphoma. “AIDS patients not only received anti-virus treatment here, but also medical treatment for other problems in their existence.”
It is learned that PUMCH’s MDT mode has created a follow-up rate of 99%, with no patient losing without reason; drug compliance raised to 99.2%, much higher than the internationally ideal rate of 95%; only 7.6% patients changed drug plan due to side effects, much lower than the national average of 18.7%; total virus suppression reached 96% after treatment, opportunistic infection dropped from 34.7% before treatment to 1.8%, and annual mortality was lower than 0.3%, reaching world advanced level; and 98% patients returned to society and led a normal life.
The research team also organized more than a hundred conferences and workshops, trained doctors, built up professional teams in demonstrative hospitals and gave instructions to local institutions, which provided technical and personnel support to the overall boost of AIDS treatment and decline of mortality in China.
“We established a comprehensive treatment system that connects multiple centers within the country and multiple departments within the hospital; we not only opened green channels between departments of PUMCH but carried out wide cooperation with other specialized hospitals, NGOs and AIDS hospitals across China, which opened multi-resource path for patients and fully met their medical needs,” said Li.