DOH89-DC-1101年度成果報告本文b9

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展町吕
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1 The HIV/AIDS Control and Study Center

2 1 2 3~6 7~ ~13 14~22 23~27 27~ HIV/AIDS 30 31~32 ( ) 1~18 1~4 1~17 1~45 1~18 1~ ~160 2

3 (Highly active antiretroviral therapieshaart) Taiwan HIV Study Group HIV HIV 3

4 4

5 SARS HAART (HIV) ~15 5

6 (HAART) 6

7 ABSTRACT Objective: AIDS prevention, AIDS patient care and AIDS pathology. Methods: This is the first year of the HIV/AIDS Control and Study Center s Phase II five-year plan; continuing the work of Phase I five-year plan, follow-up on the patients undergoing highly active antiretroviral therapies (HAART) at the National Taiwan University Hospital and Taipei Municipal Sexual Diseases Prevention Center is conducted, covering lurking infection, clinical study and the ongoing new viruses. Under stable personnel structure, this year plans to continue using the center s software and hardware resources to explore the center s characteristics, mainly geared on clinical treatment, with secondary focus on basic research and behavior science, in strengthening clinical patient service, improve combination therapies and study of medication side effects. Active efforts will be directed at setting up Taiwan HIV Study Group, aiming to accrue all AIDS assigned physicians across Taiwan to engage in the relevant clinical studies to understand the local AIDS patients clinical symptoms, lurking infection treatment and prevention, especially with tuberculosis, AIDS patients willingness to seek treatment, high-risk behavior, and efficacy analysis of anti-virus medications, virus chromosomal drug-resistant study, and the mid-, long-term side effect studies of anti-virus drug related metabolic, osteological and cardiovascular diseases. The relevant computer programming already completed is reported in Appendix 1. 7

8 In terms of clinical treatment, to understand the correlations of tuberculosis patients concurrently contracting AIDS, and AIDS patients potential exposure to tuberculosis, Dr. Wang Chen-Tai conducted an initial study of Taiwan Prevalence of Tuberculosis Patients with AIDS, and Percentage Rate of AIDS Patients Presenting Tuberculosis Co-morbidity. The results are reported in Appendix 2. Additionally Dr. Chang Tien-Chun also actively partook in the investigation of preliminary study of varied cocktails treatment on insulin resistance. The detailed results are reported in Appendix 3. The broad impact exerted by AIDS infection ranging from psychology, society, culture, economy, law to politics, is mirrored in the complexity of handling; slight deviation can well lead to irrevocable adversity. The social worker Ms. Chang Li-yu at National Taiwan University Hospital is responsible for the study of AIDS patients support groups impact on the pattern of seeking medical treatment and stress behavioral change. The results are reported in Appendix 4. The basic medical research includes the joint study by Ms. Chao Miao-Fen and Ms. Huang Ju-Ching on the selective culture and function analysis of AIDS virus type I Rev and Nef proteins of human antibodies. The results are reported in Appendix 5. The main discoveries include: based on the calculation of current HIV infection increase rate, by 2011 Taiwan s aggregate medical treatment expenditure for AIDS infection will exceed 25 billion NTD, and by 2021, more than 100 billion NTD. The relevant loss in income earning and other social benefit cost will be manifolds the treatment outlay. If reckoned according to the actual number of HIV patients, the social cost is even more staggering. This 8

9 center s entire staff is committed to provide AIDS patients with the most appropriate anti-virus medications and lurking infection treatment; moreover the prescribing protocol is updated annually together with discussion on test scope and interval to provide a standard guideline for clinical physicians. Efforts are directly at conserving resources for maximum efficiency, and researches are predicated on economic treatment approach in the interest of AIDS patients in conjunction with strengthening the care system to avail support to the patients, their families and communities. Presently AIDS clinical study has shifted from the focus of related tumors and opportunistic infections to the more effective HIV control, medication treatment of co-morbidities and strategic halt. We fully appreciate that AIDS is not only a deadly disease, it seriously affect overall social development, reduce productivity, dissuade foreign investment, lower living standards, and even mitigate government and community strength. During the SARS outbreak from end March until end May, all infection staff of this center came forth to work the frontline, which had somewhat set back our research work. But normal operation was soon restored in June, and deferred progress caught up. Conclusion and Suggestion: The high efficacy of HAART has significantly driven down the concentration of HIV, improving the patients immunity to a certain level that enabled meaningful reduction in the statistics of the morbidity rate and mortality rate. The hospitalization length was reduced from the mean 36 days in 1995 to the present 9

10 10-15 day duration. Moreover, given high patient cooperation and medication compliance, approximately 90 per cent strong of patients returned to work after treatment. Nonetheless as immunity system still cannot be fully restored, although lurking infections of pneumocystis carinii pneumonia, cytomegalovirus retinitis and Kaposi s sarcoma have been significantly reduced, the occurrences of malignant tumor, amoebic liver abscess and lymphoma actually increased. Although early discovery and treatment may contribute to better recovery, but for end-stage patients or those who relinquished treatment, the efficacy will be prodigiously discounted. Keywords: HIV, AIDS, The HIV/AIDS Control and Study center, pneumocystis carinii pneumonia, cytomegalovirus retinitis, Kaposi s sarcoma, Highly active antiretroviral therapy, HAART, opportunistic infection, Taiwan HIV study group. 10

11 ( ) (1) : HIV/AIDS 1990 HIV 1992 HIV HIV/AIDS 10% HIV/AIDS HIV/AIDS (2) () 11

12 (HAART) Taiwan HIV Study Group committee HIV HIV

13 HIV 3. HIV 1. HAART abacavir (NRTI)+ 2NRTIs Kaletra (protease inhibitor)+ 2NRTIs efavirenz (nnrti) + 2NRTIs0612 (TG, Cholesterol, LDL, HDL)TNF-αIL-6leptin 3. Hitachi 7250 TNF-αIL-6leptin ELISA RIA 4. Chi-square teststudent s t test Fisher exact test P

14 () AIDS ( ) HAART 14

15 HIV HAART HAART 2001 ( ) 15

16 1/

17 HAART ~ Updated 17

18 Management of HIV Infections in Taiwan- Working to Success Dr. Renslow Sherer Dr. Kiat Ruxrungtham Dr. David Nolan The 10 th Conference on Retroviruses and Opportunistic Infections 18

19 Impact of Chronic Hepatitis B Infection on Outcomes of HIV-1 Infected Patients Receiving HAART in an Area Hyperendemic for Hepatitis B Infection: An Eight-year Prospective Observational Study The second Internation AIDS Society Conference on HIV Pathogenesis and Treatment The 9 th European AIDS Conference 1/16 Ecumenical HIV/AIDS initiative in Africa Dr. Sue Parry /9 AIDS The 7 th Taipei Conference on HIV/AIDS Working to success) (1) 19

20 Taiwan HIV Study Group HIV HIV (2) 20

21 (3) Rev Nef HIV retroviral vector Rev Nef (4)

22 23 1 ( ) (3) /1 92/12 $7,600,000 $5,507,407 $2,032,593 $60,000 $0 () 22

23 SARS SARS SARS 1997 HIV HAART AIDS 23

24 AIDS HIV HIV/AIDS 10% HIV HIV HIV/AIDS

25 AIDS WHO 6 HIV 2 95% (World Health Organization, WHO) HIV ; 14,000 (3) HIV 5,550 1,615 (4) HAART 25

26 WHO HIV HIV/AIDS HAART HIV (8) HIV HIV AIDS HIV HIV ABCDEFGHIO10 3TCd4T3 (saquinavirindinavirritonavir) 1997 HAART HIV HIV/AIDS 26

27 HIV HIV/AIDS (5) HIV (6) HAART (7) () Taiwan HIV Study Group Updated Management of HIV Infections in Taiwan- Working to Success 27

28 AIDS HAART AIDS 28

29 () :.1997: HIV/AIDS. 4. : Infectious Diseases Society of the Republic of China Taiwan AIDS Society: Guidelines for the use of antiretroviral agents in HIV-infected persons in Taiwan. 2001;July Hung CC, Chen MY, Hsieh SM, Sheng WH, Chang SC: Clinical spectrum, morbidity and mortality of acquired immunodeficiency syndrome in Taiwan: a 5-year prospective study. J Acquir Immune Defic Syndr 2000;24: Hsieh SM, Hung CC, Chen MY, Hsueh PR, Chang SC, Luh KT: Clinical features and outcome in disseminated mycobacterial diseases in AIDS patients in Taiwan: a prospective cohort study. AIDS 1998;12:

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