| ObjectiveWith investigation of the type and incidence rate of opportunistic infections in HIV/AIDS patients in middle rural areas of China and analysis of immune status of follow-up of HIV-infected/AIDS patients by comparison to the relationship among CD4＋T cells counts and HIV viral load, this study aim to learn the relationship of opportunistic infections and mortality of HIV/AIDS patients whose HIV infection due to blood collection and supply channels by one year follow-up, so as to provide scientific basis to combat and control to opportunistic infections in HIV/AIDS patients in our country.Materials and MethodsInitial survey of 390 HIV/AIDS was taken in the type of opportunistic infection, treatment and clinical symptoms by means of prospective cohort design, selecting a higher concentration of people living with AIDS as a queue, follow-up of 12 villages in Tanghe County, Henan Province; CD4＋cells counts, viral load, drug resistance and antibodies IgM of Toxoplasma gondii were tested through venous blood, sputum was collected to examine Mycobacterium tuberculosis and Pneumocystis carinii carini, oral secretions collected were examined for fungi. After one year recruitment cohort had been tracked follow-up and investigated, and learned the mortality rate and major factors influencing of HIV patients infected by blood way.Results1. Queue the population characteristic of the follow-up study390 HIV/AIDS infected people in Tanghe County, Henan Province were recruited according to the inclusion criteria, including men of 194 (49.7%), women of 196 (50.3%); mean age of 44.95 years old; 338 HIV/AIDS patients had been treated, the time of therapy ranged from 4 months to 70 months, the average treatment time was 38.6 months.2. Queue research on opportunistic infections and relevant results(1) Of 390 HIV/AIDS patients, oportunistic infection were accounted for 47.3%(185/390), CD4＋cell counts and oportunistic infection showed statistically significant (p<0.05), while the oportunistic infection rate in the group of CD4＋cell counts less than 200/μ1 (59.57%) was higher than 200-500 cell/μl and 500/μ1.(2) 309 HIV infection patients of first survey who have accepted antiviral therapy accounted the recruitment of the people for 79.2%. The incidence of opportunistic infections in patients accepted antiviral therapy was 47.9%(148/309), while the rate of opportunistic infection in patients unaccepted antiviral therapy was 40.7%(37/91). CD4＋cell counts in patients accepted antiviral therapy (363.6/μ1) was lower than patients unaccepted (399.1/μ1)262 HIV/AIDS subjects were recuited in the follow-up study after 12 months antiviral therapy. For the patients accepted antiviral therapy during 12 months, incidence of opportunistic infections in patients of 12 months follow-up was 50.4% (132/262), significantly lower than that in patients of first invegation (38.5% 101/ 262) (p<0.05). CD4＋cell count rise from 376μ1 to 398μ1 after 12 months of follow-up study, and there is a statistical significance (p<0.01). For patients unaccepted antiviral therapy,60 HIV/AIDS subjects were recuited in the follow-up study. The rate of opportunistic infections in patients of 12 months follow-up was 40.0%(24/60), significantly higher than that in patients of first invegation (68.3%41/60) (p<0.05). CD4＋cell count fall from 403.7μ1 to 368.9μ1 after 12 months of follow-up study.(3) 7 of patients (35%) had shown opportunistic infection but no resistance mutation after highly active antiretroviral therapy (HAART) in the first investigation. After resistance mutation,23 of patients (34.8%) had shown opportunistic infection. The two groups do not have statistics differences.3. Analysis of risk factor of death 13 patients was dead in the first survey of 12 months of follow-up, rate of death was 36.87/1000 people year (95%CI 16.83-56.91); main reason of death was the opportunistic infection, account for 69.2%(9/13); multi-factors cox regression shows that opportunistic infection and CD4 cell counts (< 200μ1 vs.> 200μ1) in patients was significantly associated with patients with resistance gene and dead patients (P<0.05), risk ratio was 5.21 (1.66-16.38)and 8.69(95% CI:2.21-34.09) and 4.08(95% CI:1.25-13.35) separately.Conclusion1, The incidence of opportunistic infections of HIV/AIDS patients in cohort after HAART was very high.2, Incidence of opportunistic infections of HIV/AIDS patients with the CD4＋cell counts less than 200 cell/μ1 is high. Different prevention and treatment methods should be taken according to different immune levels.3, Opportunistic infections, Low CD4＋T lymphocyte counts level and genotypic drug resistance served the most frequent cause of deaths in this study, which implied that prevention and control of the opportunity infection should be done, the scope of drug resistance monitoring should be expanded and the prescription be adjusted in time, thus extend living time of AIDS patients.
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