Tai-sheng Li

Peking Union Medical College Hospital, Peping, Beijing, China

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Publications (58)20.93 Total impact

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    ABSTRACT: BACKGROUND: Despite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. To increase the knowledge of FUO, we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years. METHODS: The clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital (PUMCH) between January 2004 and October 2010. Furthermore, the results were compared to that reported in previous studies of FUO in PUMCH since 1985. RESULTS: Of the 997 FUO cases, definite diagnosis was eventually achieved in 797 (79.9%) patients. The most common cause of FUO was infectious diseases (479 cases, 48.0%), with tuberculosis accounting for 45.3% (217/479) of the cases of infections. One hundred and sixty-eight (16.9%) patients were diagnosed with connective tissue diseases, with Still's disease and vasculitis accounted for 31.5% (53/168) and 24.4% (41/168) of this category, respectively. Neoplasms and miscellaneous causes were found in 7.9% (79/997) and 7.1% (71/997), respectively. However, no definite diagnosis had been made in the remaining 200 (20.1%) cases until they were discharged from the hospital. CONCLUSIONS: During different periods, infectious diseases, especially tuberculosis, were the leading etiology of FUO and the proportion of tuberculosis had no significant difference. While the frequency of neoplasms was descending, the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.
    Chinese medical journal 03/2013; 126(5):808-812. · 0.90 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the etiological and clinical characteristics of fungemia in Peking Union Medical College Hospital. METHODS: Microbial and clinical information of patients with fungemia consulted in Peking Union Medical College Hospital during 2008 to 2010 were retrospectively analyzed. RESULTS: A total of 70 patients were diagnosed with fungemia, and 100% of them had underlying diseases or potential risk factors. Of them, 40 (57.1%) patients were monomicrobial fungemia, and the other 30 (42.9%) patients with positive blood cultures were caused by at least two different microbes during hospitalization. Among 122 strains of microbes isolated from blood cultures, 72 were fungi and 50 were bacteria. Among the isolated fungi, 61 (84.7%) were Candida species, 31 (50.8%) were Candida albicans and 30 (49.2%) were non-albicans. According to the colonization or infected sites other than blood of the isolated fungi, 35 cases (50.0%) were primary fungemia; 18 (25.7%) were colonizing at lower respiratory tract simultaneously; 10 (14.3%) caused central-line related fungemia; 3(4.3%) were secondary to intra-abdominal fungal infection; and another 4 (5.7%) isolates had multiple colonization sites. During hospitalization, 37 cases died with a crude mortality rate of 52.9%, and 22 (32.9%) died of fungemia itself. In single factor analysis, ICU hospitalization (χ(2) = 15.136, P < 0.001), operation history within 30 days (χ(2) = 3.540, P = 0.060) and invasive mechanical ventilation (χ(2) = 4.450, P = 0.035) were related to crude mortality. Bacteremia during hospitalization (χ(2) = 5.657, P = 0.017), circulatory underlying diseases (χ(2) = 3.399, P = 0.065) and ICU treatment (χ(2) = 4.955, P = 0.026) increased attributable mortality. In the multivariate analysis, ICU history increased mortality during hospitalization, however, the operation history within 30 days was independently irrelevant to crude mortality during hospitalization. ICU history and bacteremia during hospitalization were independently correlated to attribution mortality of the patients with fungemia. CONCLUSIONS: Fungemia, usually accompanied with bacteremia, occurs often in the patients with underlying diseases. Patients with fungemia have poor prognosis and more than 50% patients die. ICU history increases the risk both to crude and attributable mortality. The patients with fungemia who had polymicrobial bloodstream infection have a higher attribution mortality. Operation history within 30 days is independently negatively correlated to attributable mortality.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 12/2012; 51(12):952-956.
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    ABSTRACT: Background. Listeriosis is an emerging infectious disease associated with high mortality. There are few published reports from the Far East and developing countries. Our goal was to describe the clinical characteristics and outcomes of patients diagnosed with Listeria monocytogenes at a tertiary care hospital in Beijing, China.Methods. Peking Union Medical College Hospital (PUMCH), an 1800-bed hospital, consists of two campuses that house different medical departments. We retrospectively reviewed all culture-proven cases of listeriosis occurring at PUMCH between 1999 and 2011. Point estimates and 95 percent confidence intervals are presented.Results. There were 38 cases of listeriosis: 5 neonatal, 8 maternal, and 25 non-maternal cases. The median age of the adult non-maternal cases was 47 (range 18-79) years with a female predominance (72%). Forty percent (N=10) had an underlying rheumatic disease. Forty four percent (N=11) were healthcare-associated infections occurring a median of 20 (range 3-44) days after hospital admission. Only two of the eleven healthcare-associated cases clustered in space and time. One healthcare-associated case occurred in a patient receiving KHI-272 therapy, an oral, irreversible dual EGFR/HER2 inhibitor. The neonatal and maternal listeriosis cases were similar to those reported in the literature.Conclusions. Non-clustered healthcare-associated cases of L. monocytogenes occurred at a large tertiary care hospital in Beijing, China. The source of these infections is unclear. Although rare, in the setting of immunosuppression, listeria should be considered in the differential diagnosis of healthcare-associated infections- even in the absence of a point-source outbreak.
    Clinical Infectious Diseases 11/2012; · 9.37 Impact Factor
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    ABSTRACT: To evaluate the influence of long-term nucleotide reverse transcriptase inhibitors (NRTIs) on lipids metabolism in HIV/AIDS patients and correlating clinical factors. A total of 118 HIV/AIDS patients were divided into 3 groups: untreated group (40 patients), highly active antiretroviral therapy (HAART) for 1 - 2 years group (37 patients) and HAART over 5 years group (41 patients), with 20 healthy individuals as the control group. Clinical lipodystrophy (LD) was defined as concordance between patient's report of change and physical examination. Fat mass (FM) was measured by dual-energy X-ray absorptiometry (DXA). There was no significant difference in the incidence of LD between HAART for 1 - 2 years group and HAART over 5 years group (51.2% vs 40.5%, P = 0.345). The prevalence of LD was 2.4 folds with strvudine (d4T) treatment compared with zidovudine (AZT)-containing regimens (61.6% vs 23.5%, P = 0.001). Based on DXA measurements, FM of total body and limbs were significantly lower in the HAART over 5 years group than that in the control group, the untreated group and the HAART for 1 - 2 years group (P < 0.05). Trunk FM was significantly lower in the HAART over 5 years group than the untreated group and the HAART for 1 - 2 years group (P < 0.05). FM of total body and trunk were significantly lower in patients without LD in the HAART over 5 years group than patients without LD in the HAART for 1 - 2 years group (P < 0.05). FM was correlated positively with body weight and BMI. Limbs FM was correlated negatively with peripheral blood triglyceride concentration. HIV/AIDS patients with NRTIs therapy have high prevalence of LD, which mainly occurs 1 - 2 years after therapy, and increases with d4T treatment compared with AZT-containing regimens. There was no significant difference in the incidence of LD between the HAART for 1 - 2 years group and the HAART over 5 years group. FM was significantly decreased after long-term HAART in the patients with or without LD. DXA can evaluate LD objectively and guide further clinical treatment.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 11/2012; 51(11):859-62.
  • Yi-Jia Li, Huan-Ling Wang, Tai-Sheng Li
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    ABSTRACT: This review discusses progress in the studies of hepatitis B virus (HBV)/human immunodeficiency virus (HIV) coinfection and focuses on the interaction among HIV infection, chronic HBV infection, and host immunity. Data and studies published mainly from 2008 to 2011 were selected using PubMed. Original articles and critical reviews concerning HBV/HIV coinfection and HBV and HIV pathogenesis were selected. HIV may accelerate HBV progression by lowering CD4 count, weakening HBV-specific immunity, "enriching" HBV mutants, causing immune activation, etc. On the other hand, HBV may enhance HIV replication by activating HIV long terminal repeat (LTR) with X protein (HBX) and cause immune activation in synergy with HIV. Paradoxically, HBV may also inhibit HIV dissemination via dendritic cells. The interaction among HIV, HBV, and host immunity remains poorly understood. Further research is warranted to elucidate the detailed molecular mechanisms and to translate these mechanisms into clinical practice.
    Chinese medical journal 07/2012; 125(13):2371-7. · 0.90 Impact Factor
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    ABSTRACT: The pharmacokinetics of zidovudine (AZT) are possibly influenced by weight, age, sex, liver and renal functions, severity of disease, and ethnicity. Currently, little information is available on the steady-state pharmacokinetics of AZT in Chinese HIV-infected patients. The current study aimed to characterize the steady-state pharmacokinetics of AZT in a Chinese set-up. Eleven Chinese HIV-infected patients were involved in the steady-state pharmacokinetic study. In total, 300 mg of AZT, as a part of combination therapy, was given to patients, and serial blood samples were collected for 12 hours. The samples were measured by a high-performance liquid chromatography (HPLC) assay, and the results were analyzed by both the non-compartment model and the one-compartment model. The C(max) of AZT in Chinese patients was higher than that in non-Asian patients. The half-life of AZT, analyzed by the non-compartment model (P = 0.02), in male patients ((1.02 ± 0.22) hours) was shorter than that of AZT in female patients ((1.55 ± 0.29) hours). The AZT clearance, analyzed by the one-compartment model (P = 0.045), in male patients ((262.60 ± 28.13) L/h) was higher than that in female patients ((195.85 ± 60.51) L/h). The present study provides valuable information for the clinical practice of AZT-based highly active antiretroviral therapy in a Chinese set-up.
    Chinese medical journal 06/2012; 125(11):1931-5. · 0.90 Impact Factor
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    ABSTRACT: To evaluate the microbial spectrum and clinical characteristics of microbiological diagnosed bloodstream infections (BSI) with identified infective sources. The hospitalized patients microbiologically diagnosed as BSI with identified infective sources were included in this study from January 2008 to December 2009. Data were collected retrospectively and analyzed by software SPSS 17.0. In this 2-year study, 301 strains of microbes were isolated from 249 patients. There were 205 (82.33%) patients with monomicrobial BSI, while the other 44 (17.67%) patients with polymicrobial BSI. The most common identified source of bloodstream infections was lower respiratory tract infection (125, 41.5%), followed by intraabdominal infection (55, 18.3%) and intravascular devices related infection (54, 17.9%). The four most common isolated pathogens were Acinetobacter species (60, 19.9%), Escherichia coli (50, 16.6%), Pseudomonas species (35, 11.6%) and Staphylococcus Aureus (34, 11.3%). Eighty-eight (35.3%) patients died during hospitalization due to all causes, out of which 62 (24.9%) patients died owing to BSI. The patients with BSI originated from lower respiratory tract had a higher crude in-hospital case-fatality ratio than those with BSI originated from other resources (OR = 2.186; 95%CI 1.260 - 3.792; χ(2) = 7.879, P = 0.005). In the multivariate regression, age ≥ 65, invasive mechanical ventilation, reservation of central line and polymicrobial BSI during hospitalization were independent risk factors of death due to all causes. Lower respiratory tract is the most common originated source of BSI with microbiological identified sources. Gram-negative bacillus taking advantage, the microbial spectrum of BSI with identified sources in our study is different from those reported before both in primary and secondary BSI. The patients with BSI originated from respiratory tract have a higher crude in-hospital case-fatality ratio.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 05/2012; 51(5):366-70.
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    ABSTRACT: To evaluate the influence of highly active antiretroviral therapy (HAART) on bone mineral density (BMD) in HIV/AIDS patients and correlating clinical factors. 149 HIV patients were divided into 3 groups:untreated group with 41 patients, HAART for 1-2 years group with 60 patients, HAART over 5 years group with 48 patients; 20 healthy individuals included as a control group. BMD-T score and BMD-Z score were measured by dual-energy X-ray absorptiometry (DXA). BMD-Z score of right hip was significantly lower in HAART over 5 years group (0.16 ± 0.82) than untreated group (0.61 ± 1.09) (P = 0.039). BMD-Z score of right femoral neck was significantly lower in HAART over 5 years group (-0.002 ± 0.87) than untreated group (0.55 ± 1.08) (P = 0.012). BMD-Z score of HAART for 1-2 years group was not significantly decreased. BMD-Z score of right hip and right femoral neck were correlated negatively with HAART duration. The incidence of osteopenia/osteoprosis in HAART for 1 - 2 years group (31.7%) and HAART over 5 years group (31.3%) were significantly higher than untreated group (12.2%) (P < 0.05). Body weight was revealed as a risk factor of osteopenia/osteoporosis. BMD of right hip and right femur neck were significantly lower in HAART over 5 years group. The incidence of osteopenia/osteoprosis were significantly higher in patients receiving HAART. BMD were correlated negatively with HAART duration. Patients in long-term HAART combined with risk factors such as old age or lower body weight should be checked by DXA regularly.
    Zhonghua yi xue za zhi 05/2012; 92(17):1155-8.
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    ABSTRACT: Evaluate the microbiological and epidemiological characteristics of primary bloodstream infections as well as the associated patients' clinical features at Peking Union Medical College Hospital. Microbiological and clinical data of the adult patients with primary bloodstream infections during January 1, 2008 and December 31, 2009 were retrospectively collected and evaluated. Pearson χ(2) test was used to compare the difference between proportions and Logistic regression was used in multivariate analysis. Five hundred and eighty-six strains of microbes were isolated from 494 adult patients with primary bloodstream infections. There were 80 patients with polymicrobial primary bloodstream infection of the 586 isolates, coagulase-negative staphylococci (175, 29.9%) was the most common, followed by Escherichia coli (93, 15.9%), Enterococcus species (60, 10.2%), Streptococcus species (41, 7.0%), and Staphylococcus Aureus (39, 6.7%). Central-line was the leading suspected infective source among the suspected infective source involving 108 (18.4%) isolates. Excluded the 108 isolates with suspected sources, 77 (45.3%) out of 167 patients with the primary bloodstream infections caused by coagulase-negative staphylococci or Staphylococcus Aureus had a central-line, with a higher proportion of the patients with a central-line than the patients with bloodstream infection caused by other pathogens (χ(2) = 10.419, P = 0.001). One hundred and fourteen patients died during hospitalization, with the crude mortality rate 23.0%. Fifty-nine patients (11.9%) died due to primary bloodstream infection. The patients with polymicrobial bloodstream infection were with a higher attributable mortality (OR = 2.159;95%CI 1.165 - 4.002; χ(2) = 6.194, P = 0.013). In the multivariate analysis, the independent risk factors of crude mortality rate to primary bloodstream infections were elderly patients, central neurological disorder, mechanical ventilation, and reservation a central-line. The most common microbe causing primary bloodstream infections was G+ cocci. Polymicrobial primary bloodstream infection added risk to attributable in-hospital fatality ratio. Elderly patients, neurological disorder, reservation of central-line, and mechanical ventilation were the independent risk factors of crude in-hospital fatality ratio.
    Zhonghua yi xue za zhi 04/2012; 92(13):894-8.
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    ABSTRACT: To analyze the clinical characteristics of AIDS-related non-Hodgkin lymphoma (ARL) and review relative literature for the diagnosis and treatment of ARL. The clinical data of ARL patients admitted to Peking Union Medical College Hospital from April 2009 to April 2011 were retrospectively analyzed. Five male ARL patients aged 32 to 65 years old were included in this retrospective study. Among them, two patients were found to be HIV-positive for the first time, three were on regular highly active anti-retroviral therapy (HAART) for 7 - 8 months before the emergence of lymphoma-related symptoms. CD(4)(+) T cell count was (69 - 232) × 10(6)/L at presentation. Two patients firstly presented with sore throat and throat ulcer, one with cervical nodules, one with pelvic mass, one with fever and edema in right thigh. Through pathological analysis, four patients had B cell-originated lymphoma, with one Burkitt lymphoma and three diffuse large B cell lymphomas; one patient had T-cell lymphoma. Four patients were treated with chemotherapy, with one complete remission, one relapse, one non-response, and one death. One patient had radiotherapy only and had progressed disease. Bone marrow suppression and gastrointestinal disturbance were the main adverse effects of chemotherapy. Lymphoma should be considered in any HIV-infected patients presented with unexplainable adenopathy, recurrent sore throat or throat ulcer, or fever of unknown origin. Biopsy should be rigorously carried out. Appropriate chemotherapy, together with HAART, may improve the prognosis greatly.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 03/2012; 51(3):184-7.
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    ABSTRACT: To analyze the clinical characteristics of Behcet's disease with intracardiac thrombus. The data of 8 patients diagnosed as Behcet's disease with intracardiac thrombus in Peking Union Medical College Hospital from January, 1990 to January, 2011 were studied retrospectively. Behcet's disease with intracardiac thrombus was found in 8 patients (5 men and 3 women) with a median age of 28.5 years. Most of them were young men. Thrombus was mostly found in the right side of the heart. Most of the patients had pulmonary thromboembolism with negative anticardiolipid antibody and basically normal C-reactive protein and erythrocyte sedimentation rate. Intracardiac thrombus associated with Behcet's disease most commonly occurs in young men and usually involves the right side of the heart.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 11/2011; 50(11):914-7.
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    ABSTRACT: To study the changes of body composition in females patients with human immunodeficiency virus (HIV)-related lipodystrophy (LD) syndrome (HIV-LD). Totally 25 female patients who were treated in our hospital from January 2002 to December 2009 were divided into LD group and non-LD group based on the existence of LD. All these patients were receiving highly active antiretroviral therapy (HAART). In addition, 12 healthy women were set as the controls. Total and regional body composition were measured by dual X-ray absorptiometry in all three groups. The fat mass (FM) was correlated negatively with the duration of HAART (r=-0.431, P=0.029). Multiple linear regression analysis showed that FM had positive correlation with weight and negative correlation with lean mass (LM) (r = - 0. 973, P =0. 000). Total, trunk and leg FM were significantly lower in LD patients than that in controls (P <0.05).Meanwhile, total, trunk and leg bone mineral contents were statistically lower in LD patients than that in controls (P <0. 05). Lumbar bone mineral density of LD patients was lower than that of non-LD patients and controls, and there was significant difference between LD patients and controls (P = 0. 001). LM of LD patients was higher than that of non-LD patients but without statistical difference (P > 0. 05). The peripheral and central FM and bone mineral contents remarkably decrease in female patients with HIV-LD. How-ever, HIV-LD patients tend to have higher LM than non-LD patients. .
    Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 08/2011; 33(4):421-6.
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    ABSTRACT: To summarize the clinical characteristics of AIDS phobia patients and establish the preliminary clinical diagnostic criteria. The clinical information of 46 AIDS phobia patients was collected and summarized. General demographic data, clinical manifestations and laboratory results were analyzed. The clinical characteristics of AIDS phobia patients include: (1) With or without high-risk behavior of HIV-1 infection; (2) Patients repeatedly demanded HIV/AIDS related laboratory tests, suspected or believed in HIV-1 infection with daily life affected; (3) The main complaints were non-specific including influenza-like symptoms (headache, sore throat and so on), fasciculation, formication, arthrodynia, fatigue and complaint of fever with normal body temperature; physical examination did not reveal any positive physical sign except white coated tongue; (4) Symptoms mainly appeared 0-3 months after the high-risk behavior while HIV-1 antibody kept negative; (5) T lymphocyte subsets test was carried out in 23 patients and showed 19 (82.6%) with CD(4)(+) T lymphocyte count > 500/µl, the remaining 4 were 300 - 500/µl, with the lowest count of 307/µl. Few patients had inversed CD(4)(+)/CD(8)(+) ratio but without excessive CD(8)(+)T lymphocyte activation. AIDS phobia is a complicated physical and mental disease, whose diagnosis and treatment still need further investigation.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 08/2011; 50(8):650-3.
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    ABSTRACT: To investigate the change regularity of peripheral blood mononuclear cell (PBMC) mtDNA (mitochondrial deoxyribonucleic acid) content and its association with HIV-LD (human immunodeficiency virus-related lipodystrophy) in HAART (highly active antiretroviral therapy). At baseline, Months 6 and 24 of therapy, the cryopreserved PBMC were collected from 33 patients on a regular follow-up at our clinic. Among them, 17 had HIV-LD. Then total DNA was extracted and mtDNA content quantified by real-time PCR (polymerase chain reaction). The HIV/AIDS patients had a lower content of PBMC mtDNA (2(-ΔΔCt)) than the healthy controls at baseline (9.578 vs 17.195, P < 0.01). The mtDNA content was lower in the HIV-LD group than that in the no LD (NLD) group at each time point of therapy (13.619 vs 5.775, 6.360 vs 1.387, 7.170 vs 1.266, all P < 0.05). In the HIV-LD group, the half- and 2-year PBMC mtDNA content was markedly lower than those at baseline (both P < 0.05). And the change of mtDNA content (within half a year) was earlier than the onset of clinical HIV-LD at one year later. In the NLD group, the PBMC mtDNA content have an insignificant change after therapy. The mtDNA content decreased significantly in stavudine (d4T)-containing regimen group after treatment (P < 0.01), but showed no significant change in zidovudine (AZT)-containing regimen group after therapy. The decreased content of PBMC mtDNA after HIV infection and during HAART therapy is associated with HIV-LD. Nucleoside reverse transcriptase inhibitor, especially d4T, plays an important role in the progression of HIV-LD.
    Zhonghua yi xue za zhi 06/2011; 91(21):1448-52.
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    ABSTRACT: To evaluate the safety profiles of three nevirapine-based therapies for antiretroviral-naive Chinese adults infected with HIV-1 (human immunodeficiency virus-1). For this prospective multicentric randomized trial, a total of 198 antiretroviral-naive HIV-1 positive patients were recruited from 13 research centers in China. They were randomly assigned to receive three NVP-based antiretroviral therapies for 52 weeks: Group A, AZT (zidovudine) + DDI (didanosine) + NVP (nevirapine); Group B, D4T (stavudine) + 3TC (lamivudine) + NVP; Group C, AZT + 3TC + NVP. Their clinical events and laboratory examinations were monitored at baseline and the end of weeks 4, 8, 12, 24, 36 & 52 post-HAART (highly active antiretroviral therapy) to evaluate the occurrence of adverse events (AEs). The chi-square or Fisher's exact test was employed to compare the rates of AEs among three treatment groups. Multivariate logistic regression analyses were used to identify the factors associated with hepatotoxicity. For all tests, P < 0.05 was considered as statistically significant. During the 52-week HAART, 968 cases of AEs occurred in 188 patients (95.0%). Only 37.4% experienced grade 3/4 AE. And 37 patients withdrew because of HAART-related AEs (18.7%). The common AEs were hepatotoxicity, bone morrow suppression, gastrointestinal disorders, rash and hyperlipidemia, etc. Most instances of AEs occurred during the early 12 weeks. The total count of AEs for each group had no statistic significant difference (P = 0.403). Bone marrow suppression was more strongly associated with an AZT-containing HAART and it was especially prone to gastrointestinal disorders when combined with DDI. The introduction of D4T or DDI led more frequently to peripheral neuropathy and hyperlipidemia. Logistic regression analysis indicated that presence of hepatotoxicity was associated with a higher baseline level of CD4 (CD4 count > 250/µl) (OR = 2.08, 95%CI: 1.114 - 3.882, P = 0.021). The common reasons of discontinuing HAART are hepatotoxicity, gastrointestinal disorders, bone marrow suppression and rash. The occurrence of AEs should be vigorously monitored especially during the early 3 months of HAART. The HIV/AIDS patients with a CD4 count of > 250/µl shall avoid any NVP-containing regimen.
    Zhonghua yi xue za zhi 05/2011; 91(19):1318-22.
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    Wei Cao, Zhi-Feng Qiu, Tai-Sheng Li
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    ABSTRACT: To assess the peripheral T lymphocyte subsets in chronic hepatitis B virus (HBV) infection, and their dynamics in response to adefovir dipivoxil monotherapy. Proportions and absolute counts of peripheral natural killer cells, B cells, CD8+, CD4+, CD8+CD38+, CD8+CD28+ and CD4+CD28+ T cells were determined using three-color flow cytometry in chronic hepatitis B patients (n = 35), HBV carriers (n = 25) and healthy controls (n = 35). Adefovir dipivoxil was initiated in 17 chronic hepatitis B patients who were regularly followed for 72 wk, during which period the T cell subsets and serum viral load were measured at each follow-up point. The peripheral CD4+ T cell counts and CD8+ T cell counts decreased in chronic HBV infection. In chronic hepatitis B patients, proportions of CD8+CD38+ T cells were 62.0% ± 14.7%, much higher than those of HBV carriers and healthy controls. In the 13 hepatitis B patients who were treated and responded to adefovir dipivoxil, proportions of CD8+CD38+ T cells decreased from 53.9% ± 18.4% pre-therapy to 20.1% ± 11.3% by week 72 (P < 0.001), concomitant with viral load decline (HBV DNA fell from 7.31 to 3 log copies/mL). CD8+ T cell counts also underwent an average increase of 218 cells/μL by the end of 72-wk treatment. In those who failed the therapy, the CD8+CD38+ T cell population had more fluctuations. CD8+ T cells abnormally activated in chronic HBV infection can be partially reversed by antiviral therapy. HBV-associated immune activation may be a crucial part of the pathogenesis and a promising target of treatment.
    World Journal of Gastroenterology 05/2011; 17(17):2191-8. · 2.55 Impact Factor
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    ABSTRACT: Cytomegalovirus (CMV) retinitis is the most severe intraocular complication that results in total retinal destruction and loss of visual acuity in patients with acquired immunodeficiency syndrome (AIDS). This study aimed to investigate the fundus characteristics, systemic manifestations and therapeutic outcomes of CMV retinitis associated with AIDS. It was a retrospective case series. CMV retinitis was present in 39 eyes (25 patients). Best corrected visual acuities, anterior segment, fundus features, fundus fluorescence angiography (FFA) and CD4(+) T-lymphocyte counts of the patients with CMV retinitis associated with AIDS were analyzed. Intravitreal injections of ganciclovir (400 µg) were performed in 4 eyes (2 patients). Retinal vasculitis, dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface were present in 28 eyes. The vitreous was clear or mildly opaque. Late stage of the retinopathy was demonstrated in 8 eyes characterized as atrophic retina, sclerotic and attenuated vessels, retinal pigment epithelium (RPE) atrophy, and optic nerve atrophy. Retinal detachment was found in 3 eyes. The average CD4(+) T-lymphocyte count in peripheral blood of the patients with CMV retinitis was (30.6 ± 25.3) × 10(6)/L (range, (0 - 85) × 10(6)/L). After intravitreal injections of ganciclovir, visual acuity was improved and fundus lesions regressed. CMV retinitis is the most severe and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis without clear cause, human immunodeficiency virus (HIV) serology should be performed. Routine eye examination is also indicated in HIV positive patients.
    Chinese medical journal 04/2011; 124(8):1134-8. · 0.90 Impact Factor
  • Ling Luo, Tai-Sheng Li
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    ABSTRACT: As the severity of the HIV epidemic in China grew, National Free Antiretroviral Treatment (ART) Program was announced since 2003. Even though there still were many difficulties, China had obtained great achievements in fighting against HIV. Over 52 000 adult patients had received first-line HAART thus far and the mortality of AIDS in China decreased significantly. This paper presents an overview of the HIV/AIDS epidemic in China; the status of national free ART program, the difficulties suffered and the achievements made since the initiation of program and the challenges ahead for continued progress for China. This paper also provides suggestions to overcome these challenges.
    Chinese medical journal 02/2011; 124(3):440-4. · 0.90 Impact Factor
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    ABSTRACT: Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus (HIV) infection since highly active antiretroviral therapy (HAART) has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients. One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients (41 HAART-treated and 41 antiretroviral therapy (ART) naïve patients) and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity (PWV) was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage. A higher PWV ((1358.3 ± 117.8) cm/s vs. (1270.2 ± 189.2) cm/s, P = 0.010) was found in ART naïve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART naïve patients ((1283.8 ± 181.4) cm/s vs. (1358.0 ± 117.8) cm/s, P = 0.033). Multiple regression analysis revealed that age (B = 5.218, 95% confidence interval (CI) 1.420 - 9.016, P = 0.008), current smoking (B = -74.671, 95%CI -147.003 to -2.339, P = 0.043) and HAART (92.7% patients on a protease inhibitor-free regimen) (B = -169.169, 95%CI -272.508 to -65.831, P = 0.010) were associated with reduced PWV in HIV-infected patients. Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.
    Chinese medical journal 12/2010; 123(23):3396-9. · 0.90 Impact Factor
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    ABSTRACT: To report the clinical characteristics of prosthetic valve endocarditis (PVE). All 25 cases of definite PVE (Duke criteria) diagnosed at our hospital between January 1992 to December 2008 were retrospectively analyzed. Among them, 7 cases were pathologically confirmed and the others were clinically confirmed with either 2 major criteria or 1 major and ≥ 3 minor criteria. Their clinical characteristics, underlying heart diseases, previous heart operations, presenting manifestations, causative microbes, echocardiographic findings and prognosis, were studied. (1) Although most cases underwent valve transplantations for underlying heart diseases of rheumatic heart diseases and congenital heart diseases, 10 patients were complicated with infectious endocarditis (IE) prior to the operations, 4 of them were PVE. (2) Eleven of them developed PVE within 2 months postoperatively. Fever (100%), major vessel embolism (48%), and anemia (36%) were the most frequently manifestations. Fourteen cases (56%) had positive culture results with 15 causative pathogens, including 5 coagulase-negative Staphylococcus (CNS, 3 were methicillin-resistant coagulase-negative Staphylococcus, MRSCoN), 4 fungi, 2 Enterococcus faecalis, 2 Burkholderia cepacia, 1 Stenotrophomonas maltophilia, and 1 Streptococcus. (3) Prosthetic valve vegetations, periannular leakage, regurgitation, were the main echocardiographic findings. Transesophageal echocardiography (TEE) revealed 13 PVE who had no positive findings on previous transthoracic echocardiography (TTE). (4) Eighteen PVE (72%) developed peri-annular complications (12 leakage, 3 dehiscence, 2 abscesses, 1 fistula), major vessel embolism, congestive heart failure (16%) were frequently observed, 9 of the 17 patients died in hospital, in spite of intensive managements. PVE has a high mortality and is a severe complication for patients who underwent heart surgery. Its causative pathogen spectrum is quite different from that of native valve endocarditis. TTE is not sensitive for some PVE cases.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 09/2010; 49(9):758-61.

Publication Stats

67 Citations
20.93 Total Impact Points

Institutions

  • 2003–2013
    • Peking Union Medical College Hospital
      • Department of Rheumatology
      Peping, Beijing, China
  • 2006–2011
    • Chinese Academy of Medical Sciences
      Peping, Beijing, China