NGHIEN ciru KHOA HOC
NHIEM HIV/AIDS O CAC BENH NHAN KHAM VA OIEU TRI TAI BENH VIEN DA LIEU TRUNG U'ONG TLT 2006-2010
Tran Hau Khang*, Le Huyen IMy*, Vu Nguyet Minh*, Pham Ngoc Toan*, Hoang Thj Al Lien*
TOMTAT
Cdc bieu hien da, niem mgc va cdc benh lay truyen qua dddng finh due rdt thddng gap d ngddi nhiem HIV/AIDS. Td2006 den 2010 co 395 ngddi nhiim HlVdUpc phat hien tgi Benh vien Da lieu Trung dang. Ti le nhiem HIV trong tong sd benh nhan (BN) khdm la 0,056%, trong tong so BN ddgc chi dinh xet nghiem HIV Id 2,41%. San ngda, Zona, viem da ddu la nhdng nhiem trung ca hpi dda thudng gap nhdt. 34,73% BN HIV mac cdc benh lay truyen qua dudng tmh due, trong do sui mao gd chiem ti le cao nhdt. Lay nhiem HIV qua con dUdng tiem chich ma tuy Id chu yeu, lay qua quan he tmh due khong an todn dang gia tang.
Jd khda: HIV, AIDS, benh lay truyen qua dudng tinh due (STDs).
I. DAT VAN DE
Dai dich HIV/AIDS da va dang lan tran d khap noi tren the gidi. Tai chau A, Odng Nam A la ndi cd ti le hien nhiem HIV cao nhat vdi nhieu khuynh hu'dng dich te khac nhau. Trong khi ti le hien nhiem tai Cam-pu-chia, My-an-mar va Thai Lan deu cd dau hieu giam, thi tai In-dd-ne-xi-a va Viet Nam nhdng ti le nay dang tang len [3]. Theo bao cao cua Cue Phdng chong HIV/AIDS, tinh den ngay 30/6/2010, ca nUdc cd 176.436 ngu'di nhiem HIV dang cdn sdng, trong dd cd 41.239 BN AIDS [2]. Dadng lay truyen HIV qua quan he tinh due khdng an toan cd xu hu'dng gia tang hang nam [1]. Benh vien Da lieu Trung aang la noi tiep nhan nhieu ddi tapng cd nguy cP cao mac cac benh lay truyen qua dadng tinh due (STDs:
Sexually Transmitted Diseases) den kham va dieu tri. Trong sd nay, nhieu ngadi da bj nhiem HIV.
Benh vien Da lieu Trung uang
Ddng thdi, nhieu BN mac cac benh da nha Zona, san ngda, viem da dau... cung dapc phat hien bi nhiem HIV/AIDS. Day la nhdng nhiem trung cd hdi cua AIDS rat thadng gap d cac ddn vi Da lieu.
De tim hieu khuynh hadng nhiem HIV/AIDS tai mdt CP sd dau nganh ve Da lieu (Benh vien Da lieuTrung apng), chung tdi tien hanh nghien cdu nay vdi muc dich:
7. Khao sdt tinh hinh nhiem HIV/AIDS dcac BN bi benh da lieu tgi Benh vien Da lieu Trung Udng td 2006-2010.
2. Xdc dinh dudng lay nhiem HIV cua cdc BN ndy.
II. 001 TUONG VA PHl/ONG
P H A PNGHIEN CQU 1. Doi tuong
-Tat ca cac BN den kham va dieu tri tai Benh vien Da lieu Trung aong td 2006-2010.
- Hd sP benh an lau trd tai benh vien trong khoang thdi gian tren.
Cac BN dapc khang dinh nhiem HIV: mau huyet thanh dapng tinh khi 3 lan xet nghiem
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bang 3 loai sinh pham vdi nguyen ly khac nhau deu dapng tinh.
2. PhUdng phap nghien cuTu Phapng phap md ta cat ngang.
Cach tien hanh:
-KhamBN.
- Lam cac xet nghiem sang lpc:
-I- Sang lpc STDs: soi tdoi, nudi cay tim lau cau.
Soi taoi tim nam, trung roi. Test nhanh chan doan Chlamydia. Huyet thanh chan doan giang mai.
-I- Sang lpc HIV: bang ki thuat ngang ket hat vi lapng Serodia.
-I- Khang dinh nhiem HIV: bang 3 kl thuat Serodia HIV, Genscreen V2, Uniform plus 0.
- Phan tich sd lieu ta cac hd sp benh an.
- Chup anh: hinh anh nhiem trung cP hpi da va niem mac.
3. Xuf ly sd' lieu: theo phaong phap thdng ke y hpc.
III. KET QUA
1. Ti le nhiem HIV d cac BN den kham tai Benh vien Da lieu Trung Udng
Trong tdng sd 107.966 BN den kham tai phdng kham nam 2006 cd 121 ngadi bi nhiem HIV. Day la nam phat hien dapc nhieu ngadi bi nhiem HIV nhat.
Bang 1. Tlie nhiim HIV trong tong so BN khdm
N a m ^"^^^
2006 2007 2008 2009 6thang
2010
SdBN kham 107966 134573 169759 186458 103999
So B N HIV d U d n g tfnh
121 85 76 73
40
Tile
(%) 0,11 0,063 0,045 0,039 0,038
0 0 9 % 0.08%
0.07% j 0.06% ' 0.05%
0.03% I 002%
0.063%
3
^ ^ H 0.039% 0 0 3 8 ^ 0 045%JLU
Nam 2006 Nam 2O07 Nflm 20O8 NSm 2O09 Nflm 2010
Bieu do 7. Vie nhiem HIV trong tong so BN khdm
2. Ti le nhilm HIV trong tong sd' nhQng ngUdi dUdc xet nghiem HIV
Nhdng ngadi trong nhdm cd hanh vi nguy CP cao: bi STDs, nghien chich/hut, bi cac benh da, niem mac chi diem... dapc ta van de lam xet nghiem phat hien nhiem HIV.
Bang 2. Ti le nhiem HIV trong tong soBN diidc xet nghiem
\ N Nam\
2006 2007 2008 2009 6 thang
2010
So B N xet nghiem
HIV
3408 2888 3806 3944 2326
S6 B N H I V du'O'ng tinh
121 85 76 73 40
Tile
(%) 3,55 2,94 1,99 1,85 1,71
Nam 2006 Nam 2007 Nam 2009 SBm2010
Bieu do 2. Tile nhiem HIV trong tong soBN duac xet nghiem
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3. Mot so dac diem cua ngUdi nhiem HIV 3.1. Phan bo theo nhom tuoi
Tudi trung binh cua ngadi nhiem HIV la 32,26 ± 8,19. Dac biet nam 2007, trong tdng sd 85 ngadi nhiem HIV cd 2,4% tre em.
Nam
Nam 2006 Nam 2007 Nam 2008 Nam 2009 Nam 2010
Bang 3. Phan bo theo nhom tuoi qua cac nam
<15 tuoi (%)
0,0 2,4 0,0 1,4 0,0
15-19tu6i (%)
2,1 1,2 0,0 0,0 2,5
20-29 tuoi (%) 54,2 40,0 30,3 30,1 20,0
30-39 tuoi (%) 37,5 51,8 56,6 54,8 50,0
40-49 tuoi (%)
6,3 2,4 9,2 8,2 20,0
>49tu6i (%) 0,0 2,4 3,9 5,5 7,5 3.2. Phan bo theo gidi
Td 2006-2009, ti le nam bi nhiem HIV trong tdng sd BN den kham cao hpn ban ti le nay d na gidi (p<0,01).
20%
D Nam DNO'
80%
Bieu do 3. Phan bo theo gidi tinh
76 50% 82,90% 80.80%
Nam 2006 Nam 2007 Nam 2008 Nam 2009 Nam 2010
Bleu do 4. Phan bo theo gidi tinh qua cdc nam
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3.3. Phan bo theo dia du"
Trong tdng sd 24 tinh cd ngddi nhiem HIV phat hien tai phdng kham thi Ha Ndi chiem ti le cao nhat (39,44%). Tuy nhien, sa khac nhau nay khdng cd y nghTa vi sd lapng BN cua Ha Ndi kham ddng nhat.
Bang 4. Phdn boBN HIV theo dia dU
Tinh Ha Ndi Vinh Phuc Quang Ninh Hang Yen Hai Dapng Ha Tinh Bac Giang Thanh Hoa Phu Thp Bac Ninh Hda Binh PhuThp
Sd' iUdng 127
18 16 14 12 10 10 9 7 7 4 1
Ti le (%) 39,44
5,59 4,97 4,35 3,73 3,11 3,11 2,80 2,17 2,17 1,24 0,31
Tinh Nam Djnh Khdng rd Spn La Yen Bai Thai Binh
Ninh Binh Hai Phdng Ha Giang Thai Nguyen Tuyen Quang
Lang Spn Lai Chau
Sd' lUdng 25 22 9 6 4 4 4 4 3 2 2 1
Ti le (%) 7,76 6,83 2,80 1,86 1,24 1,24 1,24 1,24 0,93 0,62 0,62 0,31
3.4. Phan bo theo nguon lay khai thac dUac Theo dieu tra, phdng van, kham lam sang thi dadng lay chu yeu cua HIV do tiem chich ma tuy.
Tuy nhien, trong 2 nam 2009 va 2010, dadng lay qua quan he tinh due khdng an toan da tang len bao ddng.
; ll y^ li IJ
f*m2O06 f^^m2007 Nam2(X)a tem2009 Nam2010
Bieu do 5. Phan bo theo nguon lay
D Nghi$fi Chen
• QHTD
Trong sd cac BN nhiem HIV/AIDS lay theo dadng tinh due va cd cac bieu hien lam sang thi siji mao ga chiem ti le cao nhat (79,52%), tiet dich am dao -nieu dao 18,07%, loet sinh due ehi chiem 2,4%.
Bieu do 6. Phan boBN HIV theo nhom benh lay truyen qua dwdng tinh due
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3.5. Nhiem triing co hpi dda, niem mgc
Cae nhiem trung cP hdi d da, niem mac hay gap nhat la san ngda. Zona, viem da dau. Nhdng thapng tdn nay tdn tai dai dang, hay tai phat.
Bang 5. Nhiim triing cahpi da/niem mgc d ngu'di nhiim HIV/AIDS Chan doan
San ngda Zona
Viem da dau Vay nen
Di dng thude Nhiem kf sinh trung Nam da
So lUdng 50 26 13 11 7 3 3
Ti le (%) 32,05 16,67 8,33 7,05 4,49 1,92 1,92
Chan doan Viem ladi
Viem da lien cau Trdng ca
U d d a
Nhiem Rmarneffei Khac
SolUdng 7 4 4 2 1 25
Ti le (%) 4,49 2,56 2,56 1,28 0,64 16,03
IV. BAN LUAN
1. Tinh hinh nhiem HIV tai Benh vien Da lieu Trung Udng tU 2006-2010
Td nam 2006- 2010, ed tdng sd 395 BN nhiem HIV dapc phat hien. Ti le nhiem HIV trong tong sd BN kham la 0,056%. Ti le nay cao nhat la nam 2006 (0,11%), thap nhat la nam 2010 (0,038%).
Trong vai nam gan day, sd lapng BN tdi kham moi ngay tai Benh vien Da lieu Trung aPng tang len rat cao. Chi trong vdng 6 thang dau nam 2010, lapng BN tdi kham da gan bang ca nam 2006. Tuy nhien, sd tradng hpp phat hien HIV dapng tinh lai khdng tang. Do d d ti le nhiem HIV trong tdng sd kham giam di.
Ti le nhiem HIV trong tdng sd nhdm ngadi ed hanh vi nguy co cao dapc chi dinh xet nghiem HIV la 2,41%. Tile tinh theo nam cao nhat la nam 2006 (3,55%). Sd mau xet nghiem HIV tang hang nam nhang sd BN daong tinh lai khdng tang, hoac giam it, do d d ti le nhiem HIV trong tdng sd BN xet nghiem HIV cung giam.
Trong tdng sd 395 BN nhiem HIV, tudi trung binh la 32,26 ± 8,19. BN nhd tudi nhat la 3 tudi, BN Idn tudi nhat la 70 tudi. Ti le nhiem HIV d hai nhdm tuoi 20-29 va 30-39 cao nhat so vdi
cac nhdm tudi khae. Nhdng nam gan day, ti le nhiem HIV phan theo nhdm tudi ed xu hadng chuyen dich t d nhdm tudi 20-29 sang nhdm tudi 30-39. Ket qua nay cung phu hpp vdi bao cao tinh tinh nhiem HIV/AIDS nam 2009 eua Cue Phdng chdng HIV/AIDS [2].
Ti le BN nam gap 4 lan BN nd. Tuy nhien, ti le BN n d nhiem HIV dang tang dan. So vdi nam 2009, nam 2010 ti le BN HIV la nam giam t d 80,8% xudng 62,5%, ti le BN n d tang t d 19,2%
len 37,5%.
Vi Benh vien Da lieu Trung apng dat tai Ha Npi nen phan Idn cac BN nhiem HIV trong nghien cdu den t a eae tinh phia Bac. Da sd BN khai dia ehi d Ha Ndi nen ti le BN d Ha Ndi la cao nhat (39,44%), tiep theo la cac tinh Nam Dinh (7,76%), Vinh Phuc (5,59%).
Trong eae benh da do nhiem triing ep hdi, san ngda chiem ti le cao nhat (32,05%), tiep den la Zona (16,67%), viem da dau (8,33%). Nghien cdu eua chung tdi cho ket qua gidng vdi Boon- Kee Gob (Singapore) [4]. Cdn nghien cdu cua Viroj Wiwanitkit (Thai Lan) lai gap nhieu nhat la khd da va nhiem Candida d mieng [6].
HIV va cac benh lay truyen qua dadng tinh due
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CO mdi lien quan mat thiet.TileBN HIV cd cae bieu hien lam sang eua benh lay truyen qua dddng tinh due chiem 34,73%. Trong nhdm mac cac benh lay truyen qua dadng tinh due, ti le cao nhat la nhdm sui mao ga (79,52%). Loet sinh due ed ti le thap nhat (2,41%). Mdt nghien cdu cua Hutton-Rose N (Jamaica) [5] tien hanh tren 270 BN cd HIV den kham tai trung tam dieu tri benh lay truyen qua dadng finh due thay nhdm viem nieu dao khdng do lau chiem ti le cao nhat (19,4%), tiep theo la lau (17,2%) va nhiem Candida sinh due (13,4%).
2. DUdng lay nhiem HIV
Nhiem HIV/AIDS ed ve ludn gan vdi nhdng dinh kien xa hdi, vi da sd lien quan den cae hanh vi bi ngan cam n h a t i e m chich ma tuy, mai dam, quan he tinh due ddng gidi nam... Do do, viee khai thac ngudn lay trong nhdm ddi t a p n g nghien cau nhieu khi khd khan va cac eau tra Idi cd dp ehinh xac khdng cao, khdng phan anh d u n g thac trang. Trong nhdm BN khai thac dapc ngudn lay, chung tdi nhan thay nhdng nam trade, lay nhiem HIV qua con dadng tiem chich ma tuy la dadng lay chu yeu. Trong nghien cdu n a y , t i l e n h i e m HIVqua tiem chich ma tuy chiem tdi 87% nam 2006 va 100% nam 2008.Tuy nhien, gan day dadng lay qua quan he tinh due khdng an toan dang tang dan. Lay qua d a d n g tinh due khdng an toan nam 2009 la 25%, 6 thang dau nam 2010 tang len 46%. Dieu nay cung phu hpp vdi bao cao tinh tinh nhiem HIV/AIDS nam 2009 eua Cue Phdng chdng HIV/AIDS [2].
Ly giai van de nay, mpt trong nhdng nguyen nhan la ed sd chdng cheo gida tiem chich ma tuy va mai dam. Ngay cang cd nhieu phu ndtiem chich ma tuy va trong sd nay nhieu phu n d hoat ddng mai dam. Nam gidi tiem chi'ch ma tuy cung ddng
thdi la khach lang chPi va t h a d n g khdng dung bao cao su. Nguyen nhan khae la xu hadng lay nhiem qua tinh due ddng gidi nam tai cac thanh phd cung dang tang len. Hpn nda, quan niem sdng trong gidi tre cd nhieu thay ddi. Sdng thCf, quan he tinh due trade hdn nhan, cd nhieu ban tinh... dang t r d nen pho bien hPn. De kiem che sd lay lan eua virus HIV, can ed sd au tien quan tam hPn nda den vai trd giao due y thdc, giup thanh nien cd dapc sd hieu biet d u n g dan de t a bao ve minh va giam nhe cactac hai cua virus HIVtdtinh than den vat chat, khdng nhdng cho ca nhan, gia dinh, cdng ddng ma cho ea xa hdi.
V. KET LUAN
1. Tmh hinh nhiem HIV tai Benh vien Da lieu Trung Udng
- Ti le nhiem HIV trong t o n g sd BN kham la 0,056%.
- T i l e nhiem HIV t r o n g n h d m cd hanh vi nguy CP cao dapc ehi dinh xet nghiem HIV la 2,41%.
- Tudi trung binh eua cac BN HIV la 32,26 ± 8,19. Ti le nhiem HIV theo nhdm tuoi cd xu hadng chuyen dich t d nhdm 20-29 sang nhdm 30-39.
-Ti le BN n d nhiem HIV dang tang dan.
- San ngda. Zona, viem da dau la nhdng nhiem t r u n g co hdi da, niem mac chiem ti le cao n h a t t r e n B N H I V .
-Tl le mac cac benh lay truyen qua d d d n g tinh due d ngadi nhiem HIV chiem 34,73%, trong dd sui mao ga hay gap nhat.
2. OUdng lay nhiem HIV
- Lay nhiem HIV qua con d a d n g tiem chich ma tuy la d a d n g lay chu yeu.
- Lay qua quan he tinh due khdng an toan dang gia tang (nam 2009: 25%, nam 2010:46%).
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D A L I E U H O C S6 03 (Thang 01 / 2011)NGHIEN Ciru KHOA HOC
T A I LIEU THAM KHAO
1. Bp Y te (2009), Bao cdo tinh hinh nhiem HIV/AIDS nam 2009, Cue Phong chong HIV/AIDS.
2. Bp Y te (2010), Bdo cao cong tdc phong chong HIV/AIDS 6 thdng dau ndm 2010 vd trong tdm ke hogch 6 thdng cuoi ndm 2010, Cue Phong chong HIV/AIDS.
3. UNAIDS (2008), Nhdn dinh Igi ve tinh hinh dich AIDS d chdu A, phdc thdo cdch dng pho hieu qud, Bdo cdo cua uy ban veAIDS chdu A.
4. Boon-Kee Gob, Roy K. W. Chan, Priya Sen, Colin T. S. Theng, Hiok-Hee Tan, Yuan-Jing V\/u, Nicholas I. Paton (2007), "Spectrum of skin disorders in human immunodeficiency vlrus- Mdt so hinh anh
infected patients in Singapore and the relationship to CD4 lymphocyte counts". International Journal of Dermatology, (46), 695-699.
5. Hutton-Rose N (2008), "The prevalence of other sexually transmitted infections in confirmed HIV cases at a referral clinic in Jamaica". J R Soc Promot Health. 128(5), 242-247.
6. Viroj Wiwanitkit (2004), "Prevalence of dermatological disorders in Thai HIV-infected patients correlated w/ith different CD4 lymphocyte counts statuses: a note on 120 cases". International Journal of Dermatology,(43), 265-268.
/. l^em am dgo do nam Candida
2. Sid mao gd 3. San ngira 4. Zona
SUMMARY
HIV/AIDS INFECTION IN PATIENTS WITH STIS OR SKIN DISORDERS IN NATIONAL HOSPITAL OF DERMATOLOGY AND VENEREOLOGY
Skin disorders and STDs cause significant morbidity in human immunodeficiency virus (HlV)-infected individuals. From 2006 to June 2010, 395 HIV positive individuals were detected in the National hospital of Dermatology and Venereology. The prevalence of HIV positive persons among outpatients was 0.056%).
The prevalence of HIV positive persons among high risk groups, who were indicated HIV test was 2.41 %.
The most common skin disorders in HIV infected people were pruritic papular eruption, herpes zoster and seborrheic dermatitis. 34.73% of patients had STDs, the most common STDs was genital warts. The most common mode of HIV transmission was intravenous drug abuse, transmission by unsafe sexual contact is significantly increased.
Key words: HIV, AIDS, STDs.
So 03 (Thang 01 /2011)
