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OBJECTIVE: Short-term mortality rates remain high among critically ill human immunodeficiency virus-1 (HIV-1) patients though long-term mortality rates have dropped. Baseline risk factors for short-term mortality have not yet been determined in China. In this paper we herein describe clinical characteristics laboratory findings causes of clinical deterioration and risk factors associated with mortality among HIV-1 patients within six months after hospital admission. METHODS: We carried out a prospective study of hospitalized patients in advanced stages of HIV infection. These patients started antiretroviral therapy three or four weeks after admission. Follow-up was conducted for a period of six months. We used a multivariate logistic-regression analysis to identify risk factors associated with mortality. RESULTS: A total of 141 patients met our inclusion criteria. The mean age was 41 years. Fever and weight loss were the most common clinical manifestations of advanced HIV disease. Oral candidiasis tuberculosis cytomegaloviremia and pneumocystis pneumonia were the most common opportunistic infections. Significantly decreased CD4+ T-cell counts hypoalbuminemia anemia hyponatremia as well as elevated C-reactive protein (CRP) and glutamic alanine transaminase levels were common laboratory test abnormalities. The mortality rate was 21.3%. The patients who died were more likely than the survivors to have low CD4+ T-cell counts as well as low creatinine hemoglobin albumin and serum sodium levels while also having longer intervals of fever and higher CRP levels. A multivariate analysis demonstrated that the independent risk factors for mortality were active tuberculosis [odds ratio (OR): 2.681; 95% confidence interval (CI) 1.006-7.142; p=0.049] hyponatremia (OR: 3.027; 95% CI 1.238-7.401; p=0.015) and being at clinical stage 4 (as defined by the World Health Organization) (OR: 9.492; 95% CI 1.200-75.065; p=0.033) within the first six months of admission. CONCLUSION: Special consideration should be given to patients who have active tuberculosis are at clinical stage 4 and present with hyponatremia upon admission as these were found to be important factors associated with mortality within six months of hospital admission in HIV-1 patients.

To study the polymorphisms and secondary structure of human immunodeficiency virus (HIV-1) tat exon 1 among subtype B' and B'/C HIV-1 infected people in China and to explore the relationship between the polymorphism of tat exon 1 and the disease progression.8 subtype B' and 5 B'/C HIV-1 infected patients with slow disease progression were selected from Liaoning, Jilin and Yunnan province. 26 subtype B' and 9 B'/C HIV-1 infected patients with similar sex, age but with typical disease progression were selected. Provirus was extracted from the whole blood. The gene sequences of the Tat exon 1 were amplified by nest-polymerase chain reaction (nest-PCR). Products were purified and sequenced directly. The sequences were aligned, translated, amino acid substitution were analyzed and secondary structures were predicted.Many amino acid substitution could be found in the exon 1 of Tat in HIV-1 subtype B' and B'/C recombinant strain infected persons with different disease progression except A58T,none of them showed definitely relationship with HIV viral load and disease progression. 23N, 31S, 32Y and 46F were subtype-specific substitutions. No characteristic secondary structure of exon 1 of Tat was found.Some of the mutations of tat exon 1 might be related to HIV viral load and disease progression. However, there was no relationship found between the secondary structure of Tat protein and the disease progression.

At the end of 2005, 650,000 people lived with human immunodeficiency virus type-1 (HIV-1) in China, of whom 75 000 were AIDS patients. Many AIDS patients received highly active antiretroviral therapy (HAART) supported by the "China CARES" program but the immune responses of HAART were seldom reported. This study investigated the effect of HAART on the activation and coreceptor expression of T lymphocytes in Chinese HIV/AIDS patients and evaluated its effect on immune reconstitution.Seventeen HIV/AIDS patients were enrolled and three-color-flow cytometry was used to detect the activation of HLA-DR CD38 and the coreceptor CCR5, CXCR4 expression on T lymphocytes in whole blood samples taken from the patients before and after 3- or 6-month HAART.The activation percents of CD4(+), CD8(+) T lymphocytes were significantly higher before therapy than the normal controls (HLA-DR/CD4: 40.47 +/- 18.85 vs 11.54 +/- 4.10; CD38/CD4: 81.34 +/- 10.86 vs 53.34 +/- 11.44; HLA-DR/CD8: 63.94 +/- 12.71 vs 25.67 +/- 9.18; CD38/CD8: 86.56 +/- 11.41 vs 58.84 +/- 6.16, all P0.01). After 6-month combined antiretroviral treatment, the activation of T lymphocytes in HIV/AIDS patients was significantly decreased (HLA-DR/CD4: 28.31 +/- 13.48; CD38/CD4: 69.88 +/- 12.64; HLA-DR/CD8: 46.56 +/- 18.64; CD38/CD8: 70.17 +/- 14.54, all P0.01 compared with the pre-treatment values). Before the treatment, CCR5 expression on CD8(+) T lymphocytes was up-regulated while CXCR4 expression on CD8(+) T lymphocytes downregulated in HIV/AIDS patients compared with the normal controls (CD8/CCR5: 70.91 +/- 10.03 vs 52.70 +/- 7.68; CD8/CXCR4: 24.14 +/- 11.08 vs 50.05 +/- 11.68, all P0.01). After 6-month HAART, CCR5 expression on CD8(+) T lymphocytes significantly decreased (56.35 +/- 12.96, P0.01), while CXCR4 expression on CD8(+) T lymphocytes increased (36.95 +/- 9.96, P0.05) compared with the pre-treatment and the normal controls. A significant statistical relationship was observed between the expression of activation markers, CCR5 and the CD4(+) T lymphocyte counts after HAART (P0.05).Reduced activation of T lymphocytes and a normalization of coreceptor expression were observed in Chinese HIV/AIDS patients after HAART. Immunity can be restored in HIV/AIDS patients receiving HAART.

To determine the relative resistance to HIV-1 infection of CD4 + T lymphocytes in HIV-exposed seronegative individuals (ESNs) in China.HIV primary isolates were obtained from peripheral whole blood of HIV-infected persons. CD4 + T lymphocytes of Chinese ESNs were separated from peripheral blood mononuclear cells with magnetic cell sorting (MACS). The purified CD4 + T lymphocytes were cocultured with HIV primary isolates. The p24 level was detected and the culture medium was refreshed every 3 days within 2 weeks.For M tropic HIV strains, p24 level was significantly lower in ESN group than in control group (P0.05); for some M tropic HIV strains, even no p24 replicated in ESN group. However, T tropic virus strains had no significant difference between these two groups (P0.05).CD4 + T lymphocytes of Chinese ESNs may possess relative resistance to M tropic HIV strains, which may be one of the main influencing factors that result in ESN.

To evaluate the Virologic and Immunologic efficacy of HAART on Chinese HIV/AIDS patients and to assess the impact of of HAART on drug resistance mutations.Three cohorts of Liaoning, Jilin and Henan province received three different regimens for 6 months respectively. Regimen of Liaoning cohort comprised Efavirenz + Indinavir (EFV + IDV), regimen of Jilin cohort comprised Stavudine + Didanosine + Efavirenz (d4T + ddI + EFV) and regimen of Henan cohort comprised Stavudine + Didanosine + Nevirapine (d4T + ddI + NVP). Viral load, CD4(+) T cell count and drug resistance genotype were detected on the three cohorts before and after treatment. Partial HIV-1 pol genes encoding protease and 1 - 220 amino acid of reverse transcriptase were amplified by RT-PCR and then automatically sequenced. All sequences were compared with the data of Stanford HIV Drug Resistance Database to assess resistance mutations against reverse transcriptase inhibitors (RTIs) and protease inhibitors (PIs).During observation of 6 months, viral suppression to undetectable level and Elevated CD4(+)T cell count efficacy were achieved on partial Chinese HIV/AIDS patients in each of the three different regimens, even in some patients with rather low CD4(+)T cell count baseline. Before HAART, no primary mutations against PIs and RTIs were detected on the three cohorts, except one patient in Liaoning cohort. But after HAART, drug resistance mutations against RTIs occurred on each of the three cohorts. K103N is the most common mutation against NNRTIs, which can cause high-level resistance to each of the available NNRTIs. Y181C is another common mutation occurred in Henan cohort, which causes crossing drug resistance and multi-drug resistance to NNRTIs. In addition, intermediate level and low level resistance against NRTIs caused by K65R and L74V can also be found, but less commonly.Treatment naive Chinese HIV/AIDS patients were sensitive to HAART. Expected virologic and immunologic efficacy of HAART were achieved on Chinese HIV/AIDS patients, but after the introduce of HAART, the high prevalence of drug resistance mutations against NNRTIs and NRTIs, crossing drug resistance and multi-drug resistance reminded us to pay more attention to the drug resistance mutations detection, treatment standardization, and to avoid drugs wasting and prevent the prevalence of drug resistance strains.