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Introduction: Incidence of heart failure (HF) is increased among individuals living with human immunodeficiency virus (HIV). Whether HIV adversely affects hospitalization and mortality rates among patients with diagnosed HF has not been systematically evaluated. Hypothesis: We hypothesized that HIV infection would increase the risk of hospitalization and all-cause mortality rates in patients with HF, independent of established risk factors. Methods: We performed a systematic search of PubMed, EMBASE, Cochrane Library and Web of Science through March 7 th , 2021 for cohort studies conducted in adult patients (age≥18 years) with diagnosed HF and ascertainment of HIV infection at baseline. Outcomes assessed include all-cause mortality, HF-associated hospitalization, and all-cause hospitalization. All studies included multivariable adjustments for demographics, cardiovascular risk factors, and comorbidities. Pooled hazard ratio (HR) and 95% confidence intervals (CI) were calculated using a random-effects model. Results: We identified 7 studies consisting of 10,363 HF patients living with HIV and 48,933 HIV negative HF controls. HF patients with HIV had a higher risk of all-cause mortality compared to HIV-negative HF patients, HR (95% CI): 1.20 (1.14, 1.25), I 2 =0%. Similarly, HIV infection was associated with increased risks of both HF-associated hospitalization and all-cause hospitalization, with HR (95% CI) of 1.31 (1.03, 1.65) and 1.27 (1.12, 1.44), respectively; though significant heterogeneity was observed for both of these outcomes, I 2 =80% and 62%, respectively. Conclusions: HIV infection was independently associated with increased risk of all-cause mortality and both HF-associated and all-cause hospitalizations among individuals with HF. Our data may have important implications for HF management in this high-risk population.

Introduction: Long-term exposure to human immunodeficiency virus (HIV) associated immune dysregulation and adverse metabolic effects of highly active antiretroviral therapy could increase the risk for developing atherosclerotic cardiovascular disease (CVD). Previous prospective studies have also identified HIV infection as an independent risk factor for the development of heart failure (HF), though results remain inconsistent. We conducted a systematic review and meta-analysis of prospective studies to assess the association between HIV infection and incident HF. Hypothesis: We hypothesized that HIV infection would increase the risk of incident HF, though this association may be modified by other demographic or clinical characteristics. Methods: We performed a literature search of PubMed, EMBASE and Web of Science through June 1 st , 2020 to identify prospective studies which examined the association between HIV infection and incident HF among adults (age≥18 years). Study-specific risk estimates were combined using a random-effects model to calculate the pooled relative risk (RR) and 95% confidence intervals (CI). Results: Eight records with a total of 8,949,448 participants with 101,335 incident cases of HF (1,941 among HIV+ individuals and 99,394 among HIV- individuals) were included for meta-analysis. In our overall analysis, HIV infection was positively associated with incident HF, RR (95% CI): 1.80 (1.51-2.15), I 2 =85.6% ( Figure 1 ). This association was largely consistent among individuals without a history of CVD, RR (95% CI): 1.89 (1.51-2.37). HIV infection status tended to be a stronger risk factor for HF among younger adults (age3 ) count. Conclusions: Our meta-analysis provides additional support that HIV may be an independent risk factor for HF, with potentially important clinical and public health implications for primary prevention.

Objective Our objective was to explore the effect of depression and anxiety on adherence to antiretroviral therapy (ART) among MSM with newly diagnosed HIV infections. Design We conducted a prospective study of Chinese MSM with newly diagnosed HIV infections. Methods The Hospital Anxiety and Depression Scale was used to measure depression and anxiety at baseline, 6 and 12 months, separately. ART adherence was self-reported once every 3 months ('perfect' or no missing dose in the past 3 months vs. 'imperfect' adherence or at least one missing dose in the past 3 months). We utilized a priori substantial knowledge guided by causal models to identify confounding covariates, and performed mixed-effect logistic regression to assess the effects of depression and anxiety on ART adherence. Results We included 228 participants who initiated ART after HIV diagnosis and before the end of study. A one-unit increase in the depression and anxiety score was associated with a 16% increase [adjusted odds ratio (aOR), 1.16; 95% confidence interval (CI), 1.02-1.32] and a 17% increase (aOR, 1.17; 95% CI, 1.03-1.33) in the odds of reporting imperfect ART adherence, respectively. When depression and anxiety were categorized (normal, borderline, and likely), only likely anxiety had a significant association with imperfect ART adherence (aOR, 4.79; 95% CI, 1.12-20.50). Conclusion Depression and anxiety are risk factors for imperfect ART adherence among Chinese MSM with newly diagnosed HIV infections. Intensive intervention on depression and/or anxiety beyond regular post-HIV-testing counseling may increase adherence to ART, and improve HIV treatment outcomes.

Prospective cohort studies have been conducted to estimate HIV incidence among men who have sex with men (MSM) in first-line megacities cities (>10 million residents) in China, but few in the second-line large- or middle-size cities. This study was to investigate HIV incidence and cohort retention among MSM in a second-line city Hangzhou in eastern China. A total of 523 HIV-seronegative MSM were recruited during September 2014 to September 2015, and were followed up prospectively at 3, 6, 9, and 12 months. Questionnaire interviews were conducted, and laboratory tests were performed to evaluate baseline syphilis infection and HIV seroconversions. Chi-square test and logistic regression model were used to identify factors associated with cohort retention rate and syphilis prevalence. Of 523 participants, 137 (26.2%) completed 6-month follow-up, and use of Internet for recruiting study participants (vs other recruitments: adjusted odds ratio [AOR] = 0.5; 95% confidence interval [CI]: 0.3–0.8) and being homosexual (vs heterosexual or bisexual: AOR = 0.6; 95% CI: 0.4–0.9) were associated with lower cohort retention. The overall HIV incidence during 12 months of follow-up was 6.6 per 100 person-years (95% CI: 3.4–9.8/100 PY). The prevalence of syphilis at baseline was 6.5% (95% CI: 4.4%–8.6%), and disclosing sexual orientation (AOR = 0.4, 95% CI: 0.2–0.9) was associated with lower risk of syphilis infection. HIV is spreading rapidly among MSM in the second-line Chinese city. Effective interventions are needed to target this population in both first-line megacities and second-line large and middle-size cities.

OBJECTIVES: To assess the prevalence and risk factors of HIV among male clients of female sex workers (FSWs) in China. METHODS: Convenience sampling methods were used to recruit 315 clients using FSW-client and client-client networks. Subjects provided information on sociodemographic characteristics and sexual and drug behavior patterns. Blood samples were collected for HIV testing and urine samples for opiate testing. RESULTS: Overall HIV prevalence was 6.0%; among drug users it was 30.8%. 33.7% of respondents reported that they always use condoms in commercial sex and 63.5% that they used a condom in the last commercial sex episode. Drug use (OR: 6.1; 95% CI: 1.7 to 21.4) and lack of a regular sexual partner (OR: 6.3; 95% CI: 1.8 to 21.9) were significantly associated with HIV infection. CONCLUSIONS: Clients of FSWs serve as potential bridges for HIV transmission from the high-risk FSWs to the low-risk general population making them a key target for intervention. High HIV prevalence rates among clients in Kaiyuan is particularly alarming given their risk behavior patterns including high rates of partner exchange low condom use rates and drug-using behaviors. Innovative interventions are needed to reduce the risk of HIV among clients and reduce the bridge of transmission to the general population.

To investigate the incidence rates of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among injection drug users (IDU) in a drug trafficking city in southwest China.A prospective cohort study.A cohort of 333 HIV-seronegative IDU was followed for 36 months from November 2002 and evaluated every 6 months for seroconversions to HIV and HCV antibodies as well as hepatitis B surface antigen. Questionnaire interviews were conducted to collect information about risk behaviors.Some 68.8% of subjects completed the last follow-up survey. A total of 14 HIV, 47 HCV and 51 HBV seroconversions were observed over the 36-month follow-up period, yielding average incidence rates of 2.3 per 100 person-years for HIV, 33.3 for HCV and 11.3 for HBV. Multivariate Poisson regression analyses showed that factors independently associated with HIV seroconversion were minority ethnicity and greater frequent sharing of needles or syringes in the past 3 months one or more times per week. Predictors of HCV seroconversion included being female, greater frequent drug use in the past 3 months seven or more times per week, and frequent sharing of needles or syringes in the past 3 months one or more times per week.Blood-borne infections continue to spread, but at lower rates with time among IDU in a southwestern Chinese city where intervention programmes have existed for a few years. Rigorous implementation of harm reduction programmes may have reduced seroconversion to blood-borne infections among targeted high-risk populations.

The objective of this study was to investigate the prevalence and risk factors of syphilis infection among female sex workers in a southwestern Chinese city along a drug trafficking route. From December 2004 to January 2005 343 female sex workers (FSWs) were recruited through community outreach and peer referring. Confidential questionnaire interviews were administered to collect information on sexual and other sexually transmitted diseases/HIV risk behaviors. Cervical and blood samples were collected to test for syphilis and HIV antibodies and Neisseria gonorrhoeae infection; Condyloma acuminatum infection was diagnosed clinically. Of 343 FSWs 15.7% were infected with syphilis. The prevalence of HIV gonorrhea and C. acuminatum was 0.6% 2.0% and 1.5% respectively. The subtype of 2 HIV-1 infections was both CRF 07BC. Nearly 10% of FSWs reported using illicit drugs. Consistent use inconsistent use and never use of condoms with commercial sex clients in the last month were reported by 53.9% 38.5% and 7.6% FSWs respectively. Longer duration of sex work (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.08 -3.62) working at low-end establishments (OR = 2.03; 95% CI = 1.10 -3.76) and if primary sex partners had sex with other women in the past 6 months (OR = 2.06; 95% CI = 1.08 -3.91) were independently associated with syphilis infection. High prevalence of syphilis and overlapped unprotected commercial sex and drug using behaviors among FSWs along a drug-trafficking route may suggest a potential for rapid spread of HIV from injection drug users to FSWs and then to the general population and underscore the urgency of preventive interventions to break the bridge of FSWs for HIV/sexually transmitted disease spread. (authors)

Illegal commercial plasma donation in the late 1980s and early 1990s caused blood-borne infections in China.To estimate the prevalence of HIV and hepatitis C virus (HCV) infections and to identify associated risk factors in central China with a history of illegal plasma collection activities.A cross-sectional study was carried out in 2004, in which all adult residents in four villages in rural Shanxi Province were invited for a questionnaire interview and testing of HIV and HCV antibodies.Of 3062 participating villagers, 29.5% reported a history of selling whole blood or plasma. HIV seropositivity was confirmed in 1.3% of subjects and 12.7% were HCV positive. Their co-infection rates were 1.1% among all study subjects, 85% among HIV-positive subjects, and 8.7% among HCV-positive subjects. Selling plasma [odds ratio (OR), 22.5; 95% confidence interval (CI), 16.1-31.7; P0.001] or blood (OR, 3.1; 95% CI, 2.3-4.2; P0.001) were independently associated with HIV and/or HCV infections. Although a spouse's history of selling plasma/blood was not associated with either infection, the HIV or HCV seropositivity of a spouse was significantly associated with HIV and/or HCV infections (both OR, 3.2; 95% CI, 2.0-5.2 in men, 2.0-4.9 in women; P0.001). For men, residence in the village with a prior illegal plasma collection center (OR, 2.5; 95% CI, 1.7-3.7; P0.001) and for women, older age (OR, 3.4; 95% CI, 1.2-14.0; P = 0.04) were associated with HIV and/or HCV infections.HIV and HCV infections are now prevalent in these Chinese communities. HIV projects should consider screening and care for HCV co-infection.

HIV-related stigma is a risk factor for depression among persons living with HIV, but this has not been studied in persons who are newly diagnosed. Men who have sex with men (MSM) are vulnerable to depression and/or anxiety due to their identity as members of a discriminated minority group, potential social isolation, and, frequently, high risk of HIV acquisition. We evaluated the stigma-depression association among newly diagnosed HIV-infected Chinese MSM in Beijing. Methods: We recruited 366 MSM who were newly diagnosed in the baseline survey of a randomized clinical trial. HIV-related stigma was measured by a scale constructed with sensitivities towards Asian culture. Exploratory factor analysis helped validate the scale. Depression was assessed from the Hospital Anxiety and Depression scale (HADS). Depression was categorized as normal, borderline, and suspicious. Multivariable ordered logistic regression was used to assess the association between continuous stigma scores and depression. Results: The HADS classified 30% of participants as depressed. The HIV-related stigma scale proved valid, and 4 subscales were replicated in the exploratory factor analysis. Median scores for enacted, felt, vicarious, and internalized stigmas were 0, 17, 2, and 5, respectively. One point increase of stigma scores was associated with a 3% to 9% increase in the odds of being depressed, with internalized stigma (shame, guilt, contact avoidance) having the strongest association (aOR = 1.09, 95% CI: 1.07 to 1.12). Conclusions: HIV-related stigma was a risk factor for depression among newly diagnosed HIV-infected MSM. Interventions for coping with internalized stigma following HIV diagnosis may reduce depression and improve downstream indications of the care continuum: linkage to care, retention, and adherence to antiretroviral therapy.