Search

Objective: To predict the trend of AIDS in specific age groups and to determine the objective population for AIDS screening, this study explored the three transmission routes and characterized each patient group using the APC model based on the whole, local, and immigrant populations in Zhejiang, China.Methods: The data recruited in this paper was obtained from the national Comprehensive AIDS Prevention and Control Information System - Antiviral Therapy Management database and the Chinese Disease Prevention and Control Information System and the Statistical Yearbook of Zhejiang, China. An APC model was used to estimate the impact of age, period, and cohort on the incidence of AIDS, as well as to predict the AIDS incidence in specific age groups based on different sexes with different transmission routes.Results: The AIDS incidence peaked in males aged 20-35 years; the incidence of males was higher than that of females due to the impact of period; obvious cohort effect was observed among the immigrants. In the whole and local populations, the incidences of males in all age groups and females in both the 35-year-old group and the whole age group were predicted to increase sharply in 5 years. In the immigrant population, the AIDS incidences in both sexes in all age groups were expected to increase significantly in 5 years. Under the influence of period, the incidence of AIDS via homosexual transmission in the whole population and the local population increased and remained stable after 2015. At the same time, the incidence of AIDS transmitted by homosexual and heterosexual routes in the immigrants also showed an increasing trend.Conclusions: The results elucidate that there are sex differences in AIDS incidence, and the incidence of AIDS through various transmission routes in all groups is predicted to exhibit an upward trend in the 5 years to come. Effective intervention strategies should be developed and implemented by the public health departments in Zhejiang to control the epidemic of AIDS. [ABSTRACT FROM AUTHOR]

Background: The AIDS epidemic among young students is serious, and effective preventive interventions are urgently needed. Game-based intervention has become an innovative way to change healthy behaviors, and we have developed an AIDS educational game called AIDS Fighter · Health Defense. Objective: In this study, we tested the effect of AIDS Fighter · Health Defense on young students in improving AIDS-related knowledge, stigma, and attitude related to high-risk behaviors in Southwest China. Methods: A randomized controlled trial was conducted from September 14 to 27, 2020. In total, 96 students from 2 classes in a middle school were selected by stratified cluster sampling in Luzhou City, Southwest China. The students were randomly divided into the intervention group (n=50, 52%) and the control group (n=46, 48%). The intervention group played the AIDS educational game AIDS Fighter · Health Defense; the control group learned AIDS-related knowledge through independent learning on the QQ chat group. An AIDS-related knowledge questionnaire, a stigma scale, and an attitude questionnaire on AIDS-related high-risk behaviors were used to measure the effect of the AIDS educational game via face-to-face interviews. The user experience of the game was assessed using the Educational Game User Experience Evaluation Scale. The difference was statistically significant at P≤.05. Results: After the intervention, the AIDS knowledge awareness rate (X [SD], %) of the intervention and control groups were 70.09 (SD 11.58) and 57.49 (SD 16.58), with t=4.282 and P<.001. The stigma scores of the 2 groups were 2.44 (SD 0.57) and 2.48 (SD 0.47), with t=0.373 and P=0.71. The positive rate (X [SD], %) of attitudes of high-risk AIDS behaviors of the 2 groups were 82.00 (SD 23.44) and 79.62 (SD 17.94), with t=0.555 and P=0.58. The mean percentage of the game evaluation was 54.73% as excellent, 31.45% as good, 13.09% as medium, and 0.73% as poor. Conclusions: AIDS Fighter · Health Defense could increase AIDS-related knowledge among young students, but the effect of the game in reducing AIDS-related stigma and improving the attitudes of high-risk AIDS behaviors was not seen. Long-term effects and large-scale studies are needed to assess the efficacy of game-based intervention. [ABSTRACT FROM AUTHOR]

Improving access to HIV/AIDS healthcare services is of great concern to government and policymakers striving to strengthen overall public health. How to reasonably allocate HIV/AIDS healthcare resources and maximize the equality of access to healthcare services across subdistrict areas has become an urgent problem to be solved. However, there is limited research on this topic in China. It is necessary to evaluate spatial accessibility to improve the accessibility and equity of HIV/AIDS healthcare services. In this study, the improved multi-modal two-step floating catchment area (2SFCA) and inverted 2SFCA (i2SFCA) methods are used to measure the spatial accessibility of HIV/AIDS healthcare services and the crowdedness of the healthcare sites in Shandong Province, China. Then, the theoretical supply and the optimal spatial distribution of resources are calculated and visualized by minimizing the accessibility gaps between demand locations. This study showed that the spatial accessibility of HIV/AIDS service resources in Shandong Province was concentrated and unevenly distributed, and the accessibility scores in the marginal areas of prefecture-level cities were significantly lower than those in other areas. Regions with a large number of doctors had significantly higher levels of spatial accessibility. The ART accessibility scores in the southwest of Shandong Province were higher than those in other regions. As the travel friction coefficient increased, the accessibility scores formed an approximately circular cluster distribution centered on the healthcare sites in geographical distribution. More ART drugs needed to be supplied in marginal areas and more doctors were needed to work on HIV/AIDS in urban areas to address the spatial distribution imbalance of HIV/AIDS healthcare services. This study profoundly analyzed the spatial accessibility of HIV/AIDS healthcare services and provided essential references for decision-makers. In addition, it gives a significant exploration for achieving the goal of equal access to HIV/AIDS healthcare services in the future. [ABSTRACT FROM AUTHOR]

AbstractThe harm associated with high-risk injected opiate use and the threat of the HIV epidemic among injecting drug users has become a worldwide problem. Twenty years ago, in the face of a rapid increase in mortality rates among injecting drug users and the upcoming threat of HIV, the first harm-reduction programs were implemented in the Western world. This paper is a literature review describing four forms of harm reduction currently in use in Europe, North America, and Australia. Each represents a reasonable counterapproach to the threat of increased prevalence of HIV among injecting drug users in transitional and developing countries. The paper attempts to explain the concepts behind the most commonly used types of harm reduction and provides a brief overview of the advantages and disadvantages of each and the reasons for their implementation. The main focus of the review is on the definition and the practical aspects of harm reduction; it includes a brief introduction of Chinese harm-reduction efforts and their implications.Acta Pharmacologica Sinica (2009) 30: 513–521; doi: 10.1038/aps.2009.30; published online 6th April 2009 [ABSTRACT FROM AUTHOR]

Abstract  Censorship in the area of public health has become increasingly important in many parts of the world for a number of reasons. Groups with vested interest in public health policy are motivated to censor material. As governments, corporations, and organizations champion competing visions of public health issues, the more incentive there may be to censor. This is true in a number of circumstances: curtailing access to information regarding the health and welfare of soldiers in the Kuwait and Iraq wars, poor health conditions in Aboriginal communities, downplaying epidemics to bolster economies, and so forth. This paper will look at the use of a computer worm (the benevolent health worm) to disseminate vital information in␣situations where public health is threatened by government censorship and where there is great risk for those who ‹speak out’. The discussion of the benevolent health worm is focused on the Peoples’ Republic of China (China) drawing on three public health crises: HIV/AIDS, SARS and Avian Influenza. Ethical issues are examined first in a general fashion and then in a specific manner which uses the duty-based moral philosophy of Confucianism and a Western human rights-based analysis. Technical, political and legal issues will also be examined to the extent that they better inform the ethical debate. [ABSTRACT FROM AUTHOR]

Objectives: Studies on the prognosis and risk stratification of patients with acquired immune deficiency syndrome (AIDS) – related Burkitt lymphoma (AR-BL) are rare. We aim to construct a novel model to improve the risk assessment of these patients. Methods: We retrospectively analyzed the clinical data of 34 patients over the past 10 years and the factors associated with progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate Cox models. Then, the novel model consisting of screened factors was compared with the existing models. Results: With a 37-month median follow-up, the overall 2-year PFS and OS rates were 40.50% and 36.18%, respectively. The OS of patients who received chemotherapy was better compared with those without chemotherapy (P =.0012). Treatment with an etoposide, prednisone, oncovin, cyclophosphamide, and hydroxydaunorubicin-based regimen was associated with longer OS and PFS compared with a cyclophosphamide, doxorubicin, vincristine, and prednisone-based regimen (OS, P =.0002; PFS, P =.0158). Chemotherapy (hazard ratio [ HR ] = 0.075; 95% confidence interval [CI], 0.009-0.614) and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 2 to 4 (HR = 4.738; 95% CI, 1.178-19.061) were independent prognostic factors of OS in multivariate analysis and we established a novel prognostic risk stratification model named GZ8H model with chemotherapy and ECOG PS. Conclusion: GZ8H showed better stratification ability than the international prognostic index (IPI) or Burkitt lymphoma IPI (BL-IPI). Furthermore, the C-index of the nomogram used to predict OS was 0.884 in the entire cohort and the calibration curve showed excellent agreement between the predicted and actual results of OS. No human immunodeficiency virus-related factors were found to be associated with OS and PFS of AR-BL patients in our study. Overall, the clinical characteristics and outcomes in AR-BL were shown and prognostic factors for OS and PFS were identified in this study. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has revealed the contested politics of global health governance, though we still don't know enough about the dynamics of domestic pandemic responses, or about the relationship between the politics of those responses and the politics of global health governance, both of which have changed significantly in recent decades. Focusing on three cases (HIV/AIDS, SARS, and COVID-19) of cross-border infectious diseases, this article explores the trajectory of China's pandemic responses in the context of globalization. Attending to changing politics at domestic, international, and global levels, I argue that those responses have been a complex combination of China's domestic politics (e.g., priorities, institutions, leadership, and timing), its international relations (especially with the US), and its engagements with global health governance. It is concluded that the increasing divergence of pandemic responses in a time of ubiquitous global health crisis demands urgent attention to the connections (including contestations) between domestic pandemic responses and the evolvement of global health governance from a broader perspective that considers changes in geopolitics. [ABSTRACT FROM AUTHOR]

Aim: Tuberculous meningitis is an infectious disease of the central nervous system caused by Mycobacterium tuberculosis (M. tuberculosis). It mainly involves the meninges and brain parenchyma, as well as the spinal cord and meninges; Disability and mortality rates are high. In recent years, due to the increase of drug-resistant tuberculosis patients, population mobility and the prevalence of acquired immune deficiency syndrome, the incidence rate of tuberculosis has increased significantly, and tuberculous meningitis has also increased. Methods: At present, tuberculosis is still a worldwide infectious disease that seriously threatens human health, especially in underdeveloped and developing countries. China is the largest developing country in the world with a large population. Results: The situation of tuberculosis prevention and control is grim. Its disability rate is the highest in tuberculosis infection. In addition to the common non-specific manifestations, tuberculous meningoencephalitis may also have rare manifestations of stroke, hearing loss and visual loss. Conclusion: Understanding and timely improvement of corresponding examinations and targeted treatment will help improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Purpose-Immunotherapy has revolutionized cancer therapy, becoming the standard of care for various malignancy treatments. Human immunodeficiency virus (HIV) patients, however, are an underserved group with limited access to clinical trials and cancer therapy. This study was to evaluate the safety and efficacy of programmed cell death 1 (PD - 1) inhibitors in patients with advanced cancer and HIV/acquired immunodeficiency syndrome (AIDS). Methods and Materials-We performed a prospective, open-label, nonrandomized, phase 1 single center study. Patients with advanced cancer and HIV/AIDS received the treatment of PD - 1 inhibitors (camrelizumab, 200 mg, administered intravenously every 3 weeks), along with combination antiretroviral therapy (cART) for HIV. Results-Sixteen participants (12 men and 4 women; median age, 46.5 (29 - 78) years) were enrolled; 1 had non - Hodgkin lymphoma (NHL), and 15 had non - AIDS - defining cancers. Safety was observed over 130 cycles of treatment with camrelizumab. Most treatment-emergent adverse events at least possibly attributed to camrelizumab were grade 1 or 2, including reactive cutaneous capillary endothelial proliferation (RCCEP) (9 participants), hearing loss (1 participant), hypophysitis (1 participant). 3 participants experienced hemorrhage due to poor performance status. HIV was controlled in all participants. Best tumor responses included 3 complete response, 5 partial response, 2 stable disease, and 6 progressive disease. The 2 years progressionfree survival (PFS) was 67.0% (95% CI: -0.05, 0.00) and overall survival (OS) was 55.3% (95% CI: -0.05, 0.01) for the 16 patients who had received camrelizumab. Conclusions-This study demonstrates that camrelizumab treatment in patients with advanced cancers and HIV/AIDS was feasible and the clinical outcomes were acceptable. [ABSTRACT FROM AUTHOR]

The epidemic of HIV/AIDS exists in China from more than 26 years and is still at a low prevalence (<0.06%) on the global level. The purpose of this paper is to disclose the rational of how to keep the low rate through strenthening key strategies and comprehensive measures for prevention and control of the disease using collecting, reviewing, and analyzing surveillance data, special materials from publications, national meetings, symposiums, and forums, major research results as well as the personal experiences within the period of 1985-2011. In the meantime, the paper mentions that currently China is facing challenges and also going to carry out its actions concerning how to deal with the problems in order to respond to the UN CALL on "Getting to Zero". [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Illicit drug abuse and HIV/AIDS have increased rapidly in the past 10 to 20 years in China. This paper reviews drug abuse in China, the HIV/AIDS epidemic and its association with injection drug use (IDU), and Chinese policies on illicit drug abuse and prevention of HIV/AIDS based on published literature and unpublished official data. As a major drug trans-shipment country with source drugs from the "Golden Triangle" and "Gold Crescent" areas in Asia, China has also become an increasingly important drug consuming market. About half of China's 1.14 million documented drug users inject, and many share needles. IDU has contributed to 42% of cumulatively reported HIV/AIDS cases thus far. Drug trafficking is illegal in China and can lead to the death penalty. The public security departments adopt "zero tolerance" approach to drug use, which conflict with harm reduction policies of the public health departments. Past experience in China suggests that cracking down on drug smuggling and prohibiting drug use alone can not prevent or solve all illicit drug related problems in the era of globalization. In recent years, the central government has outlined a series of pragmatic policies to encourage harm reduction programs; meanwhile, some local governments have not fully mobilized to deal with drug abuse and HIV/AIDS problems seriously. Strengthening government leadership at both central and local levels; scaling up methadone substitution and needle exchange programs; making HIV voluntary counseling and testing available and affordable to both urban and rural drug users; and increasing utilization of outreach and nongovernmental organizations are offered as additional strategies to help cope with China's HIV and drug abuse problem. [ABSTRACT FROM AUTHOR]

Summary. The human immunodeficiency virus–acquired immune deficiency syndrome (HIV–AIDS) epidemic in Hong Kong has been under surveillance in the form of voluntary reporting since 1984. However, there has been little discussion or research on the reconstruction of the HIV incidence curve. This paper is the first to use a modified back-projection method to estimate the incidence of HIV in Hong Kong on the basis of the number of positive HIV tests only. The model proposed has several advantages over the original back-projection method based on AIDS data only. First, not all HIV-infected individuals will develop AIDS by the time of analysis, but some of them may undertake an HIV test; therefore, the HIV data set contains more information than the AIDS data set. Second, the HIV diagnosis curve usually has a smoother pattern than the AIDS diagnosis curve, as it is not affected by redefinition of AIDS. Third, the time to positive HIV diagnosis is unlikely to be affected by treatment effects, as it is unlikely that an individual receives medication before the diagnosis of HIV. Fourth, the induction period from HIV infection to the first HIV positive test is usually shorter than the incubation period which is from HIV infection to diagnosis of AIDS. With a shorter induction period, more information becomes available for estimating the HIV incidence curve. Finally, this method requires the number of positive HIV diagnoses only, which is readily available from HIV–AIDS surveillance systems in many countries. It is estimated that, in Hong Kong, the cumulative number of HIV infections during the period 1979–2000 is about 2600, whereas an estimate based only on AIDS data seems to give an underestimate. [ABSTRACT FROM AUTHOR]

Background: Cryptococcal meningitis (CM) is an inflammatory mycosis of the central nervous system caused by meninge infection or brain parenchyma with Cryptococcus species. It is associated with high morbidity and mortality, and patients with acquired immune deficiency syndrome are particularly susceptible. There have been increasing reports of CM in HIV-negative patients in China over the last few years. Case presentation: A 31-year-old healthy Chinese male presented with fever and gradually developed headache, projectile vomiting, and other manifestations that were later confirmed as Cryptococcus gattii meningoencephalitis. However, multiple disease changes occurred during the course of treatment, and the regimen was accordingly modified after the diagnosis of post-infectious inflammatory response syndrome (PIIRS). The patient eventually recovered. Conclusion: There has been a growing trend in the incidence of C. gattii meningoencephalitis in HIV-negative patients. It shows rapid onset and severe prognosis. This case report can provide a reference to treat PIIRS following CM in HIV-negative patients. [ABSTRACT FROM AUTHOR]

Background: AIDS is a worrying public health issue in China and lacks timely and effective surveillance. With the diffusion and adoption of the Internet, the ‘big data’ aggregated from Internet search engines, which contain users’ information on the concern or reality of their health status, provide a new opportunity for AIDS surveillance. This paper uses search engine data to monitor and forecast AIDS in China. Methods: A machine learning method, artificial neural networks (ANNs), is used to forecast AIDS incidences and deaths. Search trend data related to AIDS from the largest Chinese search engine, Baidu.com, are collected and selected as the input variables of ANNs, and officially reported actual AIDS incidences and deaths are used as the output variable. Three criteria, the mean absolute percentage error, the root mean squared percentage error, and the index of agreement, are used to test the forecasting performance of the ANN method. Results: Based on the monthly time series data from January 2011 to June 2017, this article finds that, under the three criteria, the ANN method can lead to satisfactory forecasting of AIDS incidences and deaths, regardless of the change in the number of search queries. Conclusions: Despite the inability to self-detect HIV/AIDS through online searching, Internet-based data should be adopted as a timely, cost-effective complement to a traditional AIDS surveillance system. [ABSTRACT FROM AUTHOR]

This article reports on ethnographic and demographic findings on AIDS and HIV infection in China. Also, it elaborates those cultural, social and political factors involved in China's attempt to manage its growing HIV epidemic. Data from the First Sino-American Management of HIV Diseases Symposium are also blended with the ethnographic material to further clarify the cultural and epidemiologic status of HIV/AIDS in China. Since HIV predominates among drug users, this fact aroused great attention from the Chinese government early on. Laws introduced in 1988 aimed at strengthening existing statutes to insure that drug dealers, traffickers, and users were prosecuted. Not only is drug-dealing illegal in China, but so is drug-taking. Also, it is argued that providing sexuality education as a means of preventing HIV infection offers no guarantee of reduced behavioral risks. It is concluded that HIV/AIDS and its management pose a transforming challenge to: (1) realistically appraise sexual expression, (2) change traditional sexual language symbols, and (3) revamp the avenues by which China presently addresses "sex."

Objectives. This paper analyzes data on the distribution of and risk factors for the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in China. Methods. Ten years of data on persons tested for HIV infection and AIDS and the proportion who tested positive were analyzed against the background of China's population count. The Chinese- and English-language literature on HIV and AIDS from 1985 through 1995 was also reviewed. Results. Overall, more males than females had HIV infection. Intravenous drug use was the primary source of transmission, followed by heterosexual contacts. Only a small number of the persons tested were homosexual, but their proportion of HIV seropositivity ranked third to that of drug users; that of general hospital patients ranked fourth. Conclusions. HIV infection and AIDS in China began as a highly regionalized and largely rural problem in Yunnan Province. However, HIV infection and AIDS have become an emerging urban problem. HIV seropositivity is low among several groups thought to have an elevated risk. [ABSTRACT FROM AUTHOR]

Background: Alexithymia is common and causes serious harm to people living with HIV/AIDS. Therefore, this study aimed to examine its prevalence and associated factors among people living with HIV/AIDS in China. Methods: A cross-sectional study was conducted in two designated AIDS medical institutions in Harbin, China between January and December 2019. In total, 767 participants completed the 20-item Toronto Alexithymia Scale, the University of California Los Angeles Loneliness short-form, the Patient Health Questionnaire-9, the HIV Treatment Regimen Fatigue Scale, and the Alcohol Use Disorders Identification Test‐Consumption. The participants responded to several questions regarding their demographic characteristics, life satisfaction, disease-related economic burden, and their antiretroviral therapy (ART) side effects. Multivariate logistic regression assessed the relationship between alexithymia and associated factors. Odds ratios (OR) and 95% confidence intervals (CI) for OR were calculated. Results: Approximately 36.1% of the participants were classified as having alexithymia. After adjusted age and education, the logistic regression model indicated that disease-related economic burden (OR = 1.477, 95% CI = 1.155–1.888), ART side effects (OR = 1.249, 95% CI = 1.001–1.559), loneliness (OR = 1.166, 95% CI = 1.101–1.236), and HIV treatment regimen fatigue (OR = 1.028, 95% CI = 1.017–1.039) were positively associated with alexithymia. Conclusions: The mental health problems of people living with HIV/AIDS are essential to understand and deserve attention. Disease-related economic burdens are major associated factors. Multiple actors should provide better services and guarantees for patients. [ABSTRACT FROM AUTHOR]

Objective: Cryptococcal meningitis (CM) threatens people's health and is the main cause of opportunistic fungus-related death in acquired immune deficiency syndrome (AIDS) patients. Herein, we investigate the clinical characteristics and prognostic factors of AIDS patients with Cryptococcus neoformans in Wenzhou, Zhejiang Province, China. Methods: Our study enrolled AIDS patients diagnosed with Cryptococcus neoformans infection who were hospitalised in our hospital. They were divided into Group A (32 patients with CM) and Group B (28 patients without CM) according to their diagnosis. The differences between the two groups of patients' clinical symptoms, imaging examinations and laboratory examinations were observed. Statistical methods were used to analyse the difference in prognosis between the two groups. Results: Headache and fever were the most common clinical characteristics for patients with CM, while respiratory symptoms and fever were the most common clinical characteristics for patients without CM. The positive rate of cryptococcal capsular antigen, India ink staining and culture in the cerebrospinal fluid examination was higher in the CM patients than in the non-CM patients. The overall morbidity and mortality rate after systemic antifungal therapy was higher in the CM patients than in the non-CM patients. A higher incidence of headache, impaired consciousness, nuchal rigidity, first intracranial pressure > 200 mmH2O and mortality was observed in the CM patients than in the non-CM patients. Multifactorial logistic regression analysis showed that headache risk factors affecting the patient's prognosis at 12 weeks. Conclusion: Patients with AIDS diagnosed with Cryptococcus neoformans infection have insidious clinical symptoms in the early stage, and their manifestation is often non-specific, resulting in poor prognosis and high mortality among CM patients compared to patients without CM. Therefore, early identification and timely antifungal therapy before the disease progresses to meningitis are of great value in improving the survival rate of patients. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the first line induction chemotherapy cycles for HIV-associated diffuse large B-cell lymphoma (DLBCL) as these are less common than HIV-negative lymphoma. Currently, the optimal treatment cycles option remains undefined. Therefore, we performed a multi-center study to analyze the clinical characteristics and outcomes of HIV-associated DLBCL patients in different treatment modes in China. Methods: Totally 273 newly diagnosed HIV-associated DLBCL patients at eleven large academic centers from October 2008 to October 2021, were analyzed. Results: In the entire cohort, the median age was 47 years (range, 21-90) at lymphoma diagnosis, and 223 patients were male (81.7%). One hundred and ninety-four (71.1%) patients were germinal center B-cell-like lymphoma (GCB) subtype. Most patients (65.2%, 178/273) had elevated lactate dehydrogenase (LDH), and advanced Ann Arbor stage (78.9% 213/273) at diagnosis. High international prognostic index (IPI) score (3-5) at diagnosis was found in 65.2% (178/273) of patients. One hundred and fifty-five patients (56.8%) had extranodal involvement. The median CD4 cell count was 168/ml (range, 2-1067), of whom 174 (63.7%) had a CD4 cell count below 200/ml. The median follow-up of our cohort was 10.1 (0.1-160) months. The overall 2-year OS rates 58.0%. Median OS times in the 0, 1-3, 4-6, and >6 cycles chemotherapy cohort were 7.1 months, 20.0 months, not reached, and not reached, respectively (Hazard Ratio (HR) =0.549, 95% Confidence interval (CI) 0.451-0.667; p<0.001). Cox multivariate analysis showed that age ≥60 (HR=2.207, 95%CI 1.321-3.690; p=0.003), high IPI score (3-5) (HR=2.926, 95% CI 1.716-4.988; p<0.001), B symptoms (HR=1.928, 95%CI 1.192-3.119; p=0.007), elevated LDH (HR=1.696, 95%CI 1.031-2.791; p=0.038) and received less than 4 cycles chemotherapy (HR=0.520, 95%CI 0.424-0.637; p<0.001) were independent risk factor for adverse prognosis based on overall survival (OS). Discussion: These results demonstrated that 4-6 cycles chemotherapy were significantly associated with improved outcomes in HIV-associated DLBCL patients. However, >6 cycles chemotherapy did not further improve the survival of patients. [ABSTRACT FROM AUTHOR]

Background: A high-risk prevention strategy is an effective way to fight against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The China AIDS Fund for Non-Governmental Organizations (CAFNGO) was established in 2015 to help social organizations intervene to protect high-risk populations in 176 cities. This study aimed to evaluate the role of social organizations in high-risk population interventions against HIV/AIDS. Methods: This study was based on the CAFNGO program from 2016 to 2020. The collected data included the number and types of social organizations participating in high-risk group interventions and the amount of funds obtained by these organizations each year. We explored the factors influencing the number of newly diagnosed AIDS cases using a spatial econometric model. Furthermore, we evaluated the effectiveness of intervention activities by comparing the percentages of the individuals who initially tested positive, and the individuals who took the confirmatory test, as well as those who retested positive and underwent the treatment. Results: Overall, from 2016 to 2020, the number of social organizations involved in interventions to protect HIV/AIDS high-risk populations increased from 441 to 532, and the invested fund increased from $3.98 to $10.58 million. The number of newly diagnosed cases decreased from 9128 to 8546 during the same period. Although the number of cities with overall spatial correlations decreased, the spatial agglomeration effect persisted in the large cities. City-wise, the number of social organizations (direct effect 19.13), the permanent resident population (direct effect 0.12), GDP per capita (direct effect 17.58; indirect effect − 15.38), and passenger turnover volume (direct effect 5.50; indirect effect − 8.64) were the major factors influencing new positive cases confirmed through the testing interventions performed by the social organizations. The initial positive test rates among high-risk populations were below 5.5%, the retesting rates among those who initially tested positive were above 60%, and the treatment rates among diagnosed cases were above 70%. Conclusions: The spatial effect of social organizations participating in interventions targeting high-risk populations funded by CAFNGO is statistically significant. Nevertheless, despite the achievements of these social organizations in tracking new cases and encouraging treatment, a series of measures should be taken to further optimize the use of CAFNGO. Working data should be updated from social organizations to CAFNGO more frequently by establishing a data monitoring system to help better track newly diagnosed AIDS cases. Multichannel financing should be expanded as well. [ABSTRACT FROM AUTHOR]

Background: Hair antiretroviral concentrations are an objective and non-invasive measure of adherence to long-term antiretroviral therapy (ART) and can further predict virologic outcomes among people living with HIV/AIDS (PLWH). Zidovudine, one of the mainstream antiretrovirals in China, has been verified to have high reliability in adherence assessment, especially for its hair concentrations. However, data are limited in its predicting virologic outcomes. Therefore, this study aimed to characterize whether hair zidovudine concentrations can predict virologic suppression among Chinese PLWH compared with hair lamivudine concentrations and two self-reported measures, the overall frequency of adherence behaviors and percentage adherence. Methods: This cross-sectional study randomly recruited 564 PLWH currently treated with zidovudine, lamivudine, and other ART agents (efavirenz, nevirapine, or lopinavir/ritonavir) in Guangxi, China. Hair antiretroviral concentrations were determined using the LC-ESI+-MS/MS method. Receiver operating characteristic (ROC) curves were used to estimate the optimal classification thresholds of hair concentrations of zidovudine and lamivudine, and the two self-reported measures. Based on those optimal classification thresholds, logistic regression was used to examine whether those four adherence measures can predict virologic suppression (HIV-1 RNA < 200 copies/mL). Results: ROC curves demonstrated good classification performance for association with virologic suppression of zidovudine with the optimal threshold at 58 pg/mg and lamivudine at 255 pg/mg but no self-reported measures. PLWH with hair zidovudine concentrations > 58 pg/mg had an adjusted odds ratio (aOR) of 43.191 (95% confidence interval (CI) = 10.171‒183.418, p < 0.001) for virologic suppression. Hair lamivudine concentrations were also associated with virologic suppression (aOR = 10.656, 95% CI = 3.670‒30.943, p < 0.001). However, two self-reported measures did not predict virologic suppression (aORs = 1.157 and 2.488, ps > 0.149). Conclusion: Hair zidovudine concentrations can be served as an alternative tool for clinically predicting virologic suppression among PLWH in China. [ABSTRACT FROM AUTHOR]

Background: As a group at high-risk for acquired immune deficiency syndrome (AIDS) infection, the psychological distress of transgender women cannot be ignored while preventing and controlling AIDS risks. Transgender women are a vulnerable group, and their psychological distress deserves attention. The purpose of this study was to evaluate the psychological distress of transgender women and further determine the influences of factors on the psychological distress of transgender women.Methods: From March 2021 to August 2021, a cross-sectional survey was conducted in Shandong province, China. Data were collected by a questionnaire designed for transgender women, and the GHQ-12 scale was used to measure their psychological distress. The questionnaire combined sociodemographic characteristics, HIV/AIDS cognition, related behaviors, substance abuse, social support, gender identity and other factors. Univariate logistic regression and multivariate logistic regression models were used to explore the psychological factors of transgender women.Results: In this study, the rate of transgender women with psychological distress was 20.08%. Earned monthly income between 10,000-15,000 yuan (OR:0.16, 95% CI:0.06-0.45) and a monthly income greater than 15,000 yuan (OR:0.07, 95% CI:0.01-0.43) were protective factors in the psychology of transgender women. Transgender women who never disclosed sexual orientation and identity (OR: 0.19, 95% CI: 0.06-0.58), who only disclosed their sexual orientation and identity to families or friends (OR: 0.41, 95% CI: 0.18-0.93) were also less likely to have psychological distress. Additionally, transgender women who did not desire to be identified with their sexual orientation and identity (OR: 3.31, 95%CI: 1.08-10.16) and who reported that the Internet did not play an essential role in helping determine sexual orientation (OR: 5.96, 95% CI: 2.91-12.20) were more likely to have psychological distress.Conclusion: Transgender women were at risk of psychological distress. Earning more money can help transgender women's psychological health. When formulating measures for transgender women, we should pay attention to enhance social inclusion and social acceptance of their gender identity and sexual orientation. Strengthening the role of the internet in transgender women's confirmation of sexual orientation and improving the social acceptance of transgender women will have a positive impact on the psychological status of transgender women. [ABSTRACT FROM AUTHOR]

Background: Since the first case of HIV infection was reported in China in 1985, the incidence and mortality of AIDS have been increasing rapidly, which has caused serious damage to the life and health of people in China and all over the world. Therefore, it is of great significance to study the technique for predicting AIDS morbidity and mortality. The purpose of this research is to explore the applicability of the mean generation function model (MGFM) in the early warning of AIDS morbidity and mortality, to predict its prevalence trend, to enrich the prediction techniques and methods of AIDS research and to provide suggestions for AIDS transmission control.Methods: In this research, the MGFM was applied to predict the incidence and mortality of AIDS in China. AIDS incidence and mortality data in China from 2008 to 2019 were used to construct the prediction model.Results: The MGFM can predict the annual incidence and mortality of AIDS. The model constructed in this research predicted that the incidence and mortality of AIDS in China will continue to increase from 2020 to 2023.Conclusion: The mean birth function model was an effective method to monitor and predict the changing trend of AIDS incidence and mortality in China. [ABSTRACT FROM AUTHOR]

Tuberculous meningitis is an infectious disease of central nervous system caused by Mycobacterium tuberculosis. It mainly invades into brain meninges and parenchyma, and may spread to the spinal cord and spinal meninges. The disability rate and mortality rate of this disease are very high. In recent years, incidence of tuberculosis increased significantly due to the increase of drug - resistant tuberculosis cases, population mobility, acquired immunodeficiency syndrome (AIDS) epidemic and other factors. Tuberculosis is still a worldwide serious threat to human life and health, especially in the underdeveloped and developing countries. China is the world's largest developing country with large population, so tuberculosis prevention and control is still a quite severe problem. In this paper, the clinical manifestations, diagnosis and differential diagnosis, treatment progress of tuberculous meningitis were reviewed systematically. [ABSTRACT FROM AUTHOR]

Background: Although progress has been made in the prevention and treatment of HIV in China, there are still a considerable number of new infections annually, especially in older men. HIV health education for older men is urgently needed. Evidence-based, acceptable, and scalable interventions are urgently needed to increase their capacity to prevent HIV. We describe a trial protocol to evaluate the effectiveness of a brief video-based intervention targeting older men's knowledge of HIV prevention.Design: This study is a randomized controlled trial. The trial will be held in the residents' activity centers of three communities.Methods: A total of 450 older men will be randomly divided into three groups (Sunset Without AIDS intervention group and two control groups) for 2 weeks. We will assess the feasibility and acceptability of intervention through interviews. The primary outcome includes changes in participants' knowledge related to AIDS after 2 weeks intervention and 1, 3, and 6 months of follow-up. The secondary outcomes, e.g., changes in participants' stigma attitude, risk behaviors attitude, and risk behaviors related to AIDS, will be respectively assessed 2 weeks, 1 month, 3 months, and 6 months after the second intervention.Discussion: Sunset Without AIDS may be an innovative way to help older men improve HIV prevention knowledge, fill the gap in video-based HIV prevention education for the older men in China, and gain experience of HIV education. This project will innovate the HIV education ideas of older men and enrich the theoretical research content of AIDS-related education of older men. The findings may also provide the basis for the research and formulation of more reasonable AIDS education strategies, prevention, and control policies for the elderly.Trial Registration: Chinese Clinical Trial Registry ChiCTR2100045708 . Registered on 23 April 2021. [ABSTRACT FROM AUTHOR]

Background: Global antiretroviral therapy has entered a new era. Integrase strand transfer inhibitor (INSTI) has become the first choice in acquired immunodeficiency syndrome (AIDS) treatment. Because INSTI has high antiviral efficacy, rapid virus inhibition, and good tolerance. However, INSTIs may increase the risk of obesity. Each INSTI has its unique impact on weight gain in patients with human immunodeficiency virus (HIV)/AIDS. This study systematically assessed different INSTIs in causing significant weight gain in HIV/AIDS patients by integrating data from relevant literature.Methods: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), and Wanfang databases were searched to find studies on the influence of different INSTIs in weight gain. Data on weight change were extracted, and a network meta-analysis was performed.Results: Eight studies reported weight changes in HIV/AIDS patients were included. Results of the network meta-analysis showed that the weight gain of HIV/AIDS patients treated with Dolutegravir (DTG) was significantly higher than that of Elvitegravir (EVG) [MD = 1.13, (0.18-2.07)]. The consistency test results showed no overall and local inconsistency, and no significant difference in the results of the direct and indirect comparison was detected (p > 0.05). The rank order of probability was DTG (79.2%) > Bictegravir (BIC) (77.9%) > Raltegravir (RAL) (33.2%) > EVG (9.7%), suggesting that DTG may be the INSTI drug that causes the most significant weight gain in HIV/AIDS patients.Conclusion: According to the data analysis, among the existing INSTIs, DTG may be the drug that causes the most significant weight gain in HIV/AIDS patients, followed by BIC. [ABSTRACT FROM AUTHOR]

Social discrimination and limited health care resources drive many people living with HIV/AIDS in China to seek help from their own families. This paper, which is based on a qualitative study of the experiences of this population, examines how the notion of family obligation has influenced how these individuals organise various aspects of their daily lives. Viewing family obligation as a matter of reciprocal relationships, a closer look is taken at the ways in which these individuals exercise their autonomy to fulfil those obligations and pursue their moral self despite their health status. The study suggests the significance as well as the limitations of incorporating family support into AIDS interventions in the Chinese context. [ABSTRACT FROM AUTHOR]

Background: Current guidelines support different management of cryptococcosis between severely immunodeficient and immunocompetent populations. However, few studies have focused on cryptococcosis patients with mild-to-moderate immunodeficiency. We performed this study to determine the clinical features of pulmonary (PC) and extrapulmonary cryptococcosis (EPC) and compared them among populations with different immune statuses to support appropriate clinical management of this public health threat.Methods: All cases were reported by 14 tertiary teaching hospitals in Jiangsu Province, China from January 2013 to December 2018. The trends in incidence, demographic data, medical history, clinical symptoms, laboratory test indicators, imaging characteristics and diagnostic method of these patients were then stratified by immune status, namely immunocompetent (IC, patients with no recognized underlying disease or those with an underlying disease that does not influence immunity, such as hypertension), mild-to-moderate immunodeficiency (MID, patients with diabetes mellitus, end-stage liver or kidney disease, autoimmune diseases treated with low-dose glucocorticoid therapy, and cancer treated with chemotherapy) and severe immunodeficiency (SID, patients with acquired immunodeficiency syndrome, haematologic malignancies, solid organ transplantation or haematologic stem cell transplantation, idiopathic CD4 lymphocytosis, agranulocytosis, aggressive glucocorticoid or immunosuppressive therapy and other conditions or treatments that result in severe immunosuppression).Results: The clinical data of 255 cryptococcosis patients were collected. In total, 66.3% of patients (169) were IC, 16.9% (43) had MID, and 16.9% (43) had SID. 10.1% of the patients (17) with IC were EPC, 18.6% of the patients (8) with MID were EPC, and 74.4% of patients (32) were EPC (IC/MID vs. SID, p < 0.001). Fever was more common in the SID group than in the IC and MID groups (69.8% vs. 14.8% vs. 37.2%, p < 0.001). Of chest CT scan, most lesions were distributed under the pleura (72.7%), presenting as nodules/lumps (90.3%) or consolidations (10.7%). Pleural effusion was more common in SID group compared to IC group (33.3% vs. 2.4%, p < 0.001). Positivity rate on the serum capsular polysaccharide antigen detection (CrAg) test was higher in the SID group than in the other two groups [100.0% vs. 84.4% (MID) vs. 78.2% (IC), p = 0.013]. Positivity rate on the serum CrAg test was also higher in cryptococcal meningitis patients than in PC patients (100.0% vs. 79.5%, p = 0.015).Conclusions: The clinical presentation of MID patients is intermediate between SID and IC patients and is similar to that of IC patients. The serum CrAg test is more sensitive for the identification of SID or EPC patients. [ABSTRACT FROM AUTHOR]

Background: College students were the key group we should pay more attention for acquired immune deficiency syndrome (AIDS) prevention and control in recent years in China. Few studies of HIV non-occupational post-exposure prophylaxis (nPEP) knowledge and service acceptance had been conducted among them in China. This study conducted a cross-sectional survey to understand the service acceptance of nPEP and its influencing factors among college students in the three cities of China.Methods: A questionnaire survey was conducted to collect information on socio-demographic, behavioral characteristic, HIV/AIDS knowledge, nPEP knowledge, acceptance of nPEP services among the college students in Beijing, Shenzhen, and Kunming of China from March to April of 2019. Each participant completed an anonymous questionnaire on line by computer-assisted or mobile phone-assisted self-interview with informed consent. Multivariable logistic regression analyses identified predictors for service acceptance of nPEP.Results: A total of 4698 students were surveyed with the average age of 20 years old. 98.0% (4605/4698) of them were undergraduates, 21.8%(1022/4698) had sexual intercourse; 48.6% (2282/4698) heard of nPEP, among which 4.95%(113/2282) received nPEP services. The awareness rate of HIV/AIDS knowledge was 85.6% (5495/4698) with the differences statistically significant between the three cities. The awareness rate of nPEP knowledge was 16.5% (774/4698). There were significant differences in receiving nPEP services among students of different ages, genders, sexual behaviors, and knowledge of HIV/AIDS by univariate analysis. Multivariable analyses indicated that age group of 18 and under (OR = 2.551, 95% CI = 1.153-5.646), male (OR = 3.131, 95% CI = 1.866-5.253), homosexual behavior (OR = 4.661,95%CI = 2.658-8.172), heterosexual behavior (OR = 1.676, 95% CI = 1.040-2.947), no awareness of AIDS knowledge (OR = 3.882, 95% CI = 2.371-6.356) and nPEP (OR = 4.788, 95% CI = 2.50-9.169) knowledge, were associated with the service acceptance of nPEP among the college students.Conclusion: The low acceptance of nPEP services was mainly affected by low level of nPEP knowledge among the college students. Further publicity and education of nPEP knowledge were necessary, as well as promotion of knowledge of HIV/AIDS prevention and treatment. More attention should be paid to the factors associated with acceptance of nPEP services. [ABSTRACT FROM AUTHOR]

Background: Self-management directly affects the health outcomes and quality of life among people living with HIV (PLWH). A better understanding of self-management level will provide evidence for researchers to develop effective interventions. Purpose: This study aims to identify the latent classes among PLWH in their levels of self-management behavior, and to explore the sociodemographic and disease-related predictors within these classes. Materials and Methods: A total of 868 PLWH were recruited from August 2017 to January 2019 in Sichuan Province, China. A latent class profile analysis was used to identify participants' self-management behavior, and multinomial logistic regression was used to explore the sociodemographic and disease-related predictors of the different latent classes. Results: Model fit indices supported a three-class model. The mean self-management scores in the three classes were 23.56 (SD=6.02), 37.91 (SD=3.80), and 47.95 (SD=4.18), respectively. The latent classes were Class 1 (a poor level of self-management behavior, 12.1%, n=104), Class 2 (a moderate level of self-management behavior, 56.1%, n=491) and Class 3 (a good level of self-management behavior, 31.7%, n=273). Antiretroviral trerapy (ART) status, infection route, and educational level were the main predictors of self-management behavior. Conclusion: The findings indicated that the level of self-management behaviors among PLWH in China is inadequate. Those with a lower educational level, who were infected through blood/injecting drugs, and who were not receiving ART, showed a significantly lower level of self-management behavior. These results could help healthcare professionals to quickly recognize PLWH who are at a high risk of low-level self-management, using individual characteristics and could provide a scientific basis for the development of effective and targeted programs to improve self-management level in PLWH. [ABSTRACT FROM AUTHOR]

Background: Although great progress has been made in the prevention and treatment of AIDS, there are still a considerable number of new infections annually, especially in adolescents. With the advance of technology, game-based education has gradually become an important tool for changing healthy behaviors among youth.Methods: A protocol for conducting a randomized controlled trial to evaluate the "AIDS Fighter · Health Defense", a game-based AIDS education project aimed at improving the ability of adolescents to prevent AIDS. During the four-week intervention, participants will receive: 1) A virus combat game; 2) Goal setting to eliminate HIV; 3) Questions to be answered to be resurrected in the game; 4) Points ranking; 5) Recognition and Rewards. The primary outcomes include changes in participants' knowledge, stigma attitude, and risk behaviors attitude related to AIDS after four weeks of intervention. The secondary outcomes are the participants' AIDS-related risk behaviors three and six months after the intervention.Discussion: AIDS Fighter· Health Defense may be an innovative approach to help adolescents improve AIDS prevention capabilities, fill the gap in game-based AIDS prevention education in China, and gain experience of AIDS management.Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000040195 . Registered 25 November 2020. [ABSTRACT FROM AUTHOR]

Background: Highly active antiretroviral therapy (ART) is still the only effective method to stop the disease progression in acquired immunodeficiency syndrome (AIDS) patients. However, poor adherence to the therapy makes it ineffective. In this work, we construct an adherence prediction model of AIDS patients using the classical recency, frequency and monetary value (RFM) model in the data mining-based customer relationship management model to obtain adherence predictor variables. Methods: We cleaned 257,305 diagnostic data elements of AIDS outpatients in Shanghai from August 2009 to December 2019 to obtain 16,440 elements. We tested the RFM and RFm (R: recent consultation month, F: consultation frequency, M/m: total/average medical costs per visit) models, three clustering methods (K-means, Kohonen and two-step clustering) and four decision algorithms (C5.0, the classification and regression tree, Chi-square Automatic Interaction Detector and Quick, Unbiased, Efficient, Statistical Tree) to select the optimal combination. The optimal model and clustering analysis were used to divide the patients into two groups (good and poor adherence), then the optimal decision algorithm was used to construct the prediction model of adherence and obtain its predictor variables. Results: The results revealed that the RFm model, K-means clustering analysis and C5.0 algorithm were optimal. After three rounds of k-means clustering analysis, the optimal RFm clustering model quality was 0.8, 10,614 elements were obtained, including 9803 and 811 from patients with good or poor adherence, respectively, and five types of patients were identified. The prediction model had an accuracy of 100% with the recent consultation month as an important adherence predictor variable. Conclusions: This work presented a prediction model for medication adherence in AIDS patients at the designated AIDS center in Shanghai, using the RFm model and the k-means and C5.0 algorithms. The model can be expanded to include patients from other centers in China and worldwide. [ABSTRACT FROM AUTHOR]

The conventional survival analysis model on HIV/AIDS prognosis is the Cox proportional hazard model, which deals with only one event type, death, regardless of the cause. Few studies have used a competing risk model to evaluate the predictors of AIDS-related mortality. To estimate the influence of antiretroviral therapy (ART) initiation time and baseline CD4+ cell counts on acquired immunodeficiency syndrome (AIDS)-related death among former plasma donors. A retrospective cohort study was conducted involving 11,905 human immunodeficiency virus (HIV) or AIDS patients in a high-risk area of Henan province in China between 1995 and 2016. Demographic and clinical data were collected. Sub-distribution hazard ratios (sHRs) for AIDS-related mortality with baseline CD4+ cell counts and ART initiation time were determined using a competing risk model. Patients who initiated ART within 90 days of HIV/AIDS diagnosis (sHR: 0.24, 95% CI: 0.22–0.27) or had baseline CD4+ counts of >500 cells/μL (sHR: 0.23, 95% CI: 0.19–0.28) were associated with lower AIDS-related mortality risk. Patients with ART initiation time >1 year but CD4+ counts >350 cells/μL (sHR: 4.42, 95% CI: 3.30–5.91) had a higher AIDS-related mortality risk than those with ART initiation time >90 days but CD4+ counts ≤350 cells/μL (sHR: 4.33, 95% CI: 3.58–5.23). Our results demonstrate that patients with high CD4+ cell counts and late ART had a 9% higher risk of AIDS-related death than those with low CD4+ cell counts and early ART. This study confirms the great significance of immediate ART initiation among former plasma donor HIV patients in China. [ABSTRACT FROM AUTHOR]

Object: Revealed the spatial‐temporal patterns of acquired immune deficiency syndrome (AIDS) incidences in Mainland China. Methods: Empirical orthogonal function (EOF) technique was applied to analyze the major spatial distribution modes and the temporal changes of AIDS incidences in Mainland China during 2002‐2017. Results: The annual average AIDS incidences increased from 0.06 per 100 000 in 2002 to 4.15 per 100 000 in 2017, with an annual average increase of 0.31 per 100 000. The southwest regions were high‐incidence areas, as well as Xinjiang province in the northwest. There were two typical spatial modes. EOF 1 represented an isodirectional spatial pattern that the incidences were relatively high in general, and the fluctuation ranges were relatively high in the southwest and northeast. EOF 2 represented a reverse spatial pattern that the incidences were relatively high (or low) in Guangxi, Yunnan, Xinjiang, Shanghai, and Henan, yet were relatively low (or high) in the remaining regions. Conclusion: The AIDS incidences in Mainland China were relatively low during 2002‐2010, yet were kept in a relatively high level since 2012. The prevention and control of AIDS need further development, especially in the southwest regions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of AIDS-defining events (ADE) on long-term mortality of HIV positive individuals on antiretroviral therapy (ART), a retrospective HIV/AIDS treatment cohort study performed in Southwestern China. Methods: The retrospective cohort was conducted among 6757 HIV/AIDS patients on ART (2NRTIs + 1NNRTI, 2NRTIs + 1PI and Single or two drugs) recruited in Guigang city, Guangxi, China, from January 2004 to December 2018. Participants were divided into ADE and non-ADE groups, and were followed-up every six months to observe treatment outcomes. Comparison of mortality between groups was performed using the log-rank test and Kaplan–Meier analysis. Cox proportional hazard regression was used to explore the risk factors of mortality. 1:1 propensity score matching (PSM) was used to balance confounding factors and adjust the mortality risk. Results: Of 6757 participants with 29,096.06 person-years of follow-up, 16.86% (1139/6757) belonged to ADE group while the others (83.14%) belonged to the non-ADE group. The most common cause of death by ADE was disseminated mycosis (31.65%), followed by recurrent severe bacterial pneumonia (28.48%), herpes zoster (17.72%), and extra-pulmonary tuberculosis (8.86%). The mortality of the ADE group was significantly higher than that of the non-ADE group [3.45/100 person-years (95% CI 2.92–3.97) vs. 2.34/100 person-years (95% CI 2.15–2.52), P<0.001]. The death risk of the ADE group was also higher than that of the non- ADE group [adjusted hazard ratio (aHR) = 1.291, 95% CI 1.061–1.571, P = 0.011], which was confirmed by PSM analysis (aHR = 1.581, 95% CI 1.192–2.099, P = 0.002). Cox analysis indicated that ADE, older age, male gender, previous non-use of cotrimoxazole, advanced WHO clinical stage, and low baseline CD4+ cell count were the risk factors for death. Conclusions: Even on ART, the mortality risk of HIV positive individuals with ADE was higher than those without ADE. Active testing, earlier diagnosis, and timely therapy with ART may reduce the death risk of ADE. [ABSTRACT FROM AUTHOR]

Background: As a kind of widely distributed disease in China, acquired immune deficiency syndrome (AIDS) has been quickly growing each year, become a serious problem and caused serious damage to the life and health of people and the social events of China and the world because of its high fatality rate. It has been much concerned by all aspects of society. Therefore, developing early warning technology and finding the trend of early development are of quite significance to prevent and control human immunodeficiency virus (HIV)/AIDS. This study aimed to explore a suitable model for the morbidity of AIDS in China and establish a professional and feasible disease prediction model for the prevention and control works of AIDS.Methods: At present, the traditional linear model is still utilized by most scholars to predict the incidence of HIV/AIDS. In addition, some scholars may attempt to use the nonlinear prediction model. Both prediction models showed good fitting and prediction effects. In China, the incidence of AIDS presents linear and nonlinear characteristics. In this research, the nonlinear back propagation artificial neural network (BP-ANN) model and the typical auto-regressive integrated moving average (ARIMA) linear model were applied to predict the incidence of HIV/AIDS and compare their fitting effects.Results: Both models were capable of predicting the expected cases of AIDS. It was seen that ARIMA and BP-ANN models could be used to forecast the monthly incidence of HIV/AIDS, but the fitting and forecasting effects of the nonlinear BP neural network model were better than those of the traditional linear ARIMA model.Conclusions: In summary, it was further concluded that the BP-ANN model was a suitable way to monitor and predict the change trend and morbidity of AIDS in China. [ABSTRACT FROM AUTHOR]

Background: Liangshan Yi Autonomous Prefecture is one of the areas that most severely affected by human immunodeficiency virus (HIV) in China, and virological failure on antiretroviral therapy (ART) is serious in this area. Analyses of prevalence and determinants of ART failure, the genetic diversity and drug resistance among people living with HIV (PLWH) helps improve HIV treatment efficiency and prevent HIV transmission.Methods: A total of 5157 PLWH were recruited from 2016 to 2017. The venous blood samples were subjected to RT-PCR, followed by sequencing of the HIV-1 pol gene, targeting the protease and reverse transcriptase fragments. HIV-1 diversity was analyzed using the DNAStar software and drug resistance mutations were analyzed using the Stanford University HIV Drug Resistance Database.Results: A total of 2156 (41.81%) PLWH showed virological failure on ART. Males (ORm = 1.25), heterosexual behaviors and drug injection (ORm = 1.44) and mother to child transmission routes (ORm = 1.58), the clinical stage of AIDS (ORm = 1.35), having used illicit drugs and shared the needles (1-4 times: ORm = 1.34; more than 5 times: ORm = 1.52), having ever replaced ART regimen (ORm = 1.48) increased the risk of virological failure among PLWH, while higher education lever (ORm = 0.77) and ≥ 12 months on ART (12 ~ 36 months: ORm = 0.72; ≥36 months: ORm = 0.66) was associated with lower likelihood of virological failure. The data revealed that CRF07_BC (1508, 95.62%) were the most common strains, and the drug-resistant rate was 32.10% among PLWH with virological failure in this area. The high frequencies of drug resistance were found in EFV and NVP of NNRTIs, ABC, FTC and 3TC of NRTIs, and TPV/r in PIs. The most common mutations in NNRTIs, NRTIs and PIs were K103N/KN (64.69%), M184V/MV/I (36.29%) and Q58E/QE (4.93%), respectively.Conclusion: We concluded that surveillance of virological failure, HIV-1 subtypes, and drug resistance to understand HIV-1 epidemiology and guide modification of ART guidelines, and target prevention and control strategies should be formatted to reduce the virological failure and drug resistance to promote viral suppression and prevent HIV-1 transmission. [ABSTRACT FROM AUTHOR]

The National Free Antiretroviral Therapy (ART) Program in China has initiated to provide ART to HIV-1 patients, which has acted as an efficient method to suppress viral replication and helps prevent onward transmissions. But the problems of HIV drug resistance (HIVDR) may also come along. There is little data on the prevalence of HIVDR in Chengdu, where the number of HIV/AIDS patients ranks first among provincial capitals. Therefore, epidemiological surveillance was conducted in this area. From 2014 to 2016, HIV/AIDS patients (15 years and older) who had received first-line ART for at least six months were enrolled. Demographic, behavioral information and medical history were recorded, and blood samples were collected for viral loads and immune cell count analyses. HIV-1 pol was obtained for HIV-1 subtypes and drug resistance-associated mutations (DRMs) among virologic failure patients. A total of 13,782 individuals were enrolled, and 481 samples were sequenced for subtypes and drug resistance analysis. Six subtypes were identified, among which CRF01_AE (54.3%) and CRF07_BC (41.6%) were the dominant subtypes, and CRF55_01B (0.4%) was detected in Chengdu for the first time. The prevalence of HIVDR in treatment-experienced patients was 1.8%, with 1.2% to nucleoside reverse transcriptase inhibitors (NRTIs), 1.7% to non-NRTIs (NNRTIs), and 0.14% to protease inhibitors (PIs). The leading DRMs observed in the study were M184I/V (59.59%) against NRTIs and K103N (37.55%) against NNRTIs. This study focused on the HIVDR surveillance among patients receiving treatment in Chengdu. The overall prevalence of HIVDR was relatively low among treated patients. These findings were believed to be contributed to an understanding of HIV-1 subtypes, HIVDR prevalence, and DRMs in Chengdu and thereby optimizing clinical management, prevention, and control of HIV. [ABSTRACT FROM AUTHOR]

Objectives: For migrant female sex workers (FSWs) at the Sino-Vietnamese border, the impact of work time in their current location on the spread of HIV/AIDS is not clear. Methods: Data were collected from the Sino-Vietnamese border cities of Guangxi, China. Migrant FSWs working in these cities were studied. FSWs who worked less than 6 months in their current location were assigned to the short-term work group (ST FSWs), and FSWs who worked equal to or longer than 6 months in their current location were assigned to the long-term work group (LT FSWs). Logistic regression was performed to examine the impact of work time in the current location and factors associated with HIV infection. Results: Among the 1667 migrant FSWs, 586 (35.2%) and 1081 (64.9%) were assigned to the ST FSW and LT FSW groups, respectively. Compared to LT FSWs, ST FSWs were more likely to be of Vietnamese nationality, be less than 18 years old when they first engaged in commercial sex work, and have a low-level of HIV-related knowledge and had higher odds of using condoms inconsistently, having more male clients, having no regular male clients, and having a history of male clients who used aphrodisiacs but lower odds of receiving free condoms distribution and education/HIV counselling and testing programme. The analysis of factors associated with HIV infection revealed that Vietnamese FSWs, less than 18 years old when they first engaged in commercial sex work, having no regular male clients, and having lower average charge per sex transaction were correlated with HIV infection. Conclusion: FSWs with short-term work at the Sino-Vietnamese border had a higher risk of risky sex and were correlated with HIV risk factors. Vietnamese FSWs were at higher risk of HIV infection, and they were more likely to have short-term work. More targeted HIV prevention should be designed for new FSWs who recently began working in a locality to further control the spread of HIV, particularly cross-border FSWs. [ABSTRACT FROM AUTHOR]

Background: HIV self-management is a lifetime and central task for people living with HIV/AIDS (PLWH). To date, there is little evidence to identify the related factors of self-management in PLWH from China. Purpose: This study aimed to investigate the status and related factors of self-management in PLWH from the Liangshan area of Sichuan Province, China. Patients and methods: A total of 322 PLWH were recruited from August to December 2017 in the study. Demographics characteristics and disease-related data were documented for each participant, social support was measured by the Medical Outcomes Study Social Support Survey (MOS-SSS-C), and self-management was evaluated by the HIV Self-Management Scale. Descriptive statistics analysis, independent Student's t-test, one-way ANOVA, Spearman rank correlation, and multiple regression analysis were used to analyze the data. Results: The total score of HIV self-management was 38.26±7.17. Significant differences in self-management scores were found among the subgroups of different education level, marital status, nation, religion, resident place, occupation, infection route, symptom, research site, and household per capita monthly income. Self-management was positively significantly correlated with social support. Multiple regression analysis identified that nation, resident place, gender, marital status, and social support were the contributors of HIV self-management. Conclusion: The study demostrated that self-management in Yi Autonomous Prefecture was relatively low. The results indicate that the associated factors of self-management should be considered to develop effective intervention to improve the self-management of PLWH. [ABSTRACT FROM AUTHOR]

Copyright of Health Policy & Planning is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The aim of this study was to investigate the prevalence of high-risky behaviors, such as unprotected anal intercourse (UAI) in the last 6 months, condom using in their last homosexual anal intercourse, No. of male partners in the last 6 months among high school and college male students who have sex with men (MSM) in China.Methods: The relevant trials were retrieved up to June 2015 from several public databases, and a meta-analysis was conducted according to the published studies. The estimated rate and its 95 % confidence intervals (CI) of the relevant indexes among high school and college student MSM were collected and calculated using a fixed-effects model (the Mantel-Haenszel method) or a random-effects model (the DerSimonian and Laird method) when appropriate.Results: A total of 15 studies (18 research data), including 3297 student MSM, were performed in this meta-analysis. The overall results showed that the rate of student MSM who reported having had UAI in the last 6 months was 65.2 % (95 % CI = 60.2 % to 70.1 %), the prevalence of student MSM having more than one male partner in the last 6 months was 58.2 % (95 % CI = 51.1 % to 65.4 %), the rate of student MSM who reported using a condom in their last homosexual anal intercourse experience was 57.5 % (95 % CI = 49.8 % to 65.1 %), the prevalence of student MSM who were infected with HIV was 3.8 % (95 % CI = 2.5 % to 5.1 %), and the rate of student MSM who were infected with syphilis was 4.6 % (95 % CI = 3.8 % to 5.4 %).Conclusions: There are high UAI prevalence and low condom using rate in the last homosexual anal intercourse experience among high school and college student MSM in China, and corresponding control measures for this group and more effective health education of student MSM are required to prevent HIV or sexually transmitted diseases from spreading to the general population. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical characteristics, diagnosis, treatment and prognosis of penicilliosis among the patients with acquired immunodeficiency syndrome (AIDS) in non-endemic areas of China, and then to discuss its incubation period and the diagnostic performance of serum galactomannan test for penicilliosis. Methods: Medical records and travel histories of penicilliosis patients in Zhongnan hospital from January 2006 to December 2013, and the interval from when the patients left the endemic area to the onset of the disease was analyzed. Serum galactomannan levels of penicilliosis patients and AIDS patients with fever were measured by the Platelia Aspergillus Enzyme Immunoassay Kit. Results: A total of 47 AIDS-associated penicilliosis were confirmed by fungal culture, which accounted for 4.8% of 981 AIDS-related admissions. The sensitivity and specificity of serum galactomannan test for penicilliosis were 95.8% (23/24) and 90.9% (30/33), respectively, (cutoff index = 1.0). Two independent predictors for early mortality (death within 12 weeks) of the patients (21.3%, 10/47) were a delayed diagnosis and no treatment with antifungal therapy. Among 14 patients who became ill after leaving endemic areas, ten patients presented with the onset symptoms within 12 months (from 11 days to 360 days). We found a patient living with asymptomatic P. marneffei fungemia who had not received any antifungal therapy until 18 months’ follow up. Conclusions: The co-infection of P. marneffei and HIV was not uncommon in the non-endemic areas of penicilliosis in China. There exists a latent form of infection for P. marneffei. The incubation period of penicilliosis may be quite different from one patient to another. In AIDS patients, the serum galactomannan test has utility for the diagnosis of penicilliosis. When patients with penicilliosis/AIDS were diagnosed early and treated with standardized antifungal therapy and combined antiretroviral therapy, their prognosis improved. [ABSTRACT FROM AUTHOR]

Background: More and more HIV therapeutic vaccines will enter clinical trials; however, little is known about the willingness to participate (WTP) in HIV therapeutic vaccine trials among HIV-positive individuals. Objective: To investigate the WTP in HIV therapeutic vaccine trials among Chinese HIV-infected patients. Methods: We conducted a cross-sectional survey on HIV-positive inpatients and outpatients at Shanghai Public Health Center. A total of 447 participants were recruited into this study. Following an introduction with general information on HIV therapeutic vaccine and its potential effectiveness and side effects, each participant completed a questionnaire in a self-administered form. The questionnaires covered demographics, high-risk behaviors, clinical characteristics and willingness to participate in HIV therapeutic vaccine trial. Results: The overall willingness to participate in HIV therapeutic vaccine trials was 91.5%. Interestingly, multivariate logistic regression analyses demonstrated that the willingness was higher for those sexually infected by HIV (odds ratio [OR]: 4.36; 95% confidence interval [CI]: 1.53–12.41), diagnosed as HIV-1 infection for greater than 5 years (OR: 7.12, 95% CI: 1.83–27.76), and with the presence of infectious complications (OR: 2.75; 95% CI: 1.02–7.45). The primary reason for participation was to delay or reduce antiretroviral treatment (ART) and to avoid ART side effects (76.6%), and then followed by delaying disease progression (74.9%), increasing immune response to suppress opportunistic infections (57.7%) and preventing the development of drug resistance (37.1%). Reasons for unwillingness to participate mainly included concern for safety (37.0%), lack of knowledge on therapeutic vaccine (33.3%), and satisfaction with ART effectiveness (22.2%). Conclusions: The WTP in HIV therapeutic vaccine trials was high among HIV-infected Chinese patients. HIV+ subjects who acquired infection through sexual contact and who were diagnosed for more than 5 years may represent a good candidate population for enrollment in therapeutic vaccine trials. [ABSTRACT FROM AUTHOR]

Background: Guangxi has become one of the provinces with the most severe HIV-1 epidemic in China, where heterosexual contact is the dominant transmission route. However, data of acute HIV infections and HIV incidence among female sex workers (FSWs) from low-grade venues are scant. Methods: A cross-sectional survey was performed among FSWs from low-grade venues in Guangxi. HIV antibody screening was performed by rapid testing (RT). HIV antibody–negative specimens were screened by pooled nucleic acid amplification testing (NAAT) for acute HIV infections. HIV antibody-positive specimens were further analyzed by Western blot (WB), followed by an HIV-1 BED capture enzyme immunoassay (BED-CEIA) to identify the recent infections. HIV-1 incidence was estimated by the data of pooled NAAT and BED-CEIA, respectively. Results: A total of 7936 FSWs were recruited and answered the questionnaires. We successfully collected the blood samples from 6469 (81.5%) participants, of which 139 (2.1%) were HIV antibody–positive and 6330 (97.9%) were HIV antibody-negative by RT. With pooled NAAT, 7 cases were found to be HIV RNA positive, representing an additional 5.0% of HIV-infected persons and an estimated HIV incidence of 1.45 (95% CI: 1.17–1.76) per 100 person years. There were 137 positive and 2 indeterminate by WB, of which 124 (90.5%) positive specimens were subjected to BED-CEIA testing identifying 28 recent infections. The HIV incidence determined by BED-CEIA testing was 1.04 (95% CI: 0.65–1.43) per 100 person years. The overall prevalence of HIV among FSWs from low-grade venues in Guangxi was 2.2% (95% CI: 1.9–2.6). Conclusions: We found that the addition of HIV RNA screening to routine HIV antibody testing significantly improved the detection of HIV infection among FSWs from low-grade venues in Guangxi. Our findings also provided the useful baseline data of HIV incidence among this population for targeting local HIV prevention, intervention, monitoring and treatment. [ABSTRACT FROM AUTHOR]

Objective: To assess the overall mortality of methadone maintenance treatment (MMT) clients in China and its associated factors. Methods: A total of 1,511 MMT clients, all of whom enrolled in China's first eight MMT clinics between March and December 2004, were included in this cohort study and followed for approximately six years, until June 2010. Mortality and its predictors were examined using Cox proportional hazards regression models. Results: A total of 154 deaths were observed within 5,391 person-years (PY) of follow-up for an all-cause mortality rate of 28.6 per 1,000 PY. The leading causes of death were drug overdose (33.8%), HIV/AIDS-unrelated disease (21.4%), and HIV/AIDS (16.9%). The all-cause mortality rate of clients engaged in MMT for one year or less was roughly three times that of clients who stayed in MMT for four years or more (14.0 vs. 4.6, p<0.0001), HIV-positive subjects was nearly four times mortality rate than that of HIV-negative individuals (28.1 vs.6.8, p<0.0001). ART-naive HIV-positive subjects had approximately two times higher mortality rate than those receiving ART (31.2 vs. 17.3, <0.0001). After adjusting for confounding variables, we found that being male (HR = 1.63, CI: 1.03–2.57, p = 0.0355) and being HIV-positive (HR = 5.16, CI: 3.70–7.10, p<0.0001) were both associated with higher risk of death whereas increased durations of methadone treatment were associated with a lower risk of death (HR = 0.26, CI: 0.18–0.38, p<0.0001 for two to three years, HR = 0.08, CI: 0.05–0.14, p<0.0001 for four or more years). Conclusion: Overall mortality was high among MMT clients in China. Specific interventions aimed at decreasing mortality among MMT clients are needed. Our study supports the need for keeping client at MMT longer and for expanding ART coverage and suggests the potential benefits of integrated MMT and ART services for drug users in China. [ABSTRACT FROM AUTHOR]

Objective: To examine the distribution of HIV-1 genotypes among injecting drug users (IDUs) from Dehong, Yunnan province. Materials and Methods: Blood samples from a total of 95 HIV-positive IDUs were retrospectively analyzed. Samples were collected between 2005 and 2009 from four cities in Dehong prefecture, western Yunnan province, the geographical origin of the HIV epidemic in China. HIV-1 gag, partial pol, vpr-env fragment, half-genome, or near-full-length sequences were analyzed to determine the HIV-1 genotypes of each subject. Results were compared with findings from past studies of IDUs in Dehong and in neighboring Myanmar. Results: We observed a high prevalence of B′/C recombinants (82.4%) among IDUs in Dehong, the structural profiles of which do not match those previously reported in Dehong or in Myanmar. Furthermore, statistically significant differences in geographical and temporal distributions of HIV-1 genotypes were characterized by a predominance of HIV-1 B′/C recombinant forms among older subjects(p = 0.034), subjects from Longchuan district (p = 0.022), and subjects diagnosed between 2000 and 2004 (p = 0.004). Conclusions: The increasing prevalence of multiple, new B′/C recombinant forms suggest that HIV-1 intersubtype recombination is substantial and ongoing in western Yunnan. This reflects the high-risk behavior of IDUs in this region and argues the need for stronger monitoring and prevention measures in Dehong and other high-prevalence areas around China. [ABSTRACT FROM AUTHOR]

Objective: To examine alcohol use and subsequent HIV risky behaviors among a sample of predominately ethnic minority people living with HIV/AIDS (PLWHA) in a rural community in Yunnan Province, China. Method: A cross-sectional study with a face-to-face questionnaire interview was conducted among eligible participants. Results: In total, 455 (94.4%) out of 482 eligible HIV patients participated in the study. Of them, 82.6% were ethnic minorities; 15.4% were never married; 96.5% were sexually experienced; 55.4% had used drugs, 67% were receiving antiretroviral therapy (ART). Over 65% were ever drinkers; of whom 61.5% were current drinkers. Among current drinkers, 32.4% drank daily and 41.2% were hazardous drinkers. Chinese white wine was the preferred choice. Higher level of alcohol use among drinkers in the preceding month was positively associated with being males (OR = 2.76, 95%CI: 1.03–7.43), ethnic minorities (OR Jingpo = 2.21, 95%CI: 1.06–4.59; OR other minorities = 3.20, 95%CI: 1.34–7.62), higher education (OR1–6 = 1.98, 95%CI: 0.99–3.96; OR≥7 = 2.35, 95%CI: 1.09–5.06) and being ART-naive (OR = 2.69, 95%CI: 1.67–4.32). About 39% of ever drinkers reported having engaged in sex after drinking since HIV diagnosis. Those who were younger than 46 years (OR16–25 = 7.77, 95%CI: 1.22–49.60, OR26–35 = 2.79, 95%CI: 1.06–7.35, OR36–45 = 2.96, 95%CI: 1.57–7.58), hazardous drinkers (OR = 1.99, 95%CI: 1.00–3.97) and drug users (OR = 3.01, 95%CI: 1.19–7.58) were more likely to have had sex after drinking. Approximately 56% of drug users had used drugs after drinking. Conclusions: High prevalence of alcohol use and subsequent risky behaviors including sexual engagement and drug use among HIV patients in rural Yunnan require tremendous and integrated efforts for prevention and control of alcohol and drug abuse and HIV spreading. [ABSTRACT FROM AUTHOR]

Objective: Voluntary counseling and testing (VCT) plays an important integral role in response to the HIV/AIDS epidemic. However, VCT service has not been effectively utilized among rural migrants, a high risk group in China. In this study, we developed a community based intervention to examine if community mobilization with comprehensive VCT is more effective than current HIV preventions with routine VCT service in promoting VCT acceptability among rural migrants in Shanghai, China. Methods: A comprehensive intervention with community mobilization and comprehensive VCT services including community-based VCT and mobile VCT was implemented during 2007–2009. Three communities in Minhang District of Shanghai were randomly selected and were designed to receive community mobilization and comprehensive VCT, traditional VCT and none intervention, respectively. After 24 months intervention, effects were evaluated by comparing outcome indicators between the baseline (2,690 participants) and follow-up surveys (1,850 participants). Findings: A substantial increase in VCT acceptance was observed among community mobilization group (94.9% vs. 88.5%, P<0.001), whereas the reverse effect was seen in the traditional VCT group (86.1% vs. 94.6%, P<0.001) and control group (69.0% vs. 91.7%, P<0.001). Rural migrants from community mobilization group were more likely to accept VCT (OR = 2.91, 95% CI 1.69–4.97). Rural migrants from community mobilization group also showed significant increase in HIV/AIDS knowledge, positive attitude towards HIV positive individuals and condom use. Conclusion: Community mobilization with comprehensive VCT has significant impact on promotion of VCT acceptance and utilization among rural migrants in Shanghai. These findings provide evidence to support community mobilization as a suitable strategy for VCT promotion among rural migrants in Shanghai, China. [ABSTRACT FROM AUTHOR]