Drug resistance mutations and its associated factors among 579 HIV/AIDS patients experiencing failure of antiretroviral therapy in Jiangsu Province, China / 中华预防医学杂志

Objective@#To understand the incidence and related factors of HIV-1 drug resistance among HIV/AIDS patients experiencing treatment failure in Jiangsu province, China.@*Methods@#The HIV/AIDS integrated prevention and control data information management system of China were used to collect the basic data of patients, blood specimens were collected from patients who had antiretroviral therapy (ART) failure with ≥12 months and older than 18 years in 2016 in Jiangsu, excluding cases with missing information, 713 cases were enrolled in this study. HIV-1 RNA was extracted, and then pol gene region was amplified and sequenced. The obtain sequences were submitted to Stanford University HIV Drug Resistance Database to interpret and analyse HIV-1 drug resistance and sub-types. Multivariate logistic regression model was used to explore the related factors of drug resistance.@*Results@#A total of 579 subjects were amplified successfully, male accounted for 85.66% (496 cases), and the median age was 39 years old. The main route of infection was sexual transmission (553 cases, 95.51%). A total of 331 patients with drug resistance gene mutation were detected, drug resistance mutation rate was 57.18%. Compared with patients with baseline CD4+T cell count >500 cells/μl, patients with CD4+T cell count in 201-500 cells/mm3 and ≤200 cells/μl had a higher incidence of genetic drug resistance, the odds ratio was 3.33 and 6.87, respectively. Compared with patients with treatment less than 24 months, patients treated for 25-48 months had a higher incidence of drug resistance, the odds ratio was 1.88. Compared with patients infected by CRF07_BC strains, patients infected by CRF01_AE strains were associated with higher incidence of drug resistance, the odds ratio was 2.22 and 3.32, respectively. Protease inhibitor (PI) resistance mutations, nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) were found in 3.80%, 33.16% and 53.37% of patients, respectively. 31.95% of patients harbored NRTI and NNRTI resistance mutations simultaneously. M184V/I and K103N/Q were the highest frequency of NRTI and NNRTI resistance mutation, the prevalence of M184V/I and K103N/Q were 28.15% and 22.28%, respectively.@*Conclusion@#The status of HIV-1 drug resistance mutations are complex and diverse among patients experiencing failure of ART in Jiangsu. Patients with lower baseline CD4+T cell count, longer treatment time and HIV-1 CRF01_AE and B strains infection were associated with higher incidence of drug resistance mutation.

The advance of detection technology of HIV self-testing / 中华预防医学杂志

At present, China's AIDS testing increased rapidly, but there are still many people living with HIV do not recognize their status, thus postponing the antiviral treatment time. HIV self-testing (HST) is an effective method to expand the testing, not only simple operation, easy to get a result, effectively protect the detection privacy, expand the selection of testers, suit to the entire population, but also the premise and basis of other AIDS comprehensive prevention measures, all over the world are promoting it. Because the HST has controversies in the window period, price and before and after controversial, and our country is in the initial stage of HST, so it is not to develop related policies, but more and more countries are in accordance with their own situations are modified or developed to allow to use rapid detection of AIDS policy to regulate the field. This paper analyzed and summarized the advantage and influence factors of HST promotion, HST believes that in the long term, the advantages outweigh the disadvantages, we need to formulate relevant policies, and improve the sensitivity of the kit, shorten the window period of time, production and promotion of operation standard of video, specification and testing the operating practices, preventing and reporting the possible social harm, investigation and understanding of the needs of the people of the crowd, to maximize the advantages of HST, find more infection, so as to curb the epidemic of AIDS.

Drop out of antiretroviral therapy in people living with AIDS/HIV and related factors in Nanjing and Yuncheng / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the incidence of drop out of antiretroviral therapy (ART) in people living with AIDS/HIV and related factors in Nanjing, Jiangsu province, and Yuncheng, Shanxi province.</p><p><b>METHODS</b>Retrospective cohort analysis was conducted. The cumulative incidence curves of drop out of ART, mortality and drug withdrawal were drawn with Kaplan-Meier method. The related factors were identified with Cox proportional hazards regression model.</p><p><b>RESULTS</b>A total of 1 006 patients were included in Yuncheng, the median length of ART follow-up was 49.59 months (QR: 20.02-92.84), and 976 patients were included in Nanjing, the median length of ART follow-up was 19.93 months (QR: 11.48-34.07). The cumulative incidence of drop out of ART at 3 months, 6 months, 1 year, 2 years, 4 years, 8 years after ART was 8.19%, 9.23%, 11.08%, 13.75%, 17.74%, 27.66% in Yuncheng, and 3.01%, 5.17%, 7.47%, 10.97%, 17.45%, 28.72% in Nanjing respectively. Age, marital status, infection route, baseline CD4 cell count, the clinical stage classified by WHO at the end of the observation were correlated with the drop out of ART.</p><p><b>CONCLUSION</b>In order to reduce the drop out of ART among people living with AIDS/HIV, it is necessary to conduct effective interventions targeting the patients with young age, the patients who divorced/widowed, the patients who were intravenous drug users, the patients with higher CD4 cell count at the beginning of ART and clinical stage III or IV at the end of the follow-up and increase the coverage of HIV test.</p>

Study on economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing.</p><p><b>METHODS</b>People living with HIV/AIDS were divided into two groups, HIV infected patients and AIDS patients. The data about their direct medical expenditure, direct non-medical expenditure and indirect economic loss in the past year were collected. Univariate and multivariate analysis were conducted to identify the potential influencing factors.</p><p><b>RESULTS</b>The median of direct medical expenditure and total costs for 133 HIV infected patients were 1,200 yuan RMB and 1,972 yuan RMB respectively. The median of direct medical expenditure and total costs for 145 AIDS patients were 1 060 yuan RMB and 2 826 yuan RMB respectively. The differences in direct medical expenditure and total costs between HIV infected patients and AIDS patients showed no statistical significance. The results from univariate analysis indicated that the sample source influenced total costs significantly. Multivariate analysis showed that onset time and CD level were negatively correlated with direct medical expenditure. The patients infected through heterosexual contact had more direct medical expenditure than those infected through homosexual contact. The patients receiving HIV test in hospitals had more direct medical expenditure than those receiving volunteer counseling and testing.</p><p><b>CONCLUSION</b>Further efforts should be made to expand HIV testing and treatment coverage in order to detect HIV infections as early as possible. Early antiretroviral treatment should be given to HIV infected patients to maintain their immunity and reduce their medical expenditure.</p>

Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in Nanjing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing.</p><p><b>METHODS</b>PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence.</p><p><b>RESULTS</b>A total of 276 PLWHA were surveyed, According to the evaluation criterion of Center for Adherence Support Evaluation (CASE), 252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking, progress of the disease and side effects, reminding of taking drug and age were correlated with self-reported HAART adherence.</p><p><b>CONCLUSION</b>It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young, suffer from side effects, have no reminding methods for taking drug.</p>

Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in ;Nanjing / 中华流行病学杂志

Objective To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. Methods PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. Results A total of 276 PLWHA were surveyed,According to the evaluation criterion of Center for Adherence Support Evaluation (CASE),252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking,progress of the disease and side effects,reminding of taking drug and age were correlated with self-reported HAART adherence. Conclusion It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young,suffer from side effects,have no reminding methods for taking drug.

Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in ;Nanjing / 中华流行病学杂志

Objective To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. Methods PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. Results A total of 276 PLWHA were surveyed,According to the evaluation criterion of Center for Adherence Support Evaluation (CASE),252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking,progress of the disease and side effects,reminding of taking drug and age were correlated with self-reported HAART adherence. Conclusion It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young,suffer from side effects,have no reminding methods for taking drug.

Recent infected and newly reported HIV cases in Jiangsu province, 2011-2013 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the status of recent infected and newly reported HIV cases in Jiangsu province.</p><p><b>METHODS</b>Information including general demographic, mode of transmission and sample source of newly reported HIV infected cases was collected. Corresponding serum or plasma samples were collected and tested with BED-CEIA. Proportions of recent HIV infections among different populations were calculated, and associated factors of recent HIV infection calculated.</p><p><b>RESULTS</b>Among cases infected through different channels as homosexual, heterosexual and needles sharing, the proportions of recent infections were 29.19% , 17.40% and 21.75% , respectively. Statistically significant difference was seen between different populations(P < 0.05). Compared with female cases, male cases were more likely to be recent infected (OR = 1.569, 95%CI: 1.168-2.107). Compared with cases older than 35 years of age, the ones that younger than that age were more likely to be recently infected (OR = 1.556, 95% CI:1.289-1.879). Compared with cases who remained single, those married cases were more likely to be long-term infections(OR = 0.789, 95%CI:0.649-0.960). Compared with patients identified by hospitals, the recent HIV infections were more likely to be found through voluntary counseling programs and testing (OR = 2.278, 95%CI: 1.853-2.801), project-based surveillance programs (OR = 2.409, 95%CI:1.860- 3.120), and unpaid blood donation sites (OR = 2.911, 95%CI:2.118-4.001)(P < 0.05).</p><p><b>CONCLUSION</b>Proportion of MSM ranked 1st in the newly reported HIV cases in Jiangsu province. Related HIV case-finding programs should be strengthened to reduce the secondary transmission.</p>

Epidemiological characteristics of HIV/AIDS patients newly received highly active antiretroviral therapy during 2005-2013 in Jiangsu province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the epidemiological characteristics of the HIV/AIDS patients newly received highly active antiretroviral therapy (HAART) during 2005-2013 in Jiangsu province.</p><p><b>METHODS</b>According to the baseline data of HIV/AIDS patients newly received HAART during 2005-2013, an Excel database was established and statistical analysis was performed using SPSS 16.0 software.</p><p><b>RESULTS</b>There were 5 788 HIV/AIDS patients newly received HAART during 2005-2013 and the number increased annually. 79.7% of these patients were from the local province, with the ratio of male to female as 4.69 : 1, mean age as 39.9 years old, 55.8% of them married, 52.0% of them were treated at CDC. 91.9% of them were infected through sexual contacts. Mean baseline CD4(+)T cell count of cases was 187 cells/µl. Median of the interval between the time of HIV confirmation and HAART initiation was 4.0 months. Proportion of the HIV/AIDS patients that were being male, elderly, unmarried, not local resident, treated in hospitals and with higher baseline CD4(+)T count etc. showed a trend of increase.</p><p><b>CONCLUSION</b>HIV/AIDS patients had the opportunity to start the HAART at early stage of the disease. However, many of them started the treafment late as the results of being diagnosed late. Programs related to both earlier detection and diagnosis on HIV cases should be strengthened.</p>

Analysis of the five-year effectiveness of highly active antiretroviral therapy among 200 HIV/AIDS patients in Jiangsu province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the five-year effectiveness of the people living with HIV/AIDS who initially received highly active antiretroviral therapy (HAART) in Jiangsu province.</p><p><b>METHODS</b>HIV/AIDS initially received HAART from 1 Jan 2005 to 31 May 2014 in Jiangsu province with the CD4(+)T cell count tested in baseline, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after treatment initiation were selected. According to their retrospectively collected baseline and follow-up data, statistical analysis was performed using SPSS 16.0 software to analyze the variation of CD4(+)T counts and its impact factors in different times after treatment initiation.</p><p><b>RESULTS</b>A total of 200 patients were included. A total of 134 patients were men, and 66 were women, the ratio of male to female was 2.03: 1; mean age was (39.7 ± 10.3) years old; 69.0% (138/200) of the patients married; 53.0% (106/200) as the most were infected with HIV through heterosexual transmission, and followed by men who have sex with men (MSM) (25.5%, 51/200); taken together as 78.5% (157/200).58.5% (117/200) were treated in the CDC. The mean (95%CI) baseline CD4(+)T cell count of cases was 106.9 (93.3-120.5) cells/µl; the CD4(+)T count tested in 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after treatment initiation were 107.3, 152.9, 221.6, 260.0, 281.3 and 316.4 cells/µl more than baseline respectively; the CD4(+)T count after treatment initiation has increased over time (F = 201.06, P < 0.01) . The mean(95%CI) CD4(+)T count tested in 5 years after treatment initiation can increase to 540.7(445.4-635.9) cells/µl with a baseline CD4(+)T count more than 200 cells/µl, but in the subgroups with a baseline CD4(+)T count less than or equal to 50 cells/µl, 51-100 cells/µl, 101-150 cells/µl and 151-200 cells/µl, it only can reach to 431.4 (375.9-487.0), 400.0 (339.9-460.2), 380.3 (330.6-430.0) and 412.1 (369.3-454.8) cells/µl respectively. The mean (95%CI) CD4(+)T count tested in 5 years after treatment initiation with 1 baseline symptom categories can increase to 449.2 (392.2-506.2) cells/µl, while 409.1(317.8-500.5)cells/µl in the subgroup with baseline symptom categories more than or equal to 2. The CD4(+)T after treatment increased slowly associated with a lower baseline CD4(+)T count level and more baseline symptom categories (F values were 3.96 and 2.35, P < 0.01).</p><p><b>CONCLUSION</b>It has a remarkable effectiveness for HIV/AIDS treatment in Jiangsu province. The patients with a baseline CD4(+)T count more than 200 counts/µl have a better immune function recovery.</p>

Recent infected and newly reported HIV cases in Jiangsu province,2011-2013 / 中华流行病学杂志

Objective To understand the status of recent infected and newly reported HIV cases in Jiangsu province. Methods Information including general demographic,mode of transmission and sample source of newly reported HIV infected cases was collected. Corresponding serum or plasma samples were collected and tested with BED-CEIA. Proportions of recent HIV infections among different populations were calculated,and associated factors of recent HIV infection calculated. Results Among cases infected through different channels as homosexual,heterosexual and needles sharing,the proportions of recent infections were 29.19%,17.40% and 21.75%, respectively. Statistically significant difference was seen between different populations(P<0.05). Compared with female cases,male cases were more likely to be recent infected(OR=1.569,95%CI:1.168-2.107). Compared with cases older than 35 years of age,the ones that younger than that age were more likely to be recently infected(OR=1.556,95%CI:1.289-1.879). Compared with cases who remained single,those married cases were more likely to be long-term infections(OR=0.789, 95%CI:0.649-0.960). Compared with patients identified by hospitals,the recent HIV infections were more likely to be found through voluntary counseling programs and testing(OR=2.278,95%CI:1.853-2.801),project-based surveillance programs(OR=2.409,95%CI:1.860- 3.120),and unpaid blood donation sites(OR=2.911,95%CI:2.118-4.001)(P<0.05). Conclusion Proportion of MSM ranked 1st in the newly reported HIV cases in Jiangsu province. Related HIV case-finding programs should be strengthened to reduce the secondary transmission.

Recent infected and newly reported HIV cases in Jiangsu province,2011-2013 / 中华流行病学杂志

Objective To understand the status of recent infected and newly reported HIV cases in Jiangsu province. Methods Information including general demographic,mode of transmission and sample source of newly reported HIV infected cases was collected. Corresponding serum or plasma samples were collected and tested with BED-CEIA. Proportions of recent HIV infections among different populations were calculated,and associated factors of recent HIV infection calculated. Results Among cases infected through different channels as homosexual,heterosexual and needles sharing,the proportions of recent infections were 29.19%,17.40% and 21.75%, respectively. Statistically significant difference was seen between different populations(P<0.05). Compared with female cases,male cases were more likely to be recent infected(OR=1.569,95%CI:1.168-2.107). Compared with cases older than 35 years of age,the ones that younger than that age were more likely to be recently infected(OR=1.556,95%CI:1.289-1.879). Compared with cases who remained single,those married cases were more likely to be long-term infections(OR=0.789, 95%CI:0.649-0.960). Compared with patients identified by hospitals,the recent HIV infections were more likely to be found through voluntary counseling programs and testing(OR=2.278,95%CI:1.853-2.801),project-based surveillance programs(OR=2.409,95%CI:1.860- 3.120),and unpaid blood donation sites(OR=2.911,95%CI:2.118-4.001)(P<0.05). Conclusion Proportion of MSM ranked 1st in the newly reported HIV cases in Jiangsu province. Related HIV case-finding programs should be strengthened to reduce the secondary transmission.

Application of RNA interference technique in the research of mammalian cells and human disease / 生物医学工程学杂志

RNA interference provides a new approach for elucidation of gene function. It holds the advantages of quickness, convenience, high effect and high specificity. In spite of these, the application of RNA interference technique in studying the mammalian cells and human disease is still in the beginning. In this paper, a review of the development of RNA interference in mammalian cells and human disease is presented.

The effect of HJ-1 NO--HFJV respirator on treating pulmonary edema caused by seawater drowning / 生物医学工程学杂志

The study was to observe the therapeutic effect of HJ-1 NO--HFJV respirator on treating pulmonary edema caused by seawater drowning. Seawater was infused into the rabbit's lung to establish the animal model of pulmonary edema caused by seawater drowning(PE-SWD). Then the animals were divided into three groups: simple PE-SWD model as control group, treat group(animal model treated with HFJV respirator and four medicines) and HFJV respiratior plus NO group. Pao2, Sao2 and pH were measured by the blood-gas analyzer. The survival time and seawater drowing-respiratiory distress syndrom(SW-RDS) were observed. The results showed that Pao2, Sao2 in NO group were remarkably higher than that of PE-SWD control group, and the survival time was longer than that of medicine treated group and the incidence of SW-RDS decreased to zero. We assume that HJ-1 NO-HFJV respirator is efficient on treating pulmonary edema.