Risk factors associated with low-level viremia in human immunodeficiency virus/acquired immunodeficiency syndrome patients after anti-retroviral therapy / 中华传染病杂志

Objective:To investigate the risk factors of low-level viremia (LLV) among human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients after combined anti-retroviral therapy (ART), and to provide evidence for reducing the risk of LLV.Methods:It was a cross-sectional observation study that enrolled HIV/AIDS patients with LLV (plasma HIV-1 RNA was 50 to 1 000 copies/mL) receiving ART over one year (LLV group) from January 2019 to December 2020 in Guangzhou Eighth People′s Hospital, Guangzhou Medical University. Contemporaneous patients with ART over one year and successful viral suppression (plasma HIV-1 RNA<50 copies/mL) were randomly selected as the control group (suppression group) with a ratio of 1∶2.5, and the risk factors for LLV were analyzed by unconditional logistic regression.Results:A total of 128 and 297 patients were enrolled in LLV group and the suppression group, respectively.ART durations were 3.62(1.83, 4.89) years and 4.91(2.90, 5.88) years, respectively. Multivariate logistic regression analysis showed that the risk factors associated with LLV included the age of initial ART treatment above 50 years old (odds ratio ( OR)=1.82, 95% confidence interval ( CI) 1.01 to 3.26, P=0.046), the baseline HIV-1 RNA over 1×10 5 copies/mL ( OR=2.18, 95% CI 1.30 to 3.68, P=0.003), using the simplified initial ART regimen ( OR=1.82, 95% CI 1.02 to 3.26, P=0.044), missing medication more than three times per year ( OR=2.49, 95% CI 1.55 to 4.01, P<0.001) and changing regimen during ART ( OR=1.90, 95% CI 1.14 to 3.14, P=0.013), while the duration of ART longer than five years could reduce the risk of LLV ( OR=0.37, 95% CI 0.22 to 0.64, P<0.001). In patients with simplified initial ART regimen, the baseline CD4 + T lymphocyte count of whom with LLV was lower than that of whom with viral suppression, and the difference was statistically significant (94.00 (24.00, 281.00)/μL vs 375.00 (310.00, 435.00)/μL, Z=-2.60, P<0.001). Conclusions:The occurrence of LLV is related to the age of initial ART treatment, the baseline HIV-1 RNA, the initial ART regimen, the medication adherence and the change of ART regimen during ART. Strategies may be beneficial to reducing the risk of LLV for HIV/AIDS patients, such as initiating ART as soon as possible, using simplified regimen as initial regimen with caution in patients with low baseline CD4 + T lymphocyte counts, strengthening compliance education, avoiding unnecessary ART regimen changes.

Incidence and factors associated with hepatitis B surface antigen seroclearance in patients co-infected with HBV/HIV during antiretroviral therapy in Guangdong, China / 中华医学杂志(英文版)

BACKGROUND@#Hepatitis B surface antigen (HBsAg) clearance is vital for a functional cure of hepatitis B virus (HBV) infection. However, the incidence and predictors of HBsAg seroclearance in patients co-infected with HBV and human immunodeficiency virus (HIV) remain largely unknown in Guangdong, China.@*METHODS@#Between 2009 and 2019, patients co-infected with HBV/HIV undergoing antiretroviral therapy (ART) in Guangzhou Eighth People's Hospital affiliated to Guangzhou Medical University were retrospectively reviewed with the endpoint on December 31, 2020. The incidence and risk factors for HBsAg seroclearance were evaluated using Kaplan-Meier and multivariate Cox regression analyses.@*RESULTS@#A total of 1550 HBV/HIV co-infected patients were included in the study, with the median age of 42 years and 86.0% (1333/1550) males. Further, 98.3% (1524/1550) received ART containing tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC). HBV DNA was examined in 1283 cases at the last follow-up. Over the median 4.7 years of follow-up, 8.1% (126/1550) patients achieved HBsAg seroclearance, among whom 50.8% (64/126) obtained hepatitis B surface antibody, 28.1% (137/488) acquired hepatitis B e antigen seroconversion, and 95.9% (1231/1283) undetectable HBV DNA. Compared with patients who maintained HBsAg positive, cases achieving HBsAg seroclearance showed no differences in age, gender, CD4 + T cell count, alanine aminotransferase (ALT) level, or fibrosis status; however, they presented lower HBV DNA levels, lower HBsAg levels, and higher rates of HBV genotype B at the baseline. Multivariate analysis showed that baseline HBsAg <1500 cutoff index (COI) (adjusted hazard ratio [aHR], 2.74, 95% confidence interval [95% CI]: 1.48-5.09), ALT elevation >2 × upper limit of normal during the first six months after receiving ART (aHR, 2.96, 95% CI: 1.53-5.77), and HBV genotype B (aHR, 3.73, 95% CI: 1.46-9.59) were independent predictors for HBsAg seroclearance (all P <0.01).@*CONCLUSIONS@#Long-term TDF-containing ART has high anti-HBV efficacy including relatively high overall HBsAg seroclearance in HBV/HIV co-infected patients. Lower baseline HBsAg levels, HBV genotype B, and elevated ALT levels during the first six months of ART are potential predictors of HBsAg seroclearance.

Clinical analysis of depression, anxiety and sleep disorders in HIV/AIDS patients in Guangzhou / 中国医师杂志

Objective:To investigate the characteristics and differences of anxiety, depression and sleep disorder among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Guangzhou, then optimize the antiretroviral therapy and provide effective mental intervention.Methods:All HIV/AIDS patients from the outpatient department of Guangzhou Eighth People's Hospital were enrolled in the present study from January 2016 to December 2016. They were evaluated by the hospital anxiety and depression scale and Pittsburgh Sleep Quality Index, to analyze the levels of depression, anxiety and sleep disorder.Results:The incidences of anxiety, depression and sleep disorder were 30.5%(61/200), 31.0%(62/200) and 22.5%(45/200) respectively. 36.1%(22/61) of patients with anxiety and 35.5%(22/62) of patients with depression were accompanied by sleep disorder. The sleep disturbance index were significant higher in HIV/AIDS patients with anxiety ( t=4.065, P<0.001) or depression ( t=3.034, P=0.003) than those without anxiety or depression. Anxiety was mainly found in HIV/AIDS patients in aged 20 to 40 group ( F=7.998, P=0.018), while depression was mostly found in HIV/AIDS patients who didn't receive higher education ( F=13.55, P=0.001), and sleep disorder was more common in people with CD4 + count <200 cells/μl ( t=2.01, P=0.046). Conclusions:Anxiety and depression, which could aggravate sleep disorder, are very common in HIV/AIDS patients. Psychological care need to be strengthened to HIV positive patients in early phase, and screening questionnaires should be conducted before antiretroviral treatment began.

Research on the causes of death associated with combined effects of HBV and HCV infection in patients with acquired immunodeficiency syndrome / 中华肝脏病杂志

Objective@#To investigate the combined effects of hepatitis B virus and hepatitis C virus (HBV/HCV) infection on the cause of death in patients with acquired immunodeficiency syndrome (AIDS).@*Methods@#The causes of death of 111 cases of AIDS with HBV/HCV (combined infection group) and 210 AIDS patients (single infection group) admitted to our hospital from 2012 to 2016 data were compared using chi-square test.@*Results@#There was no statistically significant difference in gender composition and age in the combined infection groups (P > 0.05). The main causes of death in the combined infection group were severe pneumonia (44.1%), end-stage liver disease (18.9%), and central nervous system infection (14.4%). The main causes of death in the single infection group were severe pneumonia (47.6%) and central nervous system infection (14.3%) and tumor (13.3%). There was no case of end-stage liver disease. The ratio of end-stage liver disease in the former group was significantly higher than that in the latter group (χ2 = 42.511, P < 0.001). The main cause of death in 12 HIV/HBV/HCV triple-infected patients was end-stage liver disease, accounting for 41.7%, which was significantly higher than 18.9% of end-stage liver disease in HIV/HBV or HIV/HCV dual infection (99 cases). And the difference was statistically significant (χ2 = 4.539, P = 0.033); however, the ratio of end-stage liver disease in 50 HIV/HBV co-infected patients and 49 HIV/HCV co-infected patients was 16.0% vs. 16.3%, respectively, and the difference was not statistically significant (χ2 = 0.002, P = 0.965). In the co-infected group, 36 patients had CD4+ cell counts >100/μl, the primary cause of death was end-stage liver disease, accounting for 38.2%. 75 patients with CD4+ ≤ 100/μl died due to end-stage liver disease, accounting for 9.3% and the difference was statistically significant (χ2 = 13.852, P < 0.05).@*Conclusion@#End-stage liver disease is the main cause of death in patients with AIDS combined with HBV or HCV, especially triplet infection and CD4+ cell count > 100/μl. An early diagnosis and treatment of HBV or HCV infection should commence as soon as possible.