Characteristics of HIV-infected persons and their spouses who became HIV-positive in HIV discordant couples in Dehong Prefecture， Yunnan Province / 上海预防医学

ObjectiveTo determine the characteristics， viral load and immunological status of HIV-infected persons and their spouses who became HIV-positive， and the reasons for HIV seroconversion in 55 HIV discordant couples in Dehong Dai and Jingpo Autonomous Prefecture （Dehong Prefecture）， Yunan Province. MethodsData on the 55 couples meeting the criteria of having a previously positive spouse were retrieved from the AIDS Integrated Prevention and Control Data Information System of the China Disease Control and Prevention Information System during 2015-2021. General socio-demographic information， age at diagnosis， exposure history， CD4+T lymphocyte count， and antiviral treatment were collected. Descriptive analysis and chi-square test were used to compare the distribution of pre-HIV-positive spouses and their HIV seroconverted spouses. ResultsA total of 55 spouses from HIV discordant couples had HIV seroconversion. Of them， 72.7% （40/55） of pre-HIV-positive spouses were husbands. The most recent CD4+T lymphocyte count in the pre-HIV-positive spouses was （328.31±246.27） cells·μL-1 at the time of diagnosis of their seroconverted spouses， of which 36.3% （20/55） had a CD4+T lymphocyte count of less than 200 cells·μL-1. Furthermore， of those pre-HIV-positive spouses with low CD4+T lymphocyte count， 45.0% （9/20） had an undetectable viral load， 15.0% （3/20） <400 copies·mL-1， and 25.0%（5/20） ≥400 copies·mL-1. Additionally， 16.4% （9/55） of the pre-HIV-positive spouses did not have a viral load test. The main reasons for HIV seroconversion among HIV-negative spouses in the discordant couples were poor condom use， poor compliance with antiviral therapy， and treatment discontinuation. ConclusionThe follow-up management of HIV discordant couples should be strengthened in Dehong Prefecture， especially the monitoring of viral load levels and immunological status of pre-HIV-positive spouses， to improve their compliance with antiviral therapy and reduce treatment discontinuation， which would effectively prevent and control HIV transmission between spouses.

A Case of Lymphoma with Multiple Identities

@#Discordant lymphoma (DL) is the coexistence of two or more distinct subtypes in separate anatomic sites. There are limited reports on DL cases especially involving more than two subtypes in more than two sites. We report a 76-year-old man who presented with constitutional symptoms, flank mass and painless lymphadenopathies for six months. Laboratory tests revealed moderate anaemia, markedly elevated serum IgM (13400 mg/dL), IgM Lambda paraproteinemia and Lambda light chain paraproteinuria with unmeasurable serum lactate dehydrogenase due to hyperviscous sample. CT scan showed multiple subcutaneous masses over chest wall and retroperitoneum, with lytic bone lesions, and hepatosplenomegaly. Further biopsy findings with morphological, immunohistochemical and molecular analysis of the tissue sections revealed diffuse large B-Cell lymphoma in the chest wall mass, follicular lymphoma in the inguinal lymph node and lymphoplasmacytic lymphoma in the bone marrow. This case highlights the rare DL. The importance of histopathological evaluation of lymphoma despite the availability of PET-CT scans for disease staging is undeniable.

EB virus-positive discordant lymphoma: report of 1 case and review of literature / 白血病·淋巴瘤

Objective:To investigate the clinical manifestations, laboratory tests, diagnosis and treatment of discordant lymphoma (DL).Methods:The clinical data of a patient with EB virus-positive DL admitted to Taizhou People's Hospital in November 2019 were retrospectively analyzed and the related literature was reviewed.Results:The patient underwent a cervical lymph node biopsy pathology examination at onset, and then results suggested angioimmunoblastic T-cell lymphoma (AITL). The patient subsequently developed gastrointestinal bleeding and underwent resection of small bowel lesions, and postoperative pathology suggested diffuse large B-cell lymphoma (DLBCL). The patient was finally diagnosed as DL. The R2-CHOP chemotherapy regimen was given to the patient, but the patient still had recurrent gastrointestinal bleeding and poor general condition. The patient refused chemotherapy and was changed to lenalidomide monotherapy. Finally, the patient died due to multiorgan failure, with an overall survival of 13 months.Conclusions:DL is rarely seen in lymphoma, whereas the combination of AITL and DLBCL is extremely rare. The clinicians need to improve the understanding of this disease to avoid misdiagnosis and missed diagnosis.

Angioimmunoblastic T-cell lymphoma complicated with Epstein-Barr virus-positive diffuse large B-cell lymphoma: report of two cases and review of literature / 白血病·淋巴瘤

Objective:To investigate the clinicopathological features, treatment and prognosis of patients with angioimmunoblastic T-cell lymphoma (AILT) complicated with Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of 2 cases of AILT with EBV-positive DLBCL in the Fifth Medical Center of PLA General Hospital were retrospectively analyzed, and the literature was reviewed.Results:One case of complex lymphoma (CL) developed from low fever with systemic superficial lymphadenopathy, the right axillary tumor biopsy showed that AILT complicated with EBV-positive DLBCL. After 8 cycles of chemotherapy, the patient reached unconfirmed complete remission, then received maintenance treatment with chidamide and survived until the deadline. Another case of discordant lymphoma began with subcutaneous nodules and then developed progressive enlargement of superficial lymph nodes. The pathological examination of subcutaneous nodule diagnosed as DLBCL, and the pathological examination of right inguinal lymph node diagnosed as AITL. After 7 cycles of chemotherapy, the patient died of hemophagocytic syndrome.Conclusions:AILT with EBV-positive DLBCL is rare. The main clinical symptom is AITL and the immunophenotypic characteristic indicates the presence of T cells and B cells. At the same time, the prognosis is poor, and the treatment strategy mainly depends on the lymphoma type with unfavorable prognosis.

Twin-Twin transfusion syndrome: a case report

Twin to twin transfusion syndrome is a rare but serious complication of monochorionic twin pregnancy. It is characterized by the development of abnormal placental vascular communication from one foetus (donor) to the other foetus (recipient). If left untreated it led to high rates of perinatal morbidity and mortality due to its poorly understood etiology and difficulty in diagnosing and treatment. Authors report a case of twin to twin transfusion syndrome in 24 years old primigravida with gestational age of 18 weeks 5 days diagnosed on ultrasound.

Analysis of the positive conversion rate of negative spouse and survival analysis on HIV sero－discordant couples / 中华疾病控制杂志

@#Objective To analyze the positive conversion rate of negative spouse and the survival analysis on HIV sero－discordant couples． Methods Data were collected from the case report database of the integrated AIDS prevention and control data and information system． HIV sero－discordant couples diagnosed between September 1，1997 and September 1，2018 were recruited into the cohort． The participants were divided into three groups as untreated subgroup，routine treatment subgroup and early treatment subgroup according to the situation when they started HIV treatment． The positive conversion rate of negative spouse and the survival were compared among the three subgroups． Ｒesults 598 HIV sero－discordant couples were recruited and the overall survival time of the three subgroups were 258. 92，4 987．17 and 862．25 person－year． The rate of positive conversion were 6. 18/100，0. 48/100 and 0. 23/100 person－year． Multivariate Cox regression model showed that the hazard ratio of routine treatment subgroup ( HＲ = 0. 052，95% CI: 0. 037－0. 074) and early treatment subgroup ( HＲ=0. 011，95% CI: 0. 003－0. 035) were lower than untreated subgroup． The risk of death of women was lower than that of men( HＲ=0. 667，95% CI: 0. 472－0. 944) ; the older the age，the higher the risk of death ( HＲ=1. 041，95% CI: 1. 026－1. 056) ; and the risk of death of the unemployed is higher than that of farmers ( HＲ=1. 571，95% CI: 1. 037－2. 381) ． Conclusion Targeted interventions methods and early antiviral therapy should be taken urgently for sero－discordant couples．

Parejas heterosexuales serodiscordantes en Chiapas, México. La influencia del género en la expresión de la agencia / Heterosexual HIV-Discordant Couples in Chiapas, Mexico. The Influence of Gender in Agency Expression

Resumen Hombres y mujeres heterosexuales con Virus de Inmunodeficiencia Humana (VIH) enfrentan desafíos personales (e.g. miedo a contagiar a otros y al rechazo) y sociales (el rechazo real). Para una persona con VIH (PV), estos son obstáculos en el desarrollo de su vida, especialmente si al formar una pareja, la otra persona no tiene el virus. A partir del supuesto de que las personas no carecen de poder para enfrentar y, ocasionalmente, transformar estructuras sociales, se elaboró este trabajo con el objetivo de explorar y comparar las estrategias seguidas por dos hombres y dos mujeres con VIH, en la formación de pareja, con personas que no tenían reporte (pareja serodiscordante). Los resultados destacan diferencias en las estrategias. Las dos mujeres experimentaron su sexualidad con hombres sin VIH. Sin embargo, ocultaron su diagnóstico a los hombres correspondientes. Tuvieron más dificultades, que los dos hombres, en su afán por mantener una relación de pareja estable. Además, han estado expuestas a riesgos de embarazo no deseado y violencia por ocultar el diagnóstico. Los hombres recurrieron al enamoramiento, para sostener una relación, donde la pareja correspondiente conoció, por información que ellos mismos les proporcionaron, su diagnóstico. Los resultados destacan que hay una inequidad en la disponibilidad de esquemas y recursos, entre hombres y mujeres. Frente al desafío de formar pareja y vivir la sexualidad, después del diagnóstico, las inequidades se reflejan en más dificultades y riesgos en las mujeres.

Abstract: Heterosexual men and women with Human Immunodeficiency Virus (HIV) face personal challenges (e.g. fear of infecting others and rejection) and social ones (real rejection). For a person with HIV (VP), these are obstacles in the development of their life, especially if forming a couple, where the other person does not have the virus. Based on the assumption that people do not lack the power to confront and occasionally transform social structures, this study was carried out in order to explore and compare the strategies followed by two men and two women with HIV, in forming couples, with people who did not have it (HIV-discordant couple). The results highlight differences in strategies.Although the two women experienced their sexuality with men without HIV, to do so, they hid their diagnosis from their prospective partners. They had more difficulties than the two men, in their eagerness to maintain a stable couple relationship. In addition, they were exposed to risks of unwanted pregnancy and violence, for hiding the diagnosis.The men resorted to falling in love, to sustain a relationship, where the corresponding partner knew their diagnosis, from information that the men themselves gave them. The results highlight that there is inequity in the availability of schemes and resources, between men and women. Faced with the challenge of forming a couple and living their sexuality after the diagnosis, inequities are reflected in more difficulties and risks for women.

The prevalence and determinants of female serodiscordance among HIV positive pregnant women attending PMTCT clinic in Owerri, Imo state, Nigeria

Background: Human Immunodeficiency Virus sero-discordance is high among heterosexual couples in Africa. However, only few studies have explored the factors that are associated with the prevalence in sub-Saharan Africa. The aim of this study was to determine the prevalence of female sero-discordance among HIV positive pregnant women in Owerri and to assess its possible associated factors.Methods: A cross sectional study of pregnant women (and their partners) who tested positive to HIV I and II at the Prevention of Mother to Child Transmission (PMTCT) clinic from December 2015 to May 2016 in Federal Medical Center Owerri, Imo state, Nigeria.Results: A total of 106 HIV positive pregnant women (and their partners) were studied. The prevalence of female serodiscordance was 63.2% (67/106). Pre-marital serodiscordance contributed about 52.2% (35/67) female serodiscordance among couples in the study. Sero-discordance rate for the lower, middle, and upper classes were 50% (28/56), 76.1% (35/46) and 100% (4/4) respectively and was statistically significant (p<0.01). Condom use was significantly associated with female serodiscondance (P<0.01). CD4+ count of the female partner at booking was also found statistically significantly associated with female serodiscordance (P<0.01).Conclusions: There is high prevalence of female serodiscordance among HIV positive pregnant women in Owerri. Pre-marital serodiscordance contributed significantly to high level of female serodiscordance among couples. Higher social class, condom use and high female- partner CD4+ count are significantly associated with female sero-discordance.

Restricción de crecimiento aumenta el riesgo de displasia broncopulmonar, muerte y sepsis en gemelos de 30 o menos semanas de gestación / Growth restriction increases the risk of bronchopulmonary dysplasia, death, and sepsis in twins of 30 weeks or less of gestation

INTRODUCCIÓN: Múltiples factores influyen en el riesgo de morbimortalidad del prematuro con restricción del crecimiento intrauterino (RCIU). La comparación de gemelos con crecimiento intrauterino discordante permite evaluar su efecto, excluyendo factores maternos y manejo prenatal. Nuestro objetivo fue evaluar el efecto de la RCIU sobre la morbilidad aguda, crónica y mortalidad, en parejas de recién nacidos gemelares prematuros extremos. PACIENTES Y MÉTODO: Gemelos menores de 1500 g y 30 semanas de gestación, de la Red Neocosur. Se realizaron análisis separados de pares de gemelos concordantes, discordantes leves y severos, evaluando el efecto de la RCIU sobre morbi-mortalidad. Se realizó análisis multivariado para establecer magnitud del efecto. RESULTADOS: 459 pares de gemelos, 227 concordantes, 110 discordantes leves y 122 severos. Entre los concordantes solo hubo diferencia en uso de oxígeno a las 36 semanas. En discordantes leves, el menor tuvo menos enfermedad de membrana hialina y requirió menos dosis de surfactante, pero tuvo un mayor riesgo de Displasia broncopulmonar (DBP) o muerte. En discordantes severos, el menor presentó mayor mortalidad, sepsis, utilización y permanencia en ventilación mecánica, pese a menor frecuencia de enfermedad de membrana hialina. En regresión múltiple, el riesgo combinado de DBP o muerte fue mayor en gemelo menor y discordante severo. CONCLUSIÓN: En gemelos discordantes, la patología respiratoria aguda fue más frecuente en el gemelo mayor, aunque el riesgo de DBP o muerte fue mayor en el gemelo con RCIU.

INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.

Discordant lymphoma: report of one case and review of literature / 白血病·淋巴瘤

Objective@#To investigate the clinical characteristics, diagnosis, treatment and prognosis of discordant lymphoma.@*Methods@#The clinical data of one patient with discordant lymphoma at the PLA Strategic Support Force Characteristic Medical Center were retrospectively analyzed, and the related literatures were reviewed.@*Results@#The patient was treated for thrombocytopenia and the examination showed splenomegaly. After hormone treatment, the platelet rebounded and thrombocytopenia occurred during hormone reduction. Splenectomy was performed. Postoperative pathological diagnosis of splenic marginal lymphoma was made and observed. Axillary lymph node enlargement occurred nine months later. Pathological diagnosis of diffuse large B-cell lymphoma was made by using lymph node biopsy, and the disease condition was alleviated after immunotherapy combined with chemotherapy.@*Conclusions@#Discordant lymphoma is rare and shows no special clinical manifestations. Its diagnosis should rely on pathological examination. Immunotherapy combined with chemotherapy may be more effective.

Clinical study on independent risk factors and neonatal complications in discordant twins / 中华实用儿科临床杂志

Objective To investigate the perinatal independent risk factors and neonatal complications of discordant twins.Methods Clinical data of 152 (76 pairs) discordant twins and 552 (276 pairs) concordant twins were enrolled at the Obstetrics of Peking University People's Hospital from November 1,2011 to October 31,2016.The perinatal characteristics and the neonatal complications in 2 groups were analyzed and compared.Binary Logistic regression analysis was used to identify the independent risk factors associated with the occurrence of discordant twins.Results (1) The gestational age,the incidence of term infants and birth weight of the discordant twins were significantly lower than those of the concordant twins[(35.8 ±2.5) weeks vs.(36.7 ± 1.8) weeks,48.7％ vs.60.2％,(2 277.1 ± 575.7) g vs.(2 545.0 ± 413.4) g],and the differences were statistically significant (all P ＜ 0.05).The incidence of premature infants,the incidence of infants small for gestational age and the rate of transferring discordant twins to pediatric department were significantly higher than that of concordant twins (51.3％ vs.39.9％,40.8％ vs.13.2％,46.1％ vs.26.8％),and the differences were statistically significant (all P ＜ 0.05).(2) The incidence of neonatal asphyxia,neonatal respiratory distress syndrome,neonatal pneumonia,neonatal apnea,bronchopulmonary dysplasia,neonatal sepsis and neonatal intracranial hemorrhage were significantly higher than those of concordant twins (6.6％ vs.2.5％,7.2％ vs.3.1％,5.3％ vs.1.3％,9.2％ vs.3.3％,3.9％ vs.0.9％,3.3％ vs.0.7％,4.6％ vs.O.7％),and the differences were statistically significant(all P ＜ 0.05).(3) The birth weight in the twins with low body weight group was significantly lower than that in the twins with high body weight group [(1 926.7 ± 414.1) g vs.(2 618.7 ± 504.6) g],and the differences were statistically significant (P ＜ 0.05).The incidence of small for gestational age,the rate of conversion to pediatrics and the incidence of neonatal intracranial hemorrhage in the twins with low body weight group were significantly higher than those in the twins with high body weight group (65.8％ vs.6.6％,56.6％ vs.35.5 ％,9.2％ vs.0),and the differences were statistically significant (all P ＜ 0.05).(4) Logistic regression analysis showed that hypertensive disorder during pregnancy (OR =2.127,95％ CI:1.392-3.253) and gestational diabetes mellitus (OR =1.684,95％ CI:1.112-2.552) were independent risk factors for the occurrence of discordant twins.Conclusions Hypertensive disorder during pregnancy and gestational diabetes mellitus are independent risk factors for the occurrence of discordant twins,who are much more likely to develop various neonatal complications,particularly low-birth-weight infants.Timely surveillance and treatment of short-term complications and long-time follow-up are essential to discordant twins.

Meta analysis on HIV-negative partners' or lovers' sero-conversion among HIV sero-discordant couples in China / 中国感染控制杂志

Objective To investigate HIV sero-conversion in HIV-negative partners or lovers among HIV serodiscordant couples.Methods China National Knowledge Infrastructure(CNKI),Wangfang data,and PubMed were retrieved,literatures about HIV sero-conversion in HIV-negative partners or lovers among HIV sero-discordant couples were included in the study,Meta analysis was performed by R software.Results There were 11 literatures were included in the study,Meta analysis showed that HIV-negative partners' or lovers' overall sero-conversion rates among HIV sero-discordant couples in China was 1.0/100 person-year;in different economic levels and epidemic areas,HIV-negative partners' or lovers' sero-conversion rates were both 1.0/100 person-year.Conclusion The HIV-negative partners' or lovers' sero-conversion rates among HIV sero-discordant couples in China are not high.

A comparative study of FNAC breast lesions and BI-RADS grading with a focus on grade 4 and grade 5 categories

Breast carcinoma is showing an increasing trend amongst urban women population. Breast Imaging Reporting and Data System (BI-RADS) is a widely accepted risk assessment procedure for carcinoma breast in clinical practice. Fine needle aspiration cytology (FNAC) is an established and important preoperative diagnostic modality. We have done a two year comparative study of these two procedures in the department of Pathology, at Gandhi Hospital from June 2014 to May 2016. We have done 720 FNACs for breast lesions during this period and compared the results with BI-RADS classification by mammography / ultrasound screening at the department of radiology, Gandhi Hospital. Out of total 720 patients who underwent FNAC, BI-RADS grading was available for only 540 cases. Cytological patterns were compared with BI-RADS grading for these 540 cases. The Concordance and Discordance among these findings are discussed with special emphasis on grade 4 and Grade 5 BI-RADS lesions in which carcinoma breast risk is high.

Bilateral Renal Metastasis of Hürthle Cell Thyroid Cancer with Discordant Uptake Between I-131 Sodium Iodide and F-18 FDG / 대한핵의학회잡지

Renal metastasis of thyroid cancer is extremely rare. We report the case of a 62-year-old woman with Hürthle cell thyroid cancer (HCTC) with lungs, bones, and bilateral kidneys metastases. The renal metastatic lesions were clearly demonstrated by ¹³¹I whole body scan (WBS) with SPECT/CT. However, they exhibited false-negative results in ¹⁸F-FDG PET/CT, kidney ultrasonography, and contrast-enhanced CT scan. The findings imply that tumors have low glucose metabolism and are able to accumulate radioiodine, which is not commonly found in the relatively aggressive nature of HCTC. The patient received two sessions of 200 mCi ¹³¹I therapy within 6 months duration. There was complete treatment response as evaluated by the second post-therapeutic ¹³¹I SPECT/CT and serum thyroglobulin. To our knowledge, renal metastasis from HCTC with positive ¹³¹I but negative ¹⁸F-FDGuptake has not been reported in the literature. This case suggests that ¹³¹I SPECT/CTis useful for lesion localization and prediction of ¹³¹I therapy response.

Acceptability and associated factors of pre-exposure prophylaxis based on different sexual purpose among human immunodeficiency virus male sero-discordant couples / 中华传染病杂志

Objective To study the acceptability and associated factors of pre-exposure prophylaxis (PrEP) based on different sexual purpose among human immunodeficiency virus (HIV) male serodiscordant couples.Methods HIV-negative female spouses of HIV-positive male in Guigang,Guiping and Pingnan county in Guangxi Zhuang Autonomous Region were recruited by the existing epidemic database and the method of cluster random sampling.A face-to-face questionnaire survey was conducted during June 2013 to November 2016.Information including the general condition and acceptability of PrEP was surveyed.x2 test and Logistic regression were used to analyze the data.Results A total of 526 qualified questionnaires were collected.The intention rate of PrEP based on physiological sexual purpose was 66.9％ (352/526),the intention rate of PrEP based on fertility purpose was 93.3％ (491/526).The difference was statistically significant (x =139.48,P＜0.01).The reasons of refusal included worrying about its safety,effectiveness poor confidentiality and low self-assessment risk of infection.Logistic analysis showed that the associated factors of the intention rate of PrEP based on physiological sexual purpose included cognition of PrEP (OR=0.70,P=0.014),the number of lifetime partners (OR=0.55,P＜0.01),frequency of sexual behavior (OR=1.33,P=0.016),willingness of condom use (OR=0.16,P＜0.01),infection risk self-assessment (OR =0.22,P＜0.01),male viral load (OR=1.25,P=0.035),male CD4+ T lymphocyte count (OR=0.37,P＜0.01) and male usefulness of medication or not (OR=1.59,P＜0.01).The influencing factors of the intention rate of PrEP based on physiological sexual purpose included with or without children (OR =1.70,P＜0.01),cognition of PrEP (OR=0.72,P=0.026),willingness of using condom (OR=0.18,P＜0.01),infection risk self-assessment (OR=0.14,P＜0.01) and male CD4+ T lymphocyte count (OR=0.45,P＜0.01).Conclusions The acceptability of PrEP based on fertility purpose is significantly higher than that on the physiological purpose.It is more feasible to conducting clinical trials of PrEP in peri-conceptional period HIV serodiscordant couples.The main influencing factors include the uninfected individual behavior characteristics and infection features of HIV infected men,and have nothing to do with the general social demographic characteristics.

Mortality rate and influencing factors among index partners of HIV discordant couples in the context of antiretroviral therapy, Zhumadian, Henan province, 2008-2014 / 中华流行病学杂志

Objective To analyze the mortality rate in index partners of HIV discordant couples in the context of antiretroviral therapy and related factors in Zhumadian,Henan province.Methods An open and prospective cohort survey was conducted annually during 2008-2014.Information about the index partners'demographic characteristics,CD4+T (CD4) cell counts,viral load,AIDS-related syndromes,date of therapy initiation,level of treatment institution,and outcome of death were collected.Life table was used to calculate survival rate,and Cox proportional hazards model was used to analyze the mortality related factors.Results Among 4 196 index partners receiving antiretroviral therapy between 2008 and 2014,350 were fatal,with the mortality rate of 1.88 per 100 person years (95％CI:1.86-1.90).The survival rates of these patients with the duration of follow-up from 1 to 7 years were 99.64％,97.70％,95.62％,93.54％,91.25％,86.86％ and 82.36％ respectively.Factors related to the survival of the index partners of HIV discordant couples were age ≥50 years (HR=3.48,95％CI:2.67-4.55),junior high school or above education level (HR=0.75,95％CI:0.56-1.00),baseline CD4 cell counts ＞350 cells per μl (HR=0.55,95％CI:0.42-0.72),baseline viral load ＞400 copies/ml (HR=1.71,95％CI:1.32-2.22) and initiating treatment prior to cohort entry (HR=0.65,95％ CI:0.41-1.05).Conclusions The mortality rate of index partners receiving antiretroviral therapy was relatively low,indicating a better effect of long-term treatment on patients' survival.It is necessary to further identify and control the key factors influencing the survival of patients receiving therapy,improve the timeliness and adherence of the treatment,keeping patients' immunity level.Meanwhile,much attention should be paid to the drug resistance due to long term treatment and treatment failure.

Mortality rate and influencing factors among index partners of HIV discordant couples in the context of antiretroviral therapy, Zhumadian, Henan province, 2008-2014 / 中华流行病学杂志

Objective To analyze the mortality rate in index partners of HIV discordant couples in the context of antiretroviral therapy and related factors in Zhumadian,Henan province.Methods An open and prospective cohort survey was conducted annually during 2008-2014.Information about the index partners'demographic characteristics,CD4+T (CD4) cell counts,viral load,AIDS-related syndromes,date of therapy initiation,level of treatment institution,and outcome of death were collected.Life table was used to calculate survival rate,and Cox proportional hazards model was used to analyze the mortality related factors.Results Among 4 196 index partners receiving antiretroviral therapy between 2008 and 2014,350 were fatal,with the mortality rate of 1.88 per 100 person years (95％CI:1.86-1.90).The survival rates of these patients with the duration of follow-up from 1 to 7 years were 99.64％,97.70％,95.62％,93.54％,91.25％,86.86％ and 82.36％ respectively.Factors related to the survival of the index partners of HIV discordant couples were age ≥50 years (HR=3.48,95％CI:2.67-4.55),junior high school or above education level (HR=0.75,95％CI:0.56-1.00),baseline CD4 cell counts ＞350 cells per μl (HR=0.55,95％CI:0.42-0.72),baseline viral load ＞400 copies/ml (HR=1.71,95％CI:1.32-2.22) and initiating treatment prior to cohort entry (HR=0.65,95％ CI:0.41-1.05).Conclusions The mortality rate of index partners receiving antiretroviral therapy was relatively low,indicating a better effect of long-term treatment on patients' survival.It is necessary to further identify and control the key factors influencing the survival of patients receiving therapy,improve the timeliness and adherence of the treatment,keeping patients' immunity level.Meanwhile,much attention should be paid to the drug resistance due to long term treatment and treatment failure.

A study of HIV-concordant and -discordant couples attending voluntary counselling and testing services at a tertiary care center in North India.

A large number of Indian couples are exposed to the risk of heterosexual human immunodeficiency virus (HIV) transmission. The present records-based study was undertaken at the voluntary counselling and testing facility of a tertiary care hospital in New Delhi, India to determine HIV prevalence among Indian couples; to assess the magnitude of seroconcordance and discordance among HIV-affected couples; and to compare the concordant and discordant partnerships for sociodemographic determinants and cluster of differentiation 4 (CD4) counts. Of the 1309 couples included in the study, 249 (19%) were HIV-affected, and of them 113 (45.4%) were concordantly and 136 (54.6%) discordantly affected by HIV. Males were the HIV-infected partners in 72% of the serodiscordant partnerships analyzed. Seroconcordance was significantly associated with the occupation status of being a housewife (P = 0.009). The contribution of discordant partnerships to the burden of HIV/acquired immune deficiency syndrome (AIDS) is significant, warranting novel couple-targeted counselling strategies and preventive measures, including safe sexual behavior and possibly preexposure HIV prophylaxis of the uninfected partner.

Complicaciones feto-neonatales del embarazo múltiple. Análisis embriológico

Objetivo: Analizar las características epidemiológicas y complicaciones feto/neonatales del embarazo múltiple en el Hospital Militar de Maracaibo. Métodos: Estudio descriptivo y retrospectivo en pacientes ingresadas con embarazo múltiple desde el 01 de enero de 1998 al 30 de mayo de 2013. Se registró edad materna, presentación, tipo de parto, motivo de interrupción del embarazo, corionicidad, complicaciones feto/neonatales, peso y anomalías congénitas. Resultados: De 2 469 embarazadas ingresadas para parto, 31 (1,26 %) fueron múltiples o 1/80 nacimientos. Edad materna promedio 28 años, presentación fetal más frecuente cefálica-podálica en 12 (38,7 %) y se realizó cesárea en 27 (87,1 %) pacientes. La indicación de interrupción del embarazo más frecuente fue la electiva en 12 (38,7 %) y prematuridad en 11 (35,5 %). Se obtuvieron 62 productos y la mortalidad fue 17,7%, con 11 muertes fetales y/o perinatales, de estas 8 (72,7 %) fueron por causa de la monocorionicidad (P < 0,05) y sus consecuencias, en 5 (45,46 %) fetos fue por síndrome de transfusión intergemelar. Se diagnosticó restricción del crecimiento intrauterino en 13 (20,9 %) y en 26 (42 %) crecimiento fetal discordante moderado o severo. En 8 (8,1 %) neonatos se observaron anomalías congénitas predominantemente osteomusculares Conclusión: El embarazo múltiple tiene una elevada morbimortalidad fetal y neonatal dependiente principalmente de las complicaciones derivadas de la corionicidad, amniocidad, prematuridad y de la posibilidad de anomalías congénitas. Realizar el diagnóstico temprano de la corionicidad permite planificar medidas de vigilancia prenatal y garantizar la mejor calidad de vida materno feto/neonatal.

Objective: To analyze epidemiological characteristics and fetal/neonatal complications of twin pregnancy at the Military Hospital of Maracaibo. Methods: A descriptive and retrospective study of patients admitted with twin pregnancies, from January 1st, 1998 to May 30th, 2013. Maternal age, fetal presentations, mode of delivery, reason for interruption of the pregnancy, chorionicity, fetal/neonatal complications, weight and congenital anomalies were registered. Results: There were 31 (1.26 %) twin deliveries (or 1/80) in 2 469 pregnant woman admitted for delivery. Average maternal age was 28. The most common fetal presentation was vertex-breech in 12 (38.7 %) and in 27 (87.1 %) patients cesarean section was performed. The most common indication of pregnancy interruption were the elective delivery in 12 (38.7 %) and prematurity in 11 (35.5 %). 62 fetuses were obtained and mortality was 17.7 % with 11 stillbirth and/or perinatal death, in 8 (72.7 %) were due to monochorionicity (P< 0.05) and its consequences, of these 5 (45.46 %) were for twin-twin transfusion syndrome. Intrauterine growth restriction in 13 babies (20,9 %) and mild or severe discordant fetal growth in 26 (42 %). Congenital anomalies were observed in 8 fetuses (8.1 %) with a musculoskeletal predominance. Conclusion: Multiple pregnancy has high fetal/neonatal morbimortality which is principally dependent of the complications derived from the chorionicity, amnionicity, prematurity and the possibility of congenital anomalies. An early diagnose of the chorionicity allows the planning of antenatal care and guaranteeing the improvement of the mother and fetal/neonatal life and health.

Incidence rate of HIV transmission in HIV discordant couples in Zhejiang province, 2009-2013 / 中华流行病学杂志

Objective To identify the HIV transmission in discordant couples and the epidemic characteristics of concordant couples related to HIV infection.Methods HIV/AIDS database was down-loaded from AIDS information reported system for analysis.Patients with HIV-negative couples between 2009 and 2013 in Zhejiang province were enrolled in this study.Information included demography characteristics,highly active antiretroviral therapy (HAART),HIV incidence rate and risk factors,characteristics on HIV concordant couples.Results The HIV incidence rate on HIV-negative couples of 2 575 HIV/AIDS was 3.56 per 1 000 person-year,reducing from 5.49 per 1 000 person-year in 2009 to 3.20 per 1 000 person-year in 2013.There was a slight increase on HIV incidence rate among couples in those HIV-positive men who were heterosexual,while it decreased among couples of HIV-positive women.Initiation of HAART over 1 years (OR=0.063,95％ CI:0.019-0.204) seemed to be a preventive factor for HIV transmission between the couples under study.Factors as history of infection longer than 3 years (OR=3.564,95％ CI:1.296-9.804) and beingnon-local resident (OR=2.626,95％ CI:1.098-6.230) were risky factors.Conclusion The incidence rate of HIV transmission between HIV discordant couples was low but imbalance in different areas.People who were non-local residents under HIV discordant status,would need more attention.HAART,time of infection,status of residency appeared risk factors for HIV transmission within the couples.