Analysis on survival time and influencing factors among reported HIV/AIDS in Yunnan Province, 1989-2021 / 中华流行病学杂志

Objective: To analyze the survival time of reported HIV/AIDS and influencing factors of Yunnan Province from 1989 to 2021. Methods: The data were extracted from the Chinese HIV/AIDS comprehensive response information management system. The retrospective cohort study was conducted. The life table method was applied to calculate the survival probability. Kaplan-Meier was used to draw survival curves in different situations. Furthermore, the Cox proportion hazard regression model was constructed to identify the factors related to survival time. Results: Of the 174 510 HIV/AIDS, the all-cause mortality density was 4.23 per 100 person-years, the median survival time was 20.00 (95%CI:19.52-20.48) years, and the cumulative survival rates in 1, 10, 20, and 30 years were 90.75%, 67.50%, 47.93% and 30.85%. Multivariate Cox proportional risk regression model results showed that the risk of death among 0-14 and 15-49 years old groups were 0.44 (95%CI: 0.34-0.56) times and 0.51 (95%CI:0.50-0.52) times of ≥50 years old groups. The risk for death among the first CD4+T lymphocytes counts (CD4) counts levels of 200-349 cells/μl, 350-500 cells/μl and ≥501 cells/μl groups were 0.52 (95%CI: 0.50-0.53) times, 0.41 (95%CI: 0.40-0.42) times and 0.35 (95%CI: 0.34-0.36) times of 0-199 cells/μl groups. The risk of death among the cases that have not received antiretroviral therapy (ART) was 11.56 (95%CI: 11.26-11.87) times. The risk for death among the cases losing to ART, stopping to ART, both losing and stopping ART was 1.66 (95%CI:1.61-1.72) times, 2.49 (95%CI:2.39-2.60) times, and 1.65 (95%CI:1.53-1.78) times of the cases on ART. Conclusions: The influencing factors for the survival time of HIV/AIDS cases were age at diagnosis in Yunnan province from 1989 to 2021. The first CD4 counts levels, antiretroviral therapy, and ART compliance. Early diagnosis, early antiretroviral therapy, and increasing ART compliance could extend the survival time of HIV/AIDS cases.

Survey on the transmission of HIV drug resistance in Kunming, Yunnan province in 2010 / 中华流行病学杂志

Objective To study the HIV drug resistance (HIVDR) transmission in Kunming city of Yunnan province in 2010.Methods Referring to the guidelines for HIV drug resistance threshold survey (HIVDR-TS) set by WHO,62 plasma samples of recently reported HIV-infected individuals who were older than 25 years of age,were collected from January to August 2010.Genotyping of pol genetic mutations associated with HIVDR with reverse transcriptional PCR was performed and the prevalence of HIV-1 drug resistance transmission was evaluated.Results Of the 62 plasma samples,54 were successfully sequenced and genotyped on pol sequence.Based on the pol sequences,HIV subtypes including CRF08_BC ( 53.2％ ),CRF07_BC ( 25.5％ ),CRF01_AE ( 19.1％ )and C (2.1％) were identified.According to the time of sampling,the first 47 sequenced samples were used for drug resistance prevalence analysis.A protease inhibitor (PI) relative mutation was found in one sample.Based on the WHO standard,the prevalence of transmitted HIV-1 drug resistance was ＜5％.Conclusion HIV-1 drug resistant strains transmission was still catalogued as low prevalence level in Kunming.To prevent the increase of HIVDR prevalence,normative treatment and scientific management to AIDS patients seemed to be quite important.

An epidemiological study on HIV sexual transmission in married spouse in Yunnan province / 中华流行病学杂志

Objective To understand the status of HIV sexual transmission among HIV- sero-discordant spouses and HIV-sero-accordant spouses in Yunnan province,to discuss the related factors and to provide evidence for HIV prevention and control strategy.Methods Five places with serious epidemic and 3 moderate ones were voluntarily,randomly selected.According to time sequence,300 spouses (600 people) with stable marriage were interviewed with questionnaire.Results HIV-sero-accordant spouses occupied for 40.7％ of the total spouses under survey,with the others were HIV-sero-discordant ones.Among the ones that had already been diagnosed in the families,sexual transmission was their main mode of transmission,which was accounted for 68.3％,followd by IDU as 19.7％.After disclosed the HIV test outcomes to their spouses,63.4％ HIV-sero-discordant spouses and 47.0％ HIV-sero-accordant ones changed their sexual behaviors.The rates of consistent condom use among the HIV-sero-discordant spouses increased from 16.8％ to 95.0％,and in HIV-sero-accordant spouses increased from 8.2％ to 60.9％.Data were analyzed by multi-factor logistic regression.Factors on influencing the sexual transmission in spouses would include condom use,frequency of sexual contacts and sexual transmission disease (STD) status etc.Conclusion The main transmission mode for the first HIV infected spouse was sexual transmission.Factors influencing sexual transmission in spouses would include condom use,frequency of sexual contacts,STD situation and husband was the first one being infected in the families,etc.Disclosure of the HIV results to the spouses could make a significant changes in the frequencies of sexual contact as well as the rate of condom use.

A comprehensive surveillance on HIV among 1237 men who have sex with men in thirteen cities of Yunnan / 中华流行病学杂志

Objective To understand the knowledge,risk behaviors and HIV prevalence in men who have sex with men (MSM) in thirteen cities.Methods Target samples were chosen using the snowball-rolling method,with transverse KABP and HIV-antibody testing developed for those MSM in thirteen cities of Yunnan.Results A total of 1237 valid questionnaires and 1129 blood samples were collected.Basic knowledge on HIV and the rate of the response was 93.2％.81.1％ of the respondents had anal sex with male parmers in the last six months,of them 49.7％ could persistently using condoms in each anal sex episode.29.0％ of the respondents had sex with female partners in the last six months.The HIV prevalence among the studied MSM was 8.2％ and the prevalence of syphilis among them was 3.9％.Most risky factors of those MSM infected by HIV would include:not persistently use condom when having sex and co-infection of syphilis.Conclusion Both rates of HIV infection associated risk behaviors and HIV prevalence were high in MSM under study that called for more work on HIV prevention and control MSM in Yunnan.

Incidence and risk factors of HIV infection among sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the HIV incidence and risk factors among sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province.</p><p><b>METHODS</b>A cohort of sero-negative spouses of the HIV patients had been developed and followed up since November, 2005. HIV new infections and related behaviors had been investigated every six months.</p><p><b>RESULTS</b>By the end of June, 2008, 790 sero-negative spouses of HIV patients had been recruited, of whom 702 were followed-up for at least one time. During the total 1202.35 person-years, 31 new HIV infections were identified, with an overall incidence of 2.58/100 person-years. The HIV incidence rates were 2.22/100 person-years in 2006, 2.95/100 person-years in 2007 and 2.74/100 person-years in 2008. Data from the Cox proportional hazard regression model indicated that those who resided in Yingjiang county [hazard ratio (HR) = 4.37, 95%CI: 1.48 - 12.90, P = 0.008], ever using drugs (HR = 3.49, 95%CI: 1.09 - 11.18, P = 0.035), or having an HIV-infected spouse who never exposed to antiretroviral treatment (HR = 3.60, 95%CI: 1.41 - 9.16, P = 0.007) were at higher risk for HIV infection.</p><p><b>CONCLUSION</b>Sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province had a relatively high incidence of HIV new infection during 2006-2008. More efforts should put on those people living in these areas, having a history of drug use or having an HIV-infected spouse who had never been exposed to antiretroviral treatment.</p>

Incidence and risk factors of HIV infection among sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province / 中华流行病学杂志

Objective To study the HIV incidence and risk factors among sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province. Methods A cohort of sero-negative spouses of the HIV patients had been developed and followed up since November, 2005.HIV new infections and related behaviors had been investigated every six months. Results By the end of June, 2008, 790 sero-negative spouses of HIV patients had been recruited, of whom 702 were followed-up for at least one time. During the total 1202.35 person-years, 31 new HIV infections were identified, with an overall incidence of 2.58/100 preson-years. The HIV incidence rates were 2.22/100person-years in 2006, 2.95/100 person-years in 2007 and 2.74/100 person-years in 2008. Data from the Cox proportional hazard regression model indicated that those who resided in Yingjiang county [hazard ratio (HR) =4.37, 95% CI: 1.48-12.90, P=0.008] , ever using drugs (HR=3.49, 95% CI:1.09-11.18, P=0.035) , or having an HIV-infected spouse who never exposed to antiretroviraltreatment (HR=3.60, 95% CI: 1.41-9.16, P=0.007) were at higher risk for HIV infection.Conclusion Sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province had a relatively high incidence of HIV new infection during 2006-2008. More efforts should put on those people living in these areas, having a history of drug use or having an HIV-infected spouse who had never been exposed to antiretroviral treatment.

Incidence and risk factors of HIV infection among sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province / 中华流行病学杂志

Objective To study the HIV incidence and risk factors among sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province. Methods A cohort of sero-negative spouses of the HIV patients had been developed and followed up since November, 2005.HIV new infections and related behaviors had been investigated every six months. Results By the end of June, 2008, 790 sero-negative spouses of HIV patients had been recruited, of whom 702 were followed-up for at least one time. During the total 1202.35 person-years, 31 new HIV infections were identified, with an overall incidence of 2.58/100 preson-years. The HIV incidence rates were 2.22/100person-years in 2006, 2.95/100 person-years in 2007 and 2.74/100 person-years in 2008. Data from the Cox proportional hazard regression model indicated that those who resided in Yingjiang county [hazard ratio (HR) =4.37, 95% CI: 1.48-12.90, P=0.008] , ever using drugs (HR=3.49, 95% CI:1.09-11.18, P=0.035) , or having an HIV-infected spouse who never exposed to antiretroviraltreatment (HR=3.60, 95% CI: 1.41-9.16, P=0.007) were at higher risk for HIV infection.Conclusion Sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province had a relatively high incidence of HIV new infection during 2006-2008. More efforts should put on those people living in these areas, having a history of drug use or having an HIV-infected spouse who had never been exposed to antiretroviral treatment.

Incidence and risk factors on HIV infection among injection drug users in Dehong prefecture area of Yunnan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the incidence and risk factors on HIV infection among injection drug users (IDU) in Dehong prefecture area of Yunnan province.</p><p><b>METHODS</b>An epidemiological cohort of HIV-negative IDU had been developed and followed since October, 2004. HIV new infections and related behaviors had been investigated every six months.</p><p><b>RESULTS</b>By the end of 2008, 760 HIV-negative IDU had been recruited and followed for a total of 1153.6 person-years. 47 new HIV infections were identified, with an overall incidence of 4.07/100 person-years during the follow-up period. The HIV incidence was 4.45/100 person-years during 2004 - 2006, 4.50/100 person-years in 2007 and 2.54/100 person-years in 2008. Both the behavior of drug injection and the HIV incidence among the cohort had substantially decreased during the follow-up period. Multiple regression analysis using Cox proportional hazard model indicated that people with Jing-po ethnicity (Hazard ratio, HR = 2.56, 95%CI: 1.06 - 6.19) and other minorities except for Dai (HR = 3.26, 95%CI: 0.89 - 11.96) were at higher risk for HIV infection than the people with Han ethnicity. People injecting drugs with (HR = 2.27, 95%CI: 0.98 - 5.25) or without (HR = 5.27, 95%CI: 2.25 - 12.34) needle sharing were at higher risk for HIV infection than those reporting having no drug injection behavior during the follow-up period.</p><p><b>CONCLUSION</b>Both the behavior of drug injection and the HIV incidence among former IDU in Dehong prefecture area of Yunnan province had been decreasing during the four years. However, needle sharing remained the most important risk factor for HIV new infection among IDUs. IDUs with different ethnicities seemed to have different risks towards HIV infection.</p>

A dynamic analysis on incidence and trend of HIV-1 epidemics among Intravenous Drug Users, attendants at the STD clinics and pregnant women in Yunnan province, China / 中华流行病学杂志

Objective BED-CEIA assay was used in HIV/AIDS surveillance sentinel sites to identify recent HIV-1 infection, to estimate HIV-1 incidence and to understand the epidemic trends in Yunnan province. Methods Serum specimens were collected from IDUs in sentinel sites, attendants in STD clinics and pregnant women under a cross sectional study from 2000 to 2007. Specimens confirmed as HIV-1 positive were tested with BED-CEIA to find resent HIV-1 infection, then the annual HIV-1 incidence for each group was calculated and the trends of HIV-1 incidence observed. Results 144 780 serum specimens were collected and 4932 of them were confirmed as HIV-1 positive. 4678 positive specimens were tested with BED-CEIA and 723 ont of them were identified as recent infections. Specimens from the two years were combined for testing. The average HIV-1 prevalence among IDUs was 18.2 %-26.9 % from 2000 to 2007 and the annual incidence were 14.65%, 6.21%, 4.06%, 2.23% respectively. The average HIV-1 prevalence among attendants in STD clinics was 1.6 %-3.2 % and the annual incidence rates were 1.46 %, 0.76 %, 0.52 %, 0.33 % respectively. The average HIV-1 prevalence among pregnant women was 0.2%-0.5% and the annual incidence rates were 0.16%, 0.11%, 0.10%, 0.09% respectively. Conclusion HIV-1incidence rates among IDUs, STDs and pregnant women showed a steady decease.

The analysis of human immunodeficiency virus-1 subtypes in Yunnan province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the geographical distribution and risk factors of HIV-1 subtypes in Yunnan province.</p><p><b>METHODS</b>Blood samples from 1319 HIV positives were collected in Yunnan Province from 2001 to 2006. The nested polymerase chain reaction was used to amplify the gag (p24)-protease fragments from RNA extracted from plasma or sera. The sequences were used for subtype determination by phylogenetic tree analysis.</p><p><b>RESULTS</b>Among 1319 samples studied, the subtypes has been successfully obtained from 644 samples that were constituted of seven subtypes: CRF08_BC, CRF07_BC, CRF07/08_BC, CRF01_AE, C, B' and URFB/C. C/CRF07_BC/CRF08_BC were distributed in the whole province, but CRF01_AE were mainly distributed in the boarding areas with Myanmar such as Dehong, Baoshan, Xishuangbanna and Puer. Moreover, injecting drugs users accounted for 61.6% (270/438) among C/CRF07_BC/CRF08_BC infections, while only 8.5% (15/177) among CRF01_AE infections.</p><p><b>CONCLUSION</b>Our data indicated that at least seven subtypes were identified in Yunnan province, the relationship between subtypes and transmission routes were analyzed, and the geographic difference of subtypes was also observed.</p>

Analysis for epidemic trend of acquired immunodeficiency syndrome in Yunnan Province of China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand epidemiologic characteristics and changes in epidemic trend of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) in different areas and populations of Yunnan Province.</p><p><b>METHODS</b>Seroepidemiological studies were conducted in injection drug users (IDUs), women sex workers, whoring goers, patients with sexually transmitted disease (STD), patients with tuberculosis, pregnant women and blood donors with sentinel surveillance, ad hoc investigations, regular case-finding and data collection during 1989 to 2003 in Yunnan Province.</p><p><b>RESULTS</b>Relatively high prevalence of HIV/AIDS was firstly found in IDUs from border areas of the province in 1989. By December of 2003, totally 14 905 cases with HIV infection were reported in 121 counties of 16 prefectures in Yunnan Province. Prevalence of HIV infection ranged from 21.2% to 27.8% in IDUs, over 40% in IDUs from six areas, and 1.23% to 6.67% and 0.3% to 1.8% in underground prostitutes and whoring goers, respectively. Prevalence of HIV infection was 2.1% to 2.7%, 10.8% in specific areas, in male patients with STD, and was 0.14% to 0.25% in pregnant women during 1993 to 2002 and increased to 0.37% in 2003. Prevalence of HIV infection ranged 1.5% to 1.6% in patients with tuberculosis and 0.01% in blood donors during 1999 to 2000 and increased to 0.07% in 2003.</p><p><b>CONCLUSIONS</b>Epidemic of HIV infection began in late 1980s in Yunnan, then spread from border areas to inland through IDUs, maintaining a higher prevalence in them to date. Sexual transmission of HIV/AIDS showed an increasing trend in them, with a low prevalence in general population, but appeared a wide spread in local areas.</p>