Advances in laboratory testing methods and strategies for hepatitis C virus infection / 临床肝胆病杂志

Laboratory testing for hepatitis C virus （HCV） infection provides an important basis for the identification and diagnosis of patients with HCV infection. With the continuous development of HCV testing in recent years， the performance of reagents has been significantly improved， and new testing service strategies have emerged and gradually been applied in clinical practice. This article summarizes the laboratory testing methods and strategies for HCV infection in China and globally， as well as the testing methods for HCV infection， and analyzes the influence of new methods and strategies on the prevention and control of HCV infection in China. Timely and accurate laboratory testing methods and effective and feasible testing strategies may help to realize the early identification， early diagnosis， and early treatment of HCV infection and ultimately achieve the strategic goal of eliminating viral hepatitis as a major public health threat by 2030.

Epidemiological analysis of the deaths with antiretroviral treatment among adult HIV/AIDS patients in Liangshan Yi Autonomous Prefecture from 2005 to 2015 / 中华流行病学杂志

Objective@#To analyze the deaths with antiretroviral treatment among adult HIV/AIDS patients in Liangshan Yi Autonomous Prefecture from 2005 to 2015, in order to understand the epidemiological characteristics and to further reduce the mortality rate in Liangshan Prefecture.@*Methods@#The relevant information was collected through the Management Database of Antiretroviral Treatment from the National AIDS Comprehensive Prevention Information System.@*Results@#From 2005 to 2015, a total of 14 219 adult HIV/AIDS patients received antiretroviral treatment and 1 425 death cases were reported during the treatment. The cause of death was mainly AIDS-related diseases (58.9%), and the cumulative mortality rate was 10.02%. Gender, age, the way of infection, duration of antiretroviral therapy, clinical stage when received antiretroviral therapy, and CD4+ T lymphocyte levels were factors for the mortality rate (P<0.001). The mortality increased with older age, higher initiation clinical stage and lower level of CD4+ T lymphocyte. Among the death cases, 82.6% were male, 1 182 (82.9%) were married or cohabited, most aged between 30-39 years old (48.6%). At the initial point of receiving antiretroviral therapy, 49.7% of the cases with CD4+T lymphocytes levels< 200/μl, 61.2% of the deaths cases were>1 000 copies/ml during the last viral load test, and 16.2% of deaths were ≥500/μl in the last CD4+T lymphocyte test; 44.5% of deaths were received antiretroviral treatment within one year.@*Conclusion@#Early and timely antiretroviral therapy should be carried out. It is necessary to strengthen the propaganda of antiretroviral therapy and to improve the management quality of follow-up information of antiretroviral therapy case files, and to improve the medication compliance of patients.

Effects and associated factors of HIV/AIDS anti-retroviral therapy in Liangshan Yi Autonomous Prefecture, Sichuan Province / 中华预防医学杂志

Objective@#To evaluate the effectiveness and to explore the releated factors of antiretroviral therapy among HIV/AIDS patients in Liangshan Yi Autonomous Prefecture, Sichuan Province.@*Methods@#The method of convenience sampling was adopted in July 2017 to select the research objects who were accepted antiretroviral therapy (ART) over 6 months, older than 18 years and had HIV viral load in 2016, totally 400 cases. A retrospective study was used to collect the data, including social demography, medicine use, information of medical service acquisition, their own behaviors and cognition. 395 questionnaires were effectively recovered. χ2 test and logistic regression were performed to examine relationships between factors and effects.@*Results@#All of the 395 respondents were Yi-nationality. The average age of all cases was (39.23±7.52) years old and 223 were male (56.5%). Among 395 cases patients who were detect Viral load in 2016, 221 cases were under the number of 400 copies, thze effective rate of ART was 55.9%. Multivariate analysis showed that HIV/AIDS patients who missed the medication during the antiviral therapy had poor antiviral effects. Compared to those who adhered to medication, the treatment-ineffective OR (95%CI) of the patients missing the medication during the therapy was 7.06 (3.67-13.58); Compared to those who had adverse reactions that affect the therapy, the treatment-ineffective OR (95%CI) of the patients with mild adverse reactions that did not affect the therapy was 0.45 (0.23-0.87); Compared to the patients who used drugs during the treatment, the treatment-ineffective OR (95%CI) value of the antiretroviral therapy effect of non-drug users was 0.39 (0.16-0.91);Compared to the patients who have a correct cognition that insisting on taking medicine correctly can extend their life expectancy as a common person, the treatment-ineffective OR (95%CI) values for those who hold the view that could be prolonged by 10-20 years and not/unknown were 4.18 (1.59-10.99) and 6.64 (2.67-16.53).@*Conclusion@#The HIV/AIDS patients who receive ART were less effective in Liangshan, Prefecture. Missings drugs is one of the main influencing factors for the ineffective treatment.

Analysis of related factors for primary hepatic carcinoma caused by chronic hepatitis B and hepatitis C / 中华预防医学杂志

Objective@#To explore the related factors for primary hepatic carcinoma (PHC) caused by chronic hepatitis B (CHB) and hepatitis C (CHC).@*Methods@#According to the principle of cross-sectional study, a cluster random sample method was used, a total of 366 chronic hepatitis patients in hospitals were recruited from three provincial tertiary hospitals in Shanxi, Henan and Jilin between July 2016 and October 2016, respectively. Using a self-designed unified questionnaire, face-to-face interviews was conducted on subjects, including sex, age, alcohol consumption, coffee consumption, green tea consumption, fish consumption, smoking, HBV/HCV diagnosis and treatment, diabetes mellitus, family history of PHC (whether PHC in first-degree relatives), etc. Multivariate unconditional logistic regression were performed to identify the related factors for PHC with CHB and CHC. According to the clinical diagnosis the patients were divided into a chronic hepatitis group (not developing to PHC) and a PHC group.@*Results@#Among 366 cases patients, 287 (78.4%) cases were male, 79 cases were female (21.6%), average age was (52.7±9.3) years. 202 cases were chronic hepatitis group, 164 cases were PHC group. Multivariate unconditional logistics regression analysis indicated that alcohol consumption (odds ratio (OR)=2.11, 95%CI: 1.18-3.75), family history of PHC (OR=5.12, 95%CI: 2.60-10.08) were positively correlated with the development of PHC in chronic b, green tea consumption (OR=0.45, 95%CI: 0.23-0.88), antiviral treatment (OR=0.19, 95%CI: 0.11-0.32) were negatively correlated. Alcohol consumption (OR=3.98, 95%CI: 1.14-13.85) was positively correlated with the development of PHC in chronic c, antiviral treatment (OR=0.14, 95%CI: 0.04-0.50) was negatively correlated.@*Conclusion@#Alcohol consumption, family history of PHC, green tea consumption and antiviral treatment were the related factors for the development of PHC in chronic hepatitis b. Alcohol consumption and antiviral treatment were the related factors for the development of PHC in chronic hepatitis c.

Survival time and associated factors of 8 310 AIDS patients initially receiving antiretroviral treatment of Liangshan Yi Autonomous Prefecture, Sichuan province of China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the survival time and its impact factors among AIDS patients who initially received antiretroviral treatment (ART) of Liangshan Yi Autonomous Prefecture, Sichuan province.</p><p><b>METHODS</b>A retrospective cohort study was conducted to analyze the information of AIDS patients over 18 years old initially received ART in Liangshan Yi Autonomous Prefecture during 2005-2013, which were downloaded from Chinese AIDS Antiretroviral Therapy DATA Fax Information System. Cox proportion hazard regression model was used to identify impact factors related survival time.</p><p><b>RESULTS</b>Among 8 310 ART AIDS patients who initially received ART, their mean age was (34.59 ± 9.10) years old, 65.50% (5 443 cases) were infected with HIV through injecting drug use, the mean time from testing HIV positive to starting ART were (24.68 ± 21.69) months. 436 cases died of AIDS related diseases, 28.67% (125 cases) of them died within the first 6 months of treatment. The cumulative survival rate of receiving ART in 1, 2, 3, 4 5 years were 97.11%, 93.41%, 90.61%, 88.81%, 86.02%, respectively. Multivariate Cox regression analysis showed the male patients receiveing ART were at a higher risk death of AIDS related diseases compared to the females (HR = 1.57, 95% CI: 1.13-2.182), the patients infected with HIV through injecting drug use were at a higher risk deathcompared to the infected through heterosexual transmission (HR = 1.64, 95% CI: 1.20-2.24), before the treatment patients with tuberculosis in recent1 year had higher death hazard as compared to those without tuberculosis (HR = 1.53, 95% CI: 1.05-2.21), in the treatment of the first 3 months of AIDS related diseases or symptoms of AIDS patients had higher death hazard as compared to those not suffer these diseases (HR = 1.80, 95% CI: 1.39-2.34). The patients with baseline CD4 (+) T lymphocytes cell counts < 50/µl (HR = 9.79, 95% CI: 6.03-15.89), 50-199/µl (HR = 3.26, 95% CI: 2.32-4.59), 200-349/µl (HR = 1.69, 95% CI: 1.22-2.34), were at a higher risk death than those with CD4 (+) T lymphocytes cell counts ≥ 350/µl.</p><p><b>CONCLUSION</b>Accumulate survival rate was higher after initial antiretroviral treatment among AIDS patients in Liangshan Yi Autonomous Prefecture, Sichuan province. AIDS patients who are males, have tuberculosis in recent year, infected HIV via route of intravenous drug use, with AIDS-related illness or symptoms in 3 months before ART, lower baseline CD4 (+) T lymphocyte count have higher risk of death.</p>

Survival time and related influencing factors of AIDS patients in Liangshan prefecture, Sichuan province, during 2008-2013 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the survival time and affecting factors among AIDS patients under antiretroviral treatment, between 2008 and 2013 in Liangshan, Sichuan province.</p><p><b>METHODS</b>Observational retrospective cohort study method was applied. AIDS patients were chosen from China's national comprehensive prevention and control management system of AIDS in Liangshan, during 2008-2013. Related information on demographics, source of infection, pathogenesis, treatment and death was collected. Cox proportional hazards model was applied to analyze the factors that might affect the survival on patients.</p><p><b>RESULTS</b>Among the 8 321 cases, ranging from 18 to 87.5 years old (mean age as 34.2 ± 9.8), 3 021 died and 3 721 patients had received HAART treatment. The total mortality rate dropped from 43.9/100 person-years to 20.7/100 person-years from 2008 to 2013. In the treatment group, mortality rate dropped from 27.3/100 person-years to 5.1/100 person-years, while in the untreated group it remained high-between 45.0/100-50.8/100 person-years. Proportion for the treatment coverage increased gradually, from 5.8% in 2008 to 54.5% in 2013. Median survival time of all the AIDS patients was 35.1 months, but 18.4 months in the untreated group. Survival of all the AIDS patients was associated with factors as: treatment, age when AIDS diagnosis was made and route of HIV infection (P < 0.05). The risk of death among untreated patients was 5.78 times to the treated ones, but did not seem to relate to gender or nationality (P > 0.05). Survival of the treated group was associated with factors as gender, age when AIDS diagnosis was made, nationality, route of HIV infection, CD4(+) T cell count when AIDS diagnosis was made, CD4(+) T cell count at treatment baseline, anemia at the treatment baseline (P < 0.05). Survival of the untreated group was mainly associated with age when AIDS was diagnosed (P < 0.05) while other factors did not seem to be significantly related (P > 0.05).</p><p><b>CONCLUSION</b>Antiretroviral therapy appeared an important factor that affecting the survival of AIDS patients, timely treatment and CD4(+) T cell count provided at the baseline for treatment, were two key factors that affecting the outcome of treatment. Our findings pointed out that tactic factors as: strengthening the detection, monitoring on CD4(+) T cell count, early diagnose and treatment, expanding the coverage of antiretroviral therapy, and appropriate timing for treatment etc., were important ways to enhance the effects of treatment, so as to reduce the mortality rate and prolong the time of survival.</p>

Survival analysis on AIDS patients undergoing antiretroviral treatment, Liangshan prefecture, Sichuan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the survival time and its impact factors among AIDS patients who initially received antiretroviral treatment (ART) in Liangshan prefecture during 2004-2012.</p><p><b>METHODS</b>A retrospective cohort study was conducted to analyze the information of AIDS patients who initially received ART. Data on patients was collected from the Chinese AIDS Antiretroviral Therapy DATAFax Information System. Life table was applied to calculate the survival proportion, and Cox proportion hazard regression model was used to identify impact factors that were related to the time of survival.</p><p><b>RESULTS</b>Among 5 525 AIDS patients who initially received ART, the median age was (34.5± 9.0) year old, with 73.9% being males, 65.8% were infected through injecting drug use, time from HIV tested HIV positive to starting ART was (23.0±20.1) months. 287 cases died of AIDS related diseases, and their median time of receiving ART was (12.7±10.6) months, and 32.8% of them died within the first 6 months of treatment. Cumulative survival rates of the patients who had received ART in 1, 2, 3, 4, 5 years were 97%, 93%, 89%, 88%, 84%, respectively. Results from multivariate Cox regression showed that female patients who received ART were at a lower risk to the death of AIDS related diseases(HR = 0.556, 95%CI:0.367-0.872), when compared to the males. Patients infected with HIV through injecting drug use were at a higher risk to death (HR = 1.569, 95% CI:1.061-2.321) when compared to those who were infected through heterosexual transmission. Patients with baseline CD4(+) T cells counts at <50 cells/mm(3) (HR = 11.996, 95% CI: 6.714-21.435) or 50-200 cells/mm(3) (HR = 2.481, 95%CI:1.620-3.798) were at a higher risk to death than those with CD4(+)T cell counts ≥350 cells/mm(3). Patients without pulmonary tuberculosis were at a lower risk to death(HR = 0.511, 95% CI:0.330-0.791)when compared to those with pulmonary tuberculosis a year before starting the treatment.</p><p><b>CONCLUSION</b>Antiretroviral treatment could prolong the survival time of AIDS patients and with a better rate on survival. Programs on follow-up and CD4(+)T cell counts for AIDS patients should be conducted regularly, as well as timely initiated the antiretroviral therapy.</p>

Clinical characteristics of 275 pediatric cases of acquired immune deficiency syndrome / 中华传染病杂志

Objective To study the clinical characteristic of acquired immune deficiency syndrome (AIDS) patients younger than 15 years old and to explore the influence of human immunodeficiency virus (HIV) infection on them. Methods The clinical information, including demographic profile, clinical stages of the disease, laboratory test results and developmental status were gathered from 275 antiretroviral therapy naive patients. Results Seventy eight point nine percent patients were infected by vertical transmission. Sixteen percent were infected by receiving blood products. The average age was (7.6±3. 7) years, with 5 cases younger than 1 year old, 104 cases ranging from 1 - 5 years and 166 cases elder than 6 years. Seventy point one percent patients were classified as stage 3 or 4 according to World Health Organization definitions. The average CD4 count was ( 137 ± 159 )/μL, ( 304 ± 317 ) /μL and ( 1 246 ± 776 )/μL respectively in children elder than 6 years, ranging from 1 to 5 years and younger than 1 year. One hundred and eighty one cases suffered from anemia on different severity grading. The most common HIV related symdromes included persistent fever, skin damage, persistent diarrhea, oral candidiasis and recurrent upper respiratory tract infection. Among these infected children, 49. 6% showed height lower than x - 2s and 19. 9% showed weight lower than x - 2s. Conclusions Most survival pediatric AIDS patients are elder than 6 years. HIV infection can significantly affect the children's immune system function,growth and development.