Changes in sexual behavior among MSM during the spread of COVID-19 in China: results of an online survey (preprint)

Background Sexual behavior drives the transmission of sexually transmitted infections, especially among men who have sex with men (MSM). This study aims to evaluate the sexual behavior changed among MSM during the COVID-19.Methods An online survey was conducted to collect socio-demographic, sexual behavioral, and HIV testing information before and during the COVID-19. Chi-square was used to determine the behavior differences before and during the COVID-19. We identified the factors associated with sexual behavior among MSM using logistic regression.Results Totally 506 MSM participated in the survey. Compared with participants who didn't reduce the number of sexual partners (193, 38.1%), participants who reduced sexual partners (313, 61.9%) had higher values of multiple sexual partners, causal sexual partners, used condoms with causal sexual partners, and sought sexual partners using apps. Participants who reduced the number of sexual partners than before COVID-19, reported having a higher proportion of causal sexual behavior (χ2 = 21.047, p < 0.001), which means engaged in casual sex in the last three months.Conclusions The lockdown measures significantly impacted the sexual behavior of MSM. After the epidemic is over, however, we need to increase health education for MSM to reduce their high-risk sexual behaviors and protect them from STDs.

Influenza vaccine uptake among children and older adults in China: A secondary analysis of a quasi-experimental study (preprint)

Background: Influenza vaccination is the key to reducing the influenza-related disease burden, especially among high-risk populations. However, influenza vaccine uptake is low in China. This secondary analysis of a quasi-experimental trial in Guangdong Province aimed to understand factors associated with influenza vaccine uptake among children and older people stratified by funding context. Methods: : A total of 225 children (aged 0.5-8 years) and 225 older people (aged 60 years or above) were recruited from three clinics (rural, suburban, urban). Participants were allocated into two groups based on different funding contexts: self-paid group (N=150, including 75 children and 75 older adults) in which participants paid full market price for their vaccination; and subsidized group (N=300, including 150 children and 150 older adults) in which varying levels of financial support was provided. Univariable and multivariable logistic regressions were conducted stratified by funding contexts. Results: : Overall, 75.0% (225/300) of participants in the subsidized group and 36.7% (55/150) in the self-paid group got vaccinated. Older adults had lower vaccination rates than children in both funding groups, while both age groups showed much higher uptake in the subsidized group than in the self-paid group (86.7% vs 53.3% among children; 63.3% vs 20.0% among older people). In the self-paid group, participants living with children (aOR:2.61, 95%CI: 1.06-6.42) or older people (aOR:4.76, 95%CI: 1.08-20.90) having prior influenza vaccination in the same household were more likely to be vaccinated; trust in providers’ advice (aOR=4.95, 95%CI:1.99, 12.43) or effectiveness of the vaccine (aOR: 12.18, 95%CI: 5.21-28.50), and experienced influenza-like illnesses in the family (aOR=46.52, 4.10, 533.78) were associated with higher vaccine uptake in the subsidized group. Conclusions: Older people had suboptimal vaccine uptake compared to children in both contexts and need more attention in future efforts to enhance influenza vaccination. Tailoring interventions to different vaccine funding contexts may help improve influenza vaccine uptake: In self-paid context, measures to motivate people to accept their first ever influenza vaccination may be a promising strategy. In subsidized context, strategies to improve public confidence in vaccine effectiveness and providers’ advice would be useful. Trial registration: ChiCTR2000040048. Registered on November 19, 2020.

Changes in sexual behavior among men who have sex with men during the spread of COVID-19 in China: results of an online survey (preprint)

Background: Sexual behavior drives the transmission of sexually transmitted infections, especially among men who have sex with men (MSM). This study aims to evaluate the sexual behavior changed among MSM during the outbreak of COVID-19.Material and Methods: An online survey was conducted to collect sociodemographic, sexual behavioral, and HIV testing information before and during the COVID-19 epidemic. Chi-square was used to determine the behavior differences before and during the COVID-19 pandemic. We identified the factors associated with casual sexual behavior among MSM using bivariate and multivariable logistic regression.Results: A total of 506 MSM participated in the online survey. The 506 MSM were individuals born biologically as a male, self-identified as a male, aged 18 or over, and ever engaged in sex with a man (in the past three month). Compared with participants who didn't reduce the number of sexual partners (n = 193, 38.1%), participants who reduced sexual partners (n = 313, 61.9%) had higher values of multiple sexual partners, causal sexual partners, used a condom with causal sexual partners, and sought sexual partners using apps (all p< 0.05). Participants who reduced the number of sexual partners than before COVID-19, reported having a higher proportion of causal sexual behavior (66.77% vs 46.11%, c2 = 21.047, p< 0.001), which means engaged in casual sex in the last three months. But at-risk sexual behavior, which means unprotected anal sex with a casual partner without using condom protection, did not change significantly between the two groups during COVID-19 (p>0.05). Multiple factors are related to casual sexual behavior and at-risk sexual behavior.Conclusions: During the COVID-19 pandemic, the lockdown measures significantly impacted the sexual behavior of Chinese MSM. Sustain behavior interventions are still needed during the COVID-19 pandemic.

Willingness to receive the COVID-19 vaccine among HIV positive men who have sex with men in China: a cross-sectional study (preprint)

Background：People living with HIV(PLWH) are deemed more vulnerable to the SARS-CoV-2 infection than the uninfected population. Vaccination is an effective measure for COVID-19 control, yet, little knowledge exists about the willingness of men who have sex with men (MSM) living with HIV in China to be vaccinated. Methods：This cross-sectional study evaluated the willingness of MSM living with HIV to receive COVID-19 vaccination in six cities of Guangdong, China, from July to September 2020. Factors associated with willingness to receive COVID-19 vaccination using multivariable logistic regression. Results：In total, we recruited 944 HIV-positive MSM with a mean age of 29.2±7.7 years. Of all participants, 92.4% of them were willing to receive the COVID-19 vaccine. Participants who were separated, divorced, or widowed (OR: 5.29, 95%CI: 1.02-27.48), had an annual income higher than 9,000 USD (OR: 1.70, 95%CI: 1.01-2.86), had ever taken an HIV self-test (OR: 1.78, 95%CI: 1.07-2.95), had ever disclosed sexual orientation to a doctor/nurse (OR: 3.16, 95%CI: 1.33-7.50), had ever disclosed sexual orientation to others besides their male partners (OR: 2.18, 95%CI: 1.29-3.69) were more willing to receive the vaccine. Sex with a female partner in the past six months decreased the likelihood of willingness to receive the vaccine (OR: 0.40, 95%CI: 0.17-0.95). Economic burden, worry that my health condition could not bear the risk of receiving COVID-19 vaccines, and concern that the vaccination would affect the immune status and antiretroviral therapy were the main reasons for unwillingness to receive vaccination. Conclusion: Our study showed that HIV-positive MSM had a high willingness to receive the COVID-19 vaccination. Targeted interventions such as health education should be conducted among MSM with HIV infection to enhance COVID-19 vaccine uptake.

Humoral Immune Response to Inactivated COVID-19 Vaccination at the 3rd Month among People Living with HIV (preprint)

Background: Research on the immune response to inactivated COVID-19 vaccination among people living with HIV (PLWH) is limited, especially among those with low CD4+ T lymphocyte (CD4 cell) count. This cross-sectional study aimed to assess the humoral immune response to inactivated COVID-19 vaccination among PLWH compared to HIV negative controls (HNC) and to determine the impact of CD4 cell count on vaccine response among PLWH.Methods: The neutralizing antibodies (nAbs) and the specific IgM and IgG-binding antibody responses to the inactivated COVID-19 vaccine at the third month after the second dose of inactivated COVID-19 vaccination were measured among 138 PLWH and 35 HNC. Multivariable logistic regression and multiple linear regression models were conducted to identify factors associated with the seroconversion rate of antibodies and the magnitude of anti-SARS-CoV-2 antibody titers, respectively.Results: At the end of the third month after two doses of vaccination, the seroconversion rates of IgG were comparable between PLWH (8.7%; 95%CI, 3.9-13.5%) and HNC (11.4%; 95%CI, 0.3-22.5%), respectively. The median titers and seroconversion rate of nAbs among PLWH were 0.57 (IQR: 0.30-1.11) log10 BAU/mL and 29.0% (95%CI: 21.3-36.8%), respectively, both lower than those in HNC (P＜0.05). After adjusting for age, sex, comorbidities, and CD4 cell count, the titers and seroconversion rate of nAbs were comparable between PLWH and HNC (P＞0.05). Multivariable regression analyses showed that CD4 cell count＜200 /μL was independently associated with lower titers and seroconversion rate of nAbs among PLWH (P＜0.05). A positive correlation was observed between the CD4 cell count and nAbs titers in PLWH (Spearman'sρ=0.25, P=0.034). Conclusion: Our study concluded that the immune response to inactivated COVID-19 vaccination among PLWH was independently associated with CD4 cell count, PLWH with lower CD4 cell count showed a weaker humoral immune response, especially those with CD4 cell count＜200 /μL. This finding suggests that expanding COVID-19 vaccination coverage among PLWH is impendency. In addition, aggressive ART should be carried out for PLWH, especially for those with low CD4 cell count, to improve the immune response to vaccines.

The impact of the COVID-19 on the mental health of pregnant women in Shanghai, China (preprint)

Background The COVID-19 has greatly impacted people's health, especially mental health. This study aimed to compare the psychological status of pregnant women before and after the COVID-19 outbreak.Method Participants were recruited (from September 29, 2019, to November 5, 2020) and screened by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7). The study participants were categorized into three groups based on two turning-point days: January 23, 2020, when China initiated a locked-down strategy, and May 11, 2020, when Shanghai’s COVID epidemic situation became stable.Results We recruited 478 pregnant women. After the outbreak, the depression rate (PHQ-9≥5) increased 12.3% (from 35.4–47.7%, P=0.022), and the anxiety rate (GAD-7≥5) was stable (13.3% VS 16.2%, P=0.46). The multivariable logistic regression results further confirmed that the odds of depression in pregnant women increased 79% after the outbreak (aOR=1.79, 95%CI: 1.14-2.79). Under the epidemic, the median depression scale score was still statistically higher after the epidemic situation was stable (5.0 vs. 4.0, P=0.028).Conclusion The depression rate increased among pregnant women after the outbreak and was not recovered after the epidemic turned normal among pregnant women. Health institutes should pay attention to the long-term influence of the pandemic.

Immune response and safety to inactivated COVID-19 vaccine: A comparison between People Living with HIV and HIV-naive individuals (preprint)

Background: Multi-types COVID-19 vaccines have shown safety and efficacy against COVID-19 in adults. Although current guidelines encourage people living with HIV(PLWH) to take COVID-19 vaccines, whether their immune response to COVID-19 vaccines is distinct from HIV-free individuals is still unclear. Methods: Between March to June 2021, 48 PLWH and 40 HNC, aged 18 to 59 years, were enrolled in the study in Wuchang district of Wuhan city. All of them received inactivated COVID-19 vaccine at day 0 and the second dose at day 28. The primary safety outcome was the combined adverse reactions within 7days after each injection. The primary immunogenicity outcomes were neutralizing antibodies (nAbs) responses by chemiluminescence and total specific IgM and IgG antibodies responses by ELISA and colloidal gold at baseline (day 0), day 14, day 28, day 42, and day 70. Results: In total, the study included 46 PLWH and 38 HNC who finished 70 days’ follow-up. The frequency of adverse reactions to the first and second dose was not different between PLWH (30% and 11%) vs HNC (32% and 24%). There were no serious adverse events. NAbs responses among PLWH peaked at day 70, while among HNC peaked at day 42. At day 42, the geometric mean concentration (GMC) and seroconversion rate of nAbs among PLWH were 4.46 binding antibody units (BAU)/mL (95% CI, 3.18-5.87) and 26% (95% CI, 14-41), which were lower than that among HNC [GMC (18.28 BAU/mL, 95% CI, 10.33-32.33), seroconversion rate (63%, 95% CI, 44-79)]. IgG responses among both PLWH and HNC peaked at day 70. At day 70, the geometric mean ELISA units (GMEU) and seroconversion rate of IgG among PLWH were 0.193 ELISA units (EU)/mL (95% CI, 0.119-0.313) and 51% (95% CI, 34-69), which was lower than that among HNC [GMEU (0.379 BAU/mL, 95% CI, 0.224-0.653), seroconversion rate (86%, 95% CI, 64-97)]. Conclusion: Early humoral immune response to the inactivated COVID-19 vaccine was weaker and delayed among the PLWH population than that among HNC. This observation remained consistent regardless of a high CD4 count and a low HIV viral load suppressed by antiretroviral therapy (ART).

COVID-19 Vaccine Perceptions in the Initial Phases of US Vaccine Roll-out: An Observational Study on Reddit (preprint)

Background: Open online forums like Reddit provide an opportunity to quantitatively examine COVID-19 vaccine perceptions early in the vaccine timeline. We examine COVID-19 misinformation on Reddit following vaccine scientific announcements, in the initial phases of the vaccine timeline. Methods: We collected all posts on Reddit from January 1 2020 - December 14 2020 (n=266,840) that contained both COVID-19 and vaccine-related keywords. We used topic modeling to understand changes in word prevalence within topics after the release of vaccine trial data. Social network analysis was also conducted to determine the relationship between Reddit communities (subreddits) that shared COVID-19 vaccine posts, and the movement of posts between subreddits. Results: There was an association between a Pfizer press release reporting 90\% efficacy and increased discussion on vaccine misinformation. We observed an association between Johnson and Johnson temporarily halting its vaccine trials and reduced misinformation. We found that information skeptical of vaccination was first posted in a subreddit (r/Coronavirus) which favored accurate information and then reposted in subreddits associated with antivaccine beliefs and conspiracy theories (e.g. conspiracy, NoNewNormal). Conclusions: Our findings can inform the development of interventions where individuals determine the accuracy of vaccine information, and communications campaigns to improve COVID-19 vaccine perceptions, early in the vaccine timeline. Such efforts can increase individual- and population-level awareness of accurate and scientifically sound information regarding vaccines and thereby improve attitudes about vaccines, especially in the early phases of vaccine roll-out. Further research is needed to understand how social media can contribute to COVID-19 vaccination services.

Adverse Events of Inactivated COVID-19 Vaccine in HIV-Infected Adults (preprint)

This study aims to evaluate the safety of inactivated COVID-19 vaccineamong adult people living with HIV (PLWH). In total, 259 PLWH who received at least one dose of inactivated COVID-19 vaccine were enrolled, and post-vaccination adverse events (AEs) were evaluated seven days following each vaccination dose. The overall AE frequency was 22.8% after dose one, which was higher than after dose two(10.2%)(P＜0.001). No severe side event or vaccine safety concern was observed. Our finding was essential in reducing vaccine hesitancy among PLWH.

Immune Response and Safety to Inactivated COVID-19 Vaccine: A Comparison Between People Living with HIV and HIV-naïve Individuals (preprint)

Background: Multi-types COVID-19 vaccines have shown safety and efficacy against COVID-19 in healthy adults. Although current guidelines encourage people living with HIV(PLWH) to take COVID-19 vaccines, whether their immune response to COVID-19 vaccines is distinct from HIV-free individuals is still unclear.Methods: Between March to June 2021, 48 PLWH and 40 HNC, aged 18 to 59 years, were enrolled in the study. All of them received inactivated COVID-19 vaccine at day 0 and the second dose at day 28. The primary safety outcome was the combined adverse reactions within 7days after each injection. The primary immunogenicity outcomes were neutralizing antibodies (nAbs) responses by chemiluminescence and total specific IgM and IgG antibodies responses by ELISA and colloidal gold at baseline (day 0), day 14, day 28, day 42, and day 70.Findings: In total, the study included 46 PLWH and 38 HNC who finished 70 days’ follow-up. The frequency of adverse reactions to the first and second dose was not different between PLWH (30% and 11%) vs HNC (32% and 24%). NAbs responses among PLWH peaked at day 70, while among HNC peaked at day 42. At day 42, the geometric mean concentration (GMC) and seroconversion rate of nAbs among PLWH were 4.46 binding antibody units (BAU)/mL (95% CI, 3.18-5.87) and 26% (95% CI, 14-41), which were lower than that among HNC [GMC (18.28 BAU/mL, 95% CI, 10.33-32.33), seroconversion rate (63%, 95% CI, 44-79)]. IgG responses among both PLWH and HNC peaked at day 70. At day 70, the geometric mean ELISA units (GMEU) and seroconversion rate of IgG among PLWH were 0.193 ELISA units (EU)/mL (95% CI, 0.119-0.313) and 51% (95% CI, 34-69), which was lower than that among HNC [GMEU (0.379 BAU/mL, 95% CI, 0.224-0.653), seroconversion rate (86%, 95% CI, 64-97)].Interpretation: Early humoral immune response to the inactivated COVID-19 vaccine was weaker and delayed among the PLWH population than that among HNC. This observation remained consistent regardless of a high CD4 count and a low HIV viral load suppressed by ART.Funding: This work was supported by the National Key Research and Development Program of China (2017YFE0103800), the National Nature Science Foundation of China (81903371), NIMH (R34MH119963), the National Science and Technology Major Project (2018ZX10101-001-001-003), and Special Found on Prevention and Control of New Coronary Pneumonia in Guangdong Universities (2020KZDZX1047), Medical Science and Technology Innovation Platform Support Project of Zhongnan Hospital, Wuhan University (PTXM2020008), Science and Technology Innovation Cultivation Fund of Zhongnan Hospital, Wuhan University (cxpy2017043). Medical Science Advancement Program (Basic Medical Sciences) of Wuhan University (TFJC2018004).Declaration of Interest: The authors declare no conflict of interest.Ethical Approval: The study was approved by the Research and Ethics Committee of Zhongnan Hospital, Wuhan University, P. R. China (2020079K-1). Informed consent was obtained from all individuals enrolled in this study.

People Living with HIV Easily lose their Immune Response to SARS-CoV-2: Result From A Cohort of COVID-19 Cases in Wuhan, China (preprint)

Background To date, whether the immune response for SARS-CoV-2 infection among people living with HIV(PLWH) is different from HIV-naïve individuals is still not clear.Methods In this cohort study, COVID-19 patients admitted to hospital in Wuhan between January 15 and April 1, 2020, were enrolled. Patients were categorized into PLWH and HIV-naïve group. All patients were followed up regularly (every fifteen days) until November 30, 2020, and the immune response towards SARS-CoV-2 was observed.Results Totally, 18 PLWH and 185 HIV-naïve individuals with COVID-19 were enrolled. The positive conversion rates of IgG were 56% in PLWH and 88% in HIV-naïve patients respectively, and the peak was on the 45th day after COVID-19 onset. However, the positive rate of IgG dropped to 12% in PLWH and 33% among HIV-naïve individuals by the end of the study. The positive conversion rate of IgG among asymptomatic carriers is significantly lower than that among moderate patients (AOR = 0.18, 95% CI: 0.05–0.65) and PLWH had a lower IgG seroconversion rate compared to the HIV-naive group (AOR = 0.22, 95% CI: 0.05–0.90). Patients with lower lymphocyte counts at onset had a higher positive conversion rate (AOR = 0.29, 95% CI: 0.09–0.90) and longer duration for IgG (AHR = 4.01, 95% CI: 1.78–9.02).Conclusions The positive conversion rate of IgG for SARS-CoV-2 was relatively lower and quickly lost in PLWH, which meant PLWH was in a disadvantaged situation when affected with COVID-19.

Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: A Nationwide Online Survey (preprint)

Background: People living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. There is a dearth of evidence on willingness to receive COVID-19 vaccination (WTR) among PLWHA.Methods: The study is a multicenter cross-sectional online survey conducted in eight conveniently selected Chinese metropolitan cities between January and February 2021. Participants were PLWHA aged 18-65 years and living in the study cities. Eight community-based organizations (CBO) providing services to PLWHA, one in each city, facilitated the recruitment through their networks. Eligible PLWHA completed an online survey developed using Golden Data, a widely used encrypted web-based survey platform in China. Logistic regression models and path analysis were used in data analysis.Findings: Out of 10,845 PLWHA approached by the CBO, 2740 completed the survey. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported WTR (57·2%, 1470/2570). After adjusting for potential confounders, all four constructs of the Theory of Planned Behavior (TPB) were significantly associated with WTR, including positive attitudes (adjusted odds ratio, aOR: 1·11, 95%CI: 1·09, 1·12), negative attitudes (aOR: 0·96, 95%CI: 0·94, 0.97), perceived support from significant others (perceived subjective norm) (aOR: 1·53, 95%CI: 1·46, 1·61), and perceived higher behavioral control (aOR: 1·13, 95%CI: 1·11, 1·14). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR: 1·99, 95%CI: 1·65, 2·40), CBO staff (aOR: 1·89, 95%CI: 1·51, 2·36), friends and/or family members (aOR: 3·22, 95%CI: 1·93, 5·35), and PLWHA peers (aOR: 2.38, 95%CI: 1·85, 3·08) were associated with higher WTR. Overall opinion supporting COVID-19 vaccination for PLWHA on Internet or social media was also positively associated with WTR (aOR: 1·59, 95%CI: 1·31, 1·94). Path analysis indicated that interpersonal-level variables was indirectly associated with WTR through TPB-related perceptions (β=0·43, 95% CI=0·37, 0·51).Interpretation: PLWHA in China reported a relatively low WTR. Interpersonal communication and Internet/social media may be the major sources to convey information and promote COVID-19 vaccination in the population.Funding Statement: This work was supported by the Academic technology leader project of Changzhi Medical College (Grant No. XSQ201902), he Beijing Excellent Talent Plan (2018000021223ZK04) and the National Institute of Mental Health of the National Institutes of Health under Award Numbers R34MH119963.Declaration of Interests: The authors have no conflicts of interest to disclose.Ethics Approval Statement: The Institutional Review Boards of Changzhi Medical College (RT2021003) approved this study.

COVID-19 vaccine perceptions: An observational study on Reddit (preprint)

Objectives: As COVID-19 vaccinations accelerate in many countries, narratives skeptical of vaccination have also spread through social media. Open online forums like Reddit provide an opportunity to quantitatively examine COVID-19 vaccine perceptions over time. We examine COVID-19 misinformation on Reddit following vaccine scientific announcements. Methods: We collected all posts on Reddit from January 1 2020 - December 14 2020 (n=266,840) that contained both COVID-19 and vaccine-related keywords. We used topic modeling to understand changes in word prevalence within topics after the release of vaccine trial data. Social network analysis was also conducted to determine the relationship between Reddit communities (subreddits) that shared COVID-19 vaccine posts, and the movement of posts between subreddits. Results: There was an association between a Pfizer press release reporting 90% efficacy and increased discussion on vaccine misinformation. We observed an association between Johnson and Johnson temporarily halting its vaccine trials and reduced misinformation. We found that information skeptical of vaccination was first posted in a subreddit (r/Coronavirus) which favored accurate information and then reposted in subreddits associated with antivaccine beliefs and conspiracy theories (e.g. conspiracy, LockdownSkepticism). Conclusions: Our findings can inform the development of interventions where individuals determine the accuracy of vaccine information, and communications campaigns to improve COVID-19 vaccine perceptions. Such efforts can increase individual- and population-level awareness of accurate and scientifically sound information regarding vaccines and thereby improve attitudes about vaccines. Further research is needed to understand how social media can contribute to COVID-19 vaccination services.

People Living with HIV Easily Lose Their Immune Response to SARS-CoV-2: Result from a Cohort of COVID-19 Cases in Wuhan, China (preprint)

Background: To date, whether the immune response for SARS-CoV-2 infection among people living with HIV(PLWH) is different from HIV-naïve individuals is still not clear.Methods: In this cohort study, COVID-19 patients admitted to hospital in Wuhan between January 15 and April 1, 2020, were enrolled. Patients were categorized into PLWH and HIV-naïve group. All patients were followed up regularly (every fifteen days) until November 30, 2020, and the immune response towards SARS-CoV-2 was observed.Findings: Totally, 18 PLWH and 185 HIV-naïve individuals with COVID-19 were enrolled. The positive conversion rates of IgG were 56% in PLWH and 88% in HIV-naïve patients respectively, and the peak was on the 45th day after COVID-19 onset. However, the positive rate of IgG dropped to 12% in PLWH and 33% among HIV-naïve individuals by the end of the study. The positive conversion rate of IgG among asymptomatic carriers is significantly lower than that among moderate patients (AOR=0·18, 95% CI: 0·05-0·65) and PLWH had a lower IgG seroconversion rate compared to the HIV-naive group (AOR=0·22, 95% CI: 0·05-0·90). Patients with lower lymphocyte counts at onset had a higher positive conversion rate (AOR=0·29, 95% CI: 0·09-0·90) and longer duration for IgG (AHR=4·01, 95% CI: 1·78-9·02).Interpretation: The positive conversion rate of IgG for SARS-CoV-2 was relatively lower and quickly lost in PLWH, which meant PLWH was in a disadvantaged situation when affected with COVID-19.Funding Statement: This work was supported by the National Nature Science Foundation of China (81903371), NIMH (R34MH119963), the National Science and Technology Major Project (2018ZX10101-001-001-003), and Special Found on Prevention and Control of New Coronary Pneumonia in Guangdong Universities (2020KZDZX1047), Medical Science and Technology Innovation Platform Support Project of Zhongnan Hospital，Wuhan University (PTXM2020008), Science and Technology Innovation Cultivation Fund of Zhongnan Hospital, Wuhan University (cxpy2017043), and the Medical Science Advancement Program (Basic Medical Sciences) of Wuhan University (TFJC2018004).Declaration of Interests: The authors declare no conflict of interest.Ethics Approval Statement: This study was approved by the Ethics Committee of Zhongnan Hospital affiliated with Wuhan University (2020062).

The impact of COVID-19 pandemic on HIV care continuum in Jiangsu, China (preprint)

Background The COVID-19 pandemic seriously threatens general public health services globally. This study aimed to evaluate the impact of the COVID-19 pandemic on HIV care continuum in Jiangsu province, China.Methods Data for analysis was retrieved from the web-based Comprehensive Response Information Management System (CRIMS) for HIV/AIDS in China. We used time series model of seasonal autoregressive integrated moving average (SARIMA) and Exponential smoothing to predict the amount of HIV care services during the COVID-19 measures, and Chi-square were performed to assess subgroup differences.Results Overall, the testing rated decreased 49.0% (919,938) decrease in the first three months during the COVID-19 measures, as compared with the estimated number. Although an estimated of 1555 confirmatory tests were expected in the first three months during the COVID-19 measures, only 48.7% (757) confirmed HIV/AIDS cases were actually recorded. In the actual data during the first period of COVID-19, 980 clients received confirmatory tests, only 71.4% (700) were reportedly linked to care. Only 49.5% (235) out of the expected 475 estimated number of clients received CD4 cell count test services. Meanwhile 91.23% (208) had initiated antiretroviral therapy (ART) which compared to 227 the estimated number of initiated ART. Compared with the same period during 2016 to 2019, PLWHIV who were less than 30, migrants were more likely to be influenced by the COVID-19 policies.Conclusions The COVID-19 pandemic had a negative impact on the HIV healthcare systems in Jiangsu, China. Further measures that can encounter the impact of the pandemic are needed, in order to maintain HIV care continuum.

Populational Level Driving Force of COVID-19 Epidemic and Fatality: A Global Analysis (preprint)

BackgroundThe COVID-19 has become a pandemic worldwide. 216 countries and regions reported their occurrence of COVID-19 cases by 19th Sep 2020. Meanwhile, the COVID-19 had infected more than 30 million people and caused almost one million deaths until 19th Sep 2020.MethodWe scoped data related to reported epidemic durations, incidences, fatalities, and epidemic risk factors of the studied countries. Disease Development Speed (DDS), Population-Level Incidence (PLI), and Case-Fatality Rate (CFR) were calculated to assess the COVID-19 pandemic globally. The Spearman rank correlation was applied to further explore the relationship among DDS, PLI, CFR, and their influencing factors.Result216 countries and regions had reported their COVID-19 cases by 19th Sep 2020. Globally, the medians of epidemic duration, DDS, PLI, and CFR were 167 days (IQR: 158-175 days; Range: 110-221 days),4.6 (IQR: 3.1-6.0; Range: 1.8-10.1), 17.0 (IQR: 5.3-56.0; Range: 0.36-1758.3), and 2.2% (IQR: 1.3%-3.5%) respectively. DDS, PLI, and CFR were found enjoying positive correlations with the urban population proportion, UHC (Universal Health Coverage) service coverage, the population with basic handwashing facilities at home, the number of reported deaths, and the number of doctors and nurses.ConclusionNationwide development of the COVID-19, its incidence and fatality suggested regional similarity in the world. National population structure, human resources of medical staff, structure of national health expenditure, and the sanitation facility were revealed as vital risk factors for the COVID-19 in epidemiology.

Estimating the impact of disruptions due to COVID-19 on HIV transmission and control among men who have sex with men in China (preprint)

Introduction The COVID-19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV-related mortality. We estimated how COVID-19-related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China. Methods Regional data from China indicated that the number of MSM undergoing facility-based HIV testing reduced by 59% during the COVID-19 pandemic, alongside reductions in ART initiation (34%), numbers of sexual partners (62%) and consistency of condom use (25%). A deterministic mathematical model of HIV transmission and treatment among MSM in China was used to estimate the impact of these disruptions on the number of new HIV infections and HIV-related deaths. Disruption scenarios were assessed for their individual and combined impact over 1 and 5 years for a 3-, 4- or 6-month disruption period. Results Our China model predicted that new HIV infections and HIV-related deaths would be increased most by disruptions to viral suppression, with 25% reductions for a 3-month period increasing HIV infections by 5-14% over 1 year and deaths by 7-12%. Observed reductions in condom use increased HIV infections by 5-14% but had minimal impact (<1%) on deaths. Smaller impacts on infections and deaths (<3%) were seen for disruptions to facility testing and ART initiation, but reduced partner numbers resulted in 11-23% fewer infections and 0.4-1.0% fewer deaths. Longer disruption periods of 4 and 6 months amplified the impact of combined disruption scenarios. When all realistic disruptions were modelled simultaneously, an overall decrease in new HIV infections was always predicted over one year (3-17%), but not over 5 years (1% increase - 4% decrease), while deaths mostly increased over one year (1-2%) and 5 years (1.2 increase - 0.3 decrease). Conclusions The overall impact of COVID-19 on new HIV infections and HIV-related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID-19 related disruption on HIV transmission and control among MSM in China.

Epidemiologic, Clinical, and Laboratory Findings of the COVID-19 in the current pandemic: Systematic Review and Meta-analysis (preprint)

Background: The COVID-19 pandemic has affected the world deeply, with more than 3,000,000 people infected and nearly 200,000 deaths. This review aimed to summarize the epidemiologic traits, clinical spectrum, CT results and laboratory findings of the COVID-19 pandemic. Methods: We scoped for relevant literatures published during 1 st Dec 2019 to 23 rd Apr 2020 based on four databases using English and Chinese languages. We reviewed and analyzed the relevant clinic outcomes of COVID-19. Results: The COVID-19 pandemic was found to have a higher transmission rate compared to SARS and MERS and involved 4 stages of evolution. The basic reproduction number (R 0 ) is 3.32 (95% CI:3.24-3.39), the incubation period was 5.24 days (95% CI:3.97-6.50, 5 studies) on average, and the average time for symptoms onset varied by countries. Common clinical spectrums identified included fever (38.1-39.0℃), cough and fatigue, with Acute Respiratory Distress Syndrome (ARDS) being the most common complication reported. Body temperatures above 39.0 ℃, dyspnea, and anorexia were more common symptoms in severe patients. Aged over 60 years old, having co-morbidities, and developing complications were the commonest high-risk factors associated with severe conditions. Leucopenia and lymphopenia were the most common signs of infection while liver and kidney damage were rare but may cause bad outcomes for patients. The bilateral, multifocal Ground-Glass Opacification (GGO) on peripheral, and the consolidative pulmonary opacity were the most frequent CT results and the tendency of mortality rates differed by region. Conclusions: We provided a bird’s-eye view of the COVID-19 during the current pandemic, which will help better understanding the key traits of the disease. The findings could be used for disease’s future research, control and prevention.

The Diagnostic Trap Occurred in Two COVID-19 Cases Combined Pneumocystis Pneumonia in Patient with AIDS (preprint)

Background : The limited knowledge on the diagnosis of Coronavirus disease 2019 (COVID-19) at the early stage of the pandemic may lead to misdiagnoses, especially when the nucleic acid inspection cannot meet the mass requirement. This condition is even actual for people who are living with HIV/AIDS (PLWHA), for the latter is vulnerable to variable infections. Case Presentation : In this short communication, we introduced two HIV infected individuals who had PCP but was misdiagnosed as COVID-19 initially, and finally infected with SARS-CoV-2 in hospital in Wuhan, China. Eventually, both patients improved soon after they were switched to the treatment of SMZ/TMP.Conclusions : We suggested that the hospitalized COVID-19 cases should be screened with HIV and other pathogens, to prevent that PLWHA who have PCP from being misdiagnosed as COVID-19.