Improved survival with co-trimoxazole prophylaxis among people living with HIV/AIDS who initiated antiretroviral treatment in Henan Province, China.

OBJECTIVES: This study aims to evaluate the effect of co-trimoxazole (CTX) prophylaxis on mortality reduction among HIV-infected patients receiving antiretroviral therapy (ART) in Henan Province, China. DESIGN: We conducted a retrospective study. METHODS: All individuals aged 15 years and older who initiated ART between 2008 and 2010 in Henan Province with completed CTX prophylaxis treatment information were included. The effect of CTX prophylaxis was estimated using Kaplan-Meier survival analysis and multivariate Cox proportional hazard modeling for mortality at 3-months and 12-months after ART initiation. RESULTS: Overall mortality among patients receiving both ART and CTX was nearly double at 3-months after ART initiation compared with that at 12-months (12.4 per 100 PY vs 6.3 per 100 PY, p < 0.01). After adjusting for gender, age, TB history, year of ART initiation and CD4 count at ART initiation, CTX was associated with a significant reduction in 12-month mortality (adjusted hazard ratio (AHR) = 0.65, 95% confidence interval (CI): 0.44-0.95; p = 0.027) compared with persons not receiving CTX. The protective effect was more pronounced in the first 3 months after ART initiation (AHR = 0.53, 95% CI: 0.32-0.89; p = 0.017). CONCLUSION: CTX prophylaxis together with ART reduced mortality of adult HIV patients during the first 12 months of ART in Henan Province, China. The effect was highest in the first 3 months of ART. CTX should be prescribed to all HIV-infected adults who initiate ART.

[Factor analysis on trend of infant mortality and maternal health management in Henan province from 2000 to 2010].

OBJECTIVE: To understand the trends and influential factors on infant mortality in Henan province from 2000 to 2010. METHODS: Descriptive method, Cox-Stuart trend test and multiple linear regression were used to study the infant mortality trends and related influential factors in the regions with monitoring programs of Henan province, from 2000 to 2010. RESULTS: The total urban and rural infant mortality rates dropped significantly, from 30.91 per thousand, 10.05 per thousand, 33.99 per thousand in 2000 to 7.12 per thousand, 5.51 per thousand, 8.03 per thousand in 2010, respectively. The average annual rates of decrease were 13.65 percent, 5.83 percent and 13.44 percent. The downward trends were statistically significant (P < 0.05). The infant mortality rates dropped more significantly in rural areas (25.96%) than in the urban areas (4.54%). Difference between urban and rural areas reduced from 23.49% to 2.52%. Rates on factors as setting up maternal record cards, carrying on postpartum visits, hospital delivery, or under help by new midwives and low birth weight rate etc. were remarkably influencing the rate on infant mortality (F = 229.738, P = 0.004). In order, the impact of strengths on those factors showed as: hospitalized delivery rate, low birth weight rate, the rate of 'clean' delivery, setting up record cards on postpartum visits. CONCLUSION: Total provincial, urban and rural infant mortality rates all showed downward trends. The infant mortality rates dropped more significantly in rural areas than in urban areas. Difference between urban and rural areas was gradually getting small. Rates on setting up maternal record cards, carrying on postpartum visit, hospital delivery and under help by new midwives rate were important factors that significantly impacting the infant mortality rate. Work on setting up record cards and hospital delivery should be further strengthened.

[Study on the natural history of HIV among former commercial plasma donors caused by contaminated plasma donation in central China].

OBJECTIVE: To investigate the natural history of HIV infection caused by contaminated plasma donation among former commercial plasma donors in China. METHODS: Ambispective cohort study among HIV/AIDS cases and suspected AIDS deaths was conducted from January 1, 1995 to March 31, 2008 in 7 administrative villages in Shangcai county of Henan province. Information regarding diagnostic criteria, deaths and anti-retrovirus treatment was collected. Incubation and survival time were calculated using Kaplan-Meier and life-tables method. Sensitive analysis on the time of outcome was conducted. RESULTS: A total number of 2569 cases of HIV infection including 483 suspected AIDS deaths were involved in a cohort. 200 patients with rapid progress (7.8%) and 337 long-term but non-progressive patients (13.1%) were identified. Results from the sensitive analysis showed that the median incubation period from HIV infection to AIDS was between 8.5 and 8.9 years, with incidence as 11.7 - 12.0 cases/100 person-years and the median survival time for HIV progression to death was from 8.8 to 10.7 years, with the death rate as 6.9 - 8.3 cases/100 person-years. The median survival time for AIDS patient was from 1.2 to 2.0 years, with death rate as 34.9 - 51.5 cases/100 person-years. CONCLUSION: According to sensitive analysis, the incubation period for HIV progression to AIDS, the median survival time for HIV progression to death and the median survival time for AIDS patient to death were 8.8 years, 1.2 years and 9.8 years, respectively.

Mortality survey on HIV/AIDS-related deaths in HIV epidemic regions caused by contaminated plasma donation in central China.

The objective of our study was to understand the trend of AIDS deaths and the impact of AIDS-related deaths on the local mortality rate in seven villages in Shangcai County, Henan Province. A retrospective study survey among all deaths was conducted through household visits from 1 January 1995 to 31 October 2007 in seven administrative villages in Shangcai County of Henan Province. The cause of death and characteristics of the deceased were analyzed. There were a total of 2546 deaths, of which 521 (20.5%) were HIV/AIDS-related, 525 (20.6%) were suspected AIDS deaths, and 1500 (58.9%) were unrelated HIV/AIDS deaths. The proportion of deaths among people aged 20-49 years was less than 20% from 1995 to 1997, but increased to 27.4% in 1998, and reached 49.2% in 2001, followed by a decrease in succeeding years, dropping to 29.5% in 2007. HIV/AIDS-related and suspected deaths among those aged 20-49 years accounted for 63.9% and 70.9% of all deaths, respectively. The overall mortality rate was 7 per thousand from 1995 to 1999, and 14.9 per thousand in 2002. Our study shows that confirmed HIV/AIDS-related deaths and suspected AIDS deaths were the main cause of deaths at the local level after 1998, especially among those aged 20-49.

[Studies on HIV-1 strains in Henan province].

OBJECTIVE: To study the epidemic status of human immunodeficiency virus type 1 (HIV-1) subtypes and sequence variation in Henan thus to explore the characteristics and sources of transmission. METHODS: HIV-1 env and gag gene were amplified by nested PCR from uncultured peripheral blood mononuclear cells (PBMCs) obtained from 1287 HIV-1 carriers confirmed in Henan from 2006 to 2007. 1287 env and gag genes were obtained from the patients. RESULTS: Among 1287 samples, there were 4 HIV-1 strains including subtype B', C and recombinant subtype BC and AE, accounting for 95.882% (1234/ 1287), 0.466% (6/1287), 2.875% (37/1287), 0.777% (10/1287) respectively. In comparison with the sequence of the international strains of RL42, C.95in21068, 07-BC.CN.97.C54A, 01AE.TH.90.CM240, the genetic divergence was 9.327% +/- 0.245%, 5.214% +/- 0.183%, 6.278% +/- 0.194% and 5.332% +/- 0.158%, respectively. CONCLUSION: There were 4 HIV-1 strains including subtype B', C and recombinant subtype BC and AE in Henan with main dominant subtype as subtype B' which was closely related to HIV-1 strains of Thailand B'. The major transmit route in subtype B' was through blood donation in the past years while with BC, it was through sexual transmission. The major transmit routes in subtype AE were sexual transmission and blood donation. The major route of transmission in subtype C was through sexual contact.

[Study on AIDS incidence and death in previous paid blood-donated population, central China].

OBJECTIVE: To study incidence and death among previous paid blood-donated AIDS sufferers. METHODS: A retrospective cohort study was adopted to study incidence and death of 373 previous paid blood-donated HIV sufferers and its effect factors. RESULTS: Previous paid blood-donated HIV infection was serious and the infection rate in blood-donated crowd was 35.87% (373/1040); the mean incubation period of AIDS was 8.87 years (95% CI: 8.76 - 8.99, Kaplan-Meier method); the cumulative incidence of AIDS (10 years) was 92.23% (344/373), and the incidence of total sufferers was 11.64/100 person-year; the cumulative probability of survival of one-year, three-year, five-year AIDS sufferers was separately 94.48% (325/344), 85.76% (295/344) and 83.14% (286/344), median survival time was over 5 years; the anti-virotic treatment days (960.29 +/- 486.38), infection age (33.39 +/- 9.08) disease age (41.98 +/- 8.88) had significant effects on AIDS sufferers' survival time/survival rate (chi(2) = 61.355, P = 0.000; chi(2) = 6.555, P = 0.010; chi(2) = 3.969, P = 0.046). CONCLUSION: The survival time of previous paid blood-donated HIV cases was longer, and their survival rate was higher, remarkably higher than the UNAIDS' research findings.