[Research advances in HIV pre-exposure prophylaxis drug].

In 2012, the World Health Organization (WHO) released tenofovir/emtricitabine (TDF/FTC) as pre-exposure prophylaxis drug to help people at risk of HIV infection in specific populations, and various clinical trials and real-world data have confirmed the effectiveness of TDF/FTC in preventing HIV infection. In 2019, propofol tenofovir combined with emtricitabine (TAF/FTC) was approved in the United States as the second oral drug for pre-exposure prophylaxis(PrEP). However, for people who cannot take the drug or have poor adherence to the drug, second-generation PrEP, or long-acting antiretrovirals, provide more options. This artical reviewed the research progress of the first generation of oral PrEP and the new PrEP developed in recent years to provide reference for the promotion of HIV PrEP in China.

[Progress in research of knowledge, attitude and practice of pre-exposure prophylaxis in men who have sex with men and its influencing factors].

Men who have sex with men (MSM) is a group of people at high risk for HIV infection in China, Pre-exposure prophylaxis (PrEP) is a bioprophylaxis strategy in the prevention of HIV infection in MSM, which can reduce the risk for HIV infection in this population effectively. However, in the paractice, the use level of PrEP in MSM is low in China, and there are MSM who know PrEP but receive no PrEP. This paper summarizes the current status of the awareness, willingness to use, actual use of PrEP in MSM and influencing factors both at home and abroad to provide a reference for the promotion of PrEP use in MSM in China.

Investigation on knowledge level about rational use of antimicrobial drugs among pharmacists in medical institutions in Shanxi province, China.

OBJECTIVE: To investigate the pharmacist's knowledge about rational use of antimicrobials in Shanxi of China, so as to find out the problems and provide support for the management of antimicrobials. METHODS: A questionnaire survey was conducted, which included the basic information of the respondents, the basic knowledge about antimicrobial management and the related knowledge about antimicrobial drugs. SPSS 25.0 was used for statistical analysis. RESULTS: A total of 462 pharmacists were investigated. The average score of the knowledge related to rational use of antimicrobials was 10.49 ± 4.05. It showed that the hospital type, grade, pharmacist's education, professional title and years of experience had effect on the pharmacist's knowledge level about antimicrobial drugs (P < 0.05). Multivariable logistic regression analysis showed that hospital grade and pharmacist's education were the main influencing factors (P < 0.05). CONCLUSION: Pharmacists have insufficient knowledge about the rational use of antibacterial drugs. It is essential to strengthen the training in management regulations and application of antibacterial drugs.

[Survival analysis since diagnosis of HIV-positive injecting drug users aged 15 years and above in China].

Objective: To understand death's mortality and risk factors among HIV-positive injecting drug users (IDU) aged 15 or above in China and provide further reference to future prevention and treatment policies. Method: Retrospective cohort study was conducted to calculate the mortality rate of HIV-positive IDU based on HIV/AIDS Comprehensive Response Information Management System. Cox proportion hazards regression model was performed to assess the risk factors for deaths. The Excel 2019 and SPSS 22.0 software was used for data cleaning and statistical analysis. Results: Between 2001 and 2020, 119 209 HIV-positive IDU were reported with 59 094 deaths. The all-cause mortality rate was 6.96 per 100 person-years (py), and the AIDS-related mortality rate was 1.91 per 100 py, with a decreasing trend over the years. Multivariate Cox regression indicated for all-cause death risks of HIV-positive IDU, compared with those baseline T+ lymphocyte cells (CD4) counts above 500 cells/µl, the HR (95%CI) of those CD4 counts untested, between 0-199, 200-349, 350-500 cells/µl was 2.85 (2.78-2.93), 2.47 (2.40-2.54), 1.58 (1.53-1.62) and 1.24 (1.21-1.28) respectively. The HR (95%CI) of antiretroviral treatment (ART) naïve was 7.13 (6.99-7.27) compared with those under ART. The HR (95%CI) of methadone maintenance treatment (MMT) naïve was 1.07 (1.04-1.10) compared to those receiving MMT. As for AIDS-related death risks, compared with baseline T+ lymphocyte cell CD4 counts >500 cells/µl, the HR (95%CI) of those CD4 counts untested, between 0-199, 200-349, 350-500 cells/µl was 3.26 (3.08-3.46), 5.54 (5.24-5.85), 2.35 (2.21-2.50) and 1.41 (1.32-1.50). HR (95%CI) of ART naïve was 5.96(5.74-6.18) compared to those under ART. Conclusions: Further efforts should be made timely on diagnosis, treatment, and harm reduction programs such as MMT for improvement compliance to reduce mortality risks of HIV-positive IDU.

[Epidemiological characteristics of newly reported HIV-infected adolescents aged 15-17 years outside school in China, 2011-2019].

Objective: To understand the epidemiological characteristics of HIV-infected adolescents outside school in China and provide reference to targeted prevention and control of HIV infection in this population. Methods: All the HIV-infected adolescents aged 15-17 years outside school reported during 2011-2019 were included this study. The information about their demographics, transmission routes and migration were collected from HIV/AIDS Comprehensive Response Information Management System. The χ2 test was done for comparison among groups. The Joinpoint 4.9.0 software was applied to the annual percent change (APC) for time trends analysis using the Joinpoint regression model. The Excel 2019 and SPSS 22.0 software were used for data cleaning and statistical analysis. Results: A total of 4 919 HIV-infected adolescents aged 15-17 years outside school were reported accumulatively in China between 2011 and 2019, accounting for 63.4% (4 919/7 757) of total reported HIV-infected cases in this age group. Analysis on trend revealed that the new HIV infection diagnosis rate has become stable since 2016 (APC=2.5%, P=0.173) after the increase between 2011 and 2015 (APC=36.4%, P<0.001). The migration across provinces was discovered in 13.9% (684/4 919) of the HIV-infected adolescents outside school. Males, workers, and those diagnosed in detention centers or transmitted by injecting drugs or homosexual contacts accounted for a larger proportion in migrated cases compared with non-migrated cases. The adolescents outside school mainly got HIV infected by sexual contacts route, in which 66.5% (280/421) of the males were infected by homosexual contacts, while 97.8% (182/186) of the females were infected by heterosexual contacts in 2019. Conclusions: HIV-infected adolescents aged 15-17 years outside school were mainly infected by sexual contacts. However, adolescents outside school have low awareness of sexual health and high mobility, to whom close attention should be paid to improve their awareness of sexual health and to provide them with appropriate HIV infection prevention and treatment service.

[Spatial-temporal distribution of newly detected HIV/AIDS cases among aged 15 years or older women in China, 2010-2016].

Objective: To identify the spatial clustering and its temporal trends among newly detected female HIV/AIDS cases aged 15 years or older, in China from 2010 to 2016. Methods: Newly detected HIV/AIDS cases among aged 15 years or older women in China during 2010-2016 were collected, to describe their demographic characteristics, changing trends and spatial autocorrelation. This program was conducted at county level, using the ArcGIS 10.3. Results: The number of newly detected HIV/AIDS cases among aged 15 years or older women was increasing annually from 16 603 to 26 196 in 2010 and in 2016. As the main route proportion of heterosexual transmission increased from 84.25% (13 988/16 603) in 2010 to 96.29%(25 224/26 196) in 2016. Both the number and proportion of HIV/AIDS cases among elderly women ≥50 years of age increased significantly from 17.82%(2 959/16 603) to 38.10%(9 981/26 196) in 2016. Results from spatial analysis demonstrated a county-level clustered distribution of HIV/AIDS cases across the country with a rising global Moran's I value=0.55 over the years (Z=51.46, P<0.001), which was concentrating on western and southern China, covering 9 provinces/autonomous regions/municipalities (Yunnan, Guangxi, Sichuan, Xinjiang, Guizhou, Guangdong, Chongqing, Henan and Hunan). The temporal trends of hot spots differed by age groups, with the trend of epidemic shifting towards western border and southern coastal regions among women aged 15-49 years old, while the elderly women aged ≥50 years old were spreading northward from the southwestern regions. Conclusion: Our findings indicated that an increasing trend of clusters appeared on HIV epidemic among newly detected female HIV/AIDS cases aged 15 years or older in China, particularly in the western and southern regions. Prevention and intervention strategies should target on women according to their age distribution, particularly in regions with increasing trend of HIV epidemics.

[Analysis of Spatial Clustering of HIV infected in men who have sex with men in Chongqing of 2004-2015].

Objective: To analyze the spatial clustering characteristics of HIV/AIDS among men who have sex with men (MSM) in Chongqing from January 2004 to December 2015 and understand the HIV/AIDS related behaviors among MSM by interview. Methods: Data related to MSM who were infected with HIV and whose present address were in Chongqing, were collected from Information System on the HIV/AIDS Prevention and Control. Information included the age when the information was inputted, address, occupation, education level, and marital status. The total number of MSM who were infected with HIV and reported was 6 604 in Chongqing. Those with unknown address were ruled out. The spatial autocorrelation analysis and the local spatial autocorrelation analysis were carried out by using ArcGIS 10.3. In addition, in November 2015 and May 2016, using a convenience sampling, we conducted one-on-one interviews among 23 MSM in the Chongqing Center for Disease Control and prevention. INCLUSION CRITERIA: Receiving voluntary counseling and testing in the urban area of Chongqing and willing to participate in the interview by oral informed consent; male and self-described as MSM. The content of the interview included basic information, sexual orientation, sexual role, the main place of making friends, the main place of sexual behavior, a long-term experience in other provinces and drug abuse. Results: The HIV/AIDS reported number in Chongqing from 2004 to 2015 showed an uptrend, except in 2010. The age distribution of 6 604 cases of HIV positive patients was mainly concentrated in the 15-34 years old, about 68.5% (4 522 cases). There was a positive spatial autocorrelation in MSM, except 2005 (Moran's I=-0.046, P=0.823), form 2004 to 2015, Global Moran's I values were 0.308, 0.254, 0.335, 0.683, 0.673, 0.558, 0.620, 0.673, 0.685, 0.654 and 0.649, respectively; all P values were <0.01. The result of local spatial autocorrelation analysis showed that high-high accumulation area development in Chongqing city was divided into two stages in 2004-2015, which were Yuzhong, Jiangbei, and Shapingba district in 2004-2007 and the expanded Jiulongpo, Nan'an, and Yubei district in 2008-2015. Qualitative interviews results revealed that the age of the respondents was 20-44, and the mainly way of making friends were using mobile phone App and internet (17 participants). Most of the participants (11 participants) were making friends in the bar. The majority of respondents would ask the friends or themselves to use condoms when meeting with them the first time (19 participants), and 8 of respondents reported that they would not use condoms when their old friends refused to use condoms. Conclusion: The HIV infected MSM mainly aged between 15-34 years old and the spatial distribution of HIV/AIDS among MSM was clustered in economically developed main area in Chongqing. MSM began to make friends on the Internet, and could not adhere to using condom, which indicated that we should focus on internet intervention to find more efficacious interventions.

[The characteristics of HIV-positive men who have sex with men in China and predictors of their migration, 2008-2015].

Objective: To characterize the migration patterns of men who have sex with men (MSM) living with HIV/AIDS in the period 2008-2015 and to characterize the determinants of their migration. Methods: All identified HIV/AIDS cases transmitted through self-reported homosexual contact reported to the National Case Reporting System(CRS) by the end of December 31, 2015 were included in this study. Data of basic demographic characteristics, household registration and address of the research objects were collected. Retrospective cohort study was used to analyze the migration characteristics of HIV/AIDS cases between 2008 and 2015.We used the χ2 test to analyze their migration patterns and epidemiological characteristics, and multilevel logistic regression to investigate the determinants of migration. Results: While mobile cases comprised 46.1% of the sample (n=54 714), we detected a significant rising trend (χ2=130.93, P<0.001) as this proportion rose from 42.0% (1 335/3 182) in 2008 to 47.9% (15 623/32 610) in 2015. Of the 13 580 mobile cases with Hukou registration in Eastern China, 89.8% (12 201) migrated to other parts of Eastern China. Meanwhile, 52.0% of the 26 088 cases registered in Central China (n=13 570) and 30.5% of the 14 106 registered in Western China (n=4 298) migrated to Eastern China. Furthermore, 96.2% of mobile cases (n=52 627) resided in the urban areas, of which 40.8% (n=21 452) migrated from rural areas to urban areas and 58.4% (n=30 722) migrated between urban areas. The annual proportion of cases who changed their address within 1 year of diagnosis ranged from 12.0%-18.5%. The results of the multilevel model showed that cases who were aged 25-49 years (OR=1.30, 95% CI: 1.26-1.34), single (OR=1.95, 95% CI: 1.87-2.02), and had a high school education or above (OR=1.68, 95% CI: 1.64-1.73) were more likely to migrate. AIDS (OR=0.71, 95% CI: 0.69-0.74), Hukou registration in an urban area (OR=0.63, 95%CI: 0.61-0.65), in Central China (OR=0.84, 95%CI: 0.73-0.97), Western China (OR=0.75, 95%CI: 0.64-0.87), and in regions with a high population density or above-average gross domestic product (GDP) per head (OR=0.77, 95% CI: 0.69-0.87 and OR=0.70, 95% CI: 0.62-0.79, respectively) were negatively associated with migration. Conclusion: The number and proportion of mobile HIV cases showed a rising annual trend. Age, marital status, level of education and disease severity, in addition to the population density and level of economic development of cases' place of origin, were significant determinants of migration.

[Characteristics of HIV infections among over 50-year-olds population in China].

OBJECTIVE: To analyze the characteristics on demographical, spatial distribution and transmission mode of HIV infections among 50-year-old population. METHODS: Related information on demography, spatial distribution, high risk behavioral and history of HIV infections among 50-year-old population were collected and analyzed. Possible time of infection based on their first CD4 testing results right after the HIV diagnoses, was estimated. RESULTS: Since 2008, the number of new HIV/AIDS cases among the over-50-year-olds was reported increasing annually. The number of aged 50 and above in 2014 was 4.2 times than the number in 2008. 50-year-old or older population were infected mainly through heterosexual behavior (88.0%). Among these cases, 83.9% self-reported as having histories on extramarital sex intercourse and the number was increasing yearly. Among male cases who admitted as having heterosexual experience, 95.1% of them reported as having histories of extramarital sex intercourse while 53.4% of the female cases reported as having the same experiences. 46.6% of spouses of the females or with fixed partners were HIV positive. Through estimating the time of infection and the time interval between infection and diagnosis, we found that the proportion was 15.5%, from infection to diagnosis as 3 years among the 50 and older age groups, but the proportion of 8 years from infection to diagnosis was 43.6%. We estimated that 66.5% of the new HIV cases who were at age 50 and over, were infected when they were at that age span. The average time from infection and being tested was (6.8 ± 2.7) years. CONCLUSION: The increasing number of being diagnosed on HIV among the 50-year-olds population might be related to both high risk exposure and belated diagnoses among this population, calling for the necessity of deriving the sources of HIV infection and tailoring the HIV prevention strategies in this population.

Structural characterization of the exopolysaccharide produced by Streptococcus thermophilus 05-34 and its in situ application in yogurt.

An exopolysaccharide (EPS) producing strain was isolated from Tibetan kefir grains in China, which was identified by 16S rDNA tests and designated as Streptococcus thermophilus 05-34. The high-performance liquid chromatography analysis showed that it was composed of galactose and glucose in a molar ratio of 1.0:0.8 with a molecular mass of 2.5 × 10(4) Da. EPS was further revealed to have α-d-glucose, α-d-galactose, ß-d-glucose, and ß-d-galactose by Fourier transform infrared spectroscopy combined with 1D (1) H nuclear magnetic resonance spectroscopy. The length of EPS ranged from 10 to 100 nm and the maximal height of lumps was 2.5 nm through atomic force micrograph analysis. Furthermore, yogurt fermented with EPS-producing S. thermophilus 05-34 exhibited lower susceptibility to whey separation, higher viscosity, and sensory scores than those made with non-EPS-producing strain in yogurt production. These results suggested that EPS-producing Streptococcus thermophilus 05-34 provided a potential application in the fermented dairy industry.