Current syphilis infection in virally suppressed people living with HIV: a cross-sectional study in eastern China.

Background: Antiretroviral therapy (ART) has been shown to reduce human immunodeficiency virus (HIV) viral replication and ultimately achieve viral suppression and eliminate HIV transmission. However, little is known about the impact of viral suppression on high-risk behaviors and sexually transmitted infections (STIs). Objective: This study aimed to assess the rates of current syphilis infection in virally suppressed people living with HIV (PLWH) and whether with the duration of ART can reduce the current syphilis infection in eastern China. Method: We conducted a cross-sectional survey of PLWH in Zhejiang Province, China, in 2022. PLWH who were on ART >6 months and were virally suppressed (viral load <50 copies/mL) were included in the study. Data were collected from the National Epidemiological Database of Zhejiang Province and all participants were tested for viral load and current syphilis. Multivariable logistic regression was used to identify risk factors associated with current syphilis infection. Result: A total of 30,744 participants were included in the analysis. 82.7% of participants were male, the mean age was 44.9 ± 14.1 years, 84.9% had received ART in a hospital setting, the mean time on ART was 5.9 ± 3.1 years and 5.6% of participants were infected with current syphilis. Multivariable logistic regression showed that being male [adjusted odds ratio (aOR): 2.12, 95% confidence interval (CI): 1.69-2.66], high level of education (aOR: 1.23, 95% CI: 1.02-1.49), homosexual route of HIV infection (aOR: 1.80, 95% CI: 1.60-2.04), non-local registered residence (aOR: 1.29, 95% CI: 1.11-1.51), had history of STIs before HIV diagnosis (aOR: 1.95, 95 % CI: 1.75-2.18) and treatment provided by a municipal hospital (aOR: 2.16, 95% CI: 1.31-3.55) were associated with increased risk of current syphilis infection. Being married (aOR: 0.67, 95% CI: 0.58-0.76) was associated with a decreased risk of current syphilis infection. Conclusion: Our findings revealed a high rate of current syphilis infection among virally suppressed PLWH in eastern China. Duration of ART did not reduce the prevalence of current syphilis infection. Targeted interventions to reduce current syphilis infection should be prioritized for subgroups at higher risk.

Spatiotemporal Pattern and Its Determinants for Newly Reported HIV/AIDS Among Older Adults in Eastern China From 2004 to 2021: Retrospective Analysis Study.

BACKGROUND: In recent years, the number and proportion of newly reported HIV/AIDS cases among older adults have increased dramatically. However, research on the pattern of temporal and spatial changes in newly reported HIV/AIDS among older adults remains limited. OBJECTIVE: This study analyzed the spatial and temporal distribution of HIV/AIDS cases and its influencing factors among older adults in Eastern China from 2004 to 2021, with the goal of improving HIV/AIDS prevention and intervention. METHODS: We extracted data on newly reported HIV/AIDS cases between 2004 and 2021 from a case-reporting system and used a Joinpoint regression model and an age-period-cohort model to analyze the temporal trends in HIV/AIDS prevalence. Spatial autocorrelation and geographically weighted regression models were used for spatial aggregation and influence factor analysis. RESULTS: A total of 12,376 participants with HIV/AIDS were included in the study. The newly reported HIV infections among older adults increased from 0.13 cases per 100,000 people in 2004 to 7.00 cases per 100,000 people in 2021. The average annual percent change in newly reported HIV infections was 28.0% (95% CI -21.6% to 34.8%). The results of the age-period-cohort model showed that age, period, and cohort factors affected the newly reported HIV infections among older adults. The newly reported HIV/AIDS cases among men who have sex with men (MSM) had spatial clustering, and the hotspots were mainly concentrated in Hangzhou. The disposable income of urban residents, illiteracy rate among people aged 15 years or older, and number of hospital beds per 1000 residents showed a positive association with the newly reported HIV infections among older MSM in the Zhejiang province. CONCLUSIONS: HIV/AIDS among older adults showed an increasing trend and was influenced by age, period, and cohort effects. Older MSM with HIV/AIDS showed regional clustering and was associated with factors such as the disposable income of urban residents, the illiteracy rate among people aged 15 years or older, and the number of hospital beds per 1000 people. Targeted prevention and control measures are needed to reduce HIV infection among those at higher risk.

Successful virologic outcomes over time among HAART-treated HIV-infected patients.

Few large studies evaluated the effects of time trends on virologic suppression in people living with HIV/AIDS (PLWHA) in China. To address this, An retrospective observational longitudinal study was conducted. We examined annual trends in the rate of virologic suppression, the viral load at the time of virologic suppression, and other determinants of virologic suppression in Zhejiang Province, China in PLWHA between January 2013 and July 2018. Patients who received a treatment regimen for at least 24 weeks were included. Virologic suppression was defined as VL ≤50 copies/mL. Generalized estimating equation logistic regression models were used to adjust for covariates. We included 16,265 patients with 45023 tests. The proportion of patients who experienced an unsuccessful virologic outcome decreased continuously throughout the observation period (18.14% to 6.64%). Time was significantly negatively associated with detectable VL (all ORs <1). Other factors were positively associated with detectable VL, including patients <30 years of age, single, non-adherent to treatment, and with a follow-up CD4 count <200 cells/µL. Patients infected through homosexual transmission and those with a longer ART duration were more likely to reach virologic suppression. We demonstrated outstanding time trend improvements in the virological outcomes of PLWHA in China.

Development and Validation of a Risk Prediction Tool to Identify People at Greater Risk of Having Hepatitis C among Drug Users.

BACKGROUND: People who use drugs (PWUD) are among those with the highest risk for hepatitis C virus (HCV) infection. Highly effective direct-acting antiviral agents offer an opportunity to eliminate HCV. A simple tool for the prediction of HCV infection risk in PWUD is urgently needed. This study aimed to develop and validate a risk prediction tool to identify people at greater risk of having hepatitis C among PWUD that is applicable in resource-limited settings. METHODS: We extracted data from national HIV/AIDS sentinel surveillance in PWUD (Zhejiang Province, 2016-2021) and developed and validated a risk score to improve HCV testing in PWUD. This risk score consists of seven risk factors identified using multivariable logistic regression modeling (2016-2020, exploratory group). We validated this score using surveillance data for 2021 (validation group). The accuracy of the model was determined using C-statistics. RESULTS: We identified seven risk factors, including sex, age, marital status, educational attainment, and the use of heroin, morphine, and methamphetamine. In the exploratory group, the positive rates of detecting the HCV antibody in the low-risk (0-9 points), intermediate-risk (10-16 points), and high-risk (≥17 points) groups were 6.72%, 17.24%, and 38.02%, respectively (Ptrend < 0.001). In the validation group, the positive rates in the low-, medium-, and high-risk groups were 4.46%, 12.23%, and 38.99%, respectively (Ptrend < 0.001). CONCLUSIONS: We developed and validated a drug-specific risk prediction tool for identifying PWUD at increased risk of HCV infection. This tool can complement and integrate the screening strategy for the purpose of early diagnosis and treatment.

Application of machine learning algorithms in predicting HIV infection among men who have sex with men: Model development and validation.

Background: Continuously growing of HIV incidence among men who have sex with men (MSM), as well as the low rate of HIV testing of MSM in China, demonstrates a need for innovative strategies to improve the implementation of HIV prevention. The use of machine learning algorithms is an increasing tendency in disease diagnosis prediction. We aimed to develop and validate machine learning models in predicting HIV infection among MSM that can identify individuals at increased risk of HIV acquisition for transmission-reduction interventions. Methods: We extracted data from MSM sentinel surveillance in Zhejiang province from 2018 to 2020. Univariate logistic regression was used to select significant variables in 2018-2019 data (P < 0.05). After data processing and feature selection, we divided the model development data into two groups by stratified random sampling: training data (70%) and testing data (30%). The Synthetic Minority Oversampling Technique (SMOTE) was applied to solve the problem of unbalanced data. The evaluation metrics of model performance were comprised of accuracy, precision, recall, F-measure, and the area under the receiver operating characteristic curve (AUC). Then, we explored three commonly-used machine learning algorithms to compare with logistic regression (LR), including decision tree (DT), support vector machines (SVM), and random forest (RF). Finally, the four models were validated prospectively with 2020 data from Zhejiang province. Results: A total of 6,346 MSM were included in model development data, 372 of whom were diagnosed with HIV. In feature selection, 12 variables were selected as model predicting indicators. Compared with LR, the algorithms of DT, SVM, and RF improved the classification prediction performance in SMOTE-processed data, with the AUC of 0.778, 0.856, 0.887, and 0.942, respectively. RF was the best-performing algorithm (accuracy = 0.871, precision = 0.960, recall = 0.775, F-measure = 0.858, and AUC = 0.942). And the RF model still performed well on prospective validation (AUC = 0.846). Conclusion: Machine learning models are substantially better than conventional LR model and RF should be considered in prediction tools of HIV infection in Chinese MSM. Further studies are needed to optimize and promote these algorithms and evaluate their impact on HIV prevention of MSM.

A spatial analysis of the epidemiology of HIV-infected students in Zhejiang province, China.

BACKGROUND: The upsurge in HIV infections among students is a matter of particular concern. However, few studies have explored the epidemiological characteristics including the risky sexual networking of HIV-infected students in Zhejiang province, China. METHODS: Using the provincial surveillance data of HIV-infected students, we conducted a retrospective epidemiology study to describe the epidemiological characteristics of 628 newly diagnosed cases from 2011 to 2016 and detailed information of 124 cases from 2015 to 2016. Spatial analyses were conducted using ArcGIS software, and statistical analyses were performed using SPSS software. RESULTS: A total of 628 cases of HIV/AIDS were diagnosed among students in Zhejiang Province, China between 2011 and 2016. The cases showed an overall increasing trend over time, while the proportions of students with HIV disease status, cases diagnosed by HIV voluntary counseling and testing (VCT), and cases of homosexual transmission remained stable over time. Significant spatial heterogeneity in the cases was seen at the county level. Detailed data on 124 HIV-positive individuals collected from the local Center for Disease Control and Prevention (CDC) from 2015 and 2016, showed that the majority of them (85.5%,) engaged in homosexual behavior, and 93.4% had sex with casual partners. These partners included not only social members, but also other students. Online dating applications represented the most common means of seeking and communicating with homosexual partners. The level of awareness regarding the risk of HIV infection, and the amount coverage of face-to-face education towards students were both low. CONCLUSIONS: HIV infections among students were characterized by increasing trend and spatial clustering in Zhejiang Province between 2011 and 2016, with homosexual sexual activity being the main mode of infection. Interventions are urgently required to prevent HIV infection in this population by increasing awareness of the disease. HIV testing programs and information regarding disease prevention specifically through online dating applications are needed.

HIV risk behavior and HIV testing among rural and urban men who have sex with men in Zhejiang Province, China: A respondent-driven sampling study.

BACKGROUND: Currently, human immunodeficiency virus (HIV) sentinel surveillance among men who have sex with men (MSM) in China conducted in large and medium-sized cities, and no HIV sentinel surveillance conducted in rural areas. HIV testing and intervention is predominantly conducted in urban areas, there have been a limited number of studies in rural areas MSM, it is necessary to conduct the investigation of HIV risk sexual behavior, HIV testing among rural and urban MSM. METHOD: Between December 2013 and August 2015, a cross-sectional study was conducted in rural and urban areas in Zhejiang Province using respondent-driven sampling (RDS). Participants completed face-to-face interviewer-administered questionnaire surveys and were tested for HIV. RESULTS: A total of 710 MSM participants were recruited, of whom 36.1% were from rural areas. The overall HIV prevalence was 16.6%, and was considerably lower among MSM living in rural areas (3.9%) than those living in urban areas (24.2%). 61.1% participants had not condom use with male sexual behavior in the past 6 months (86.7% in rural areas and 46.7% in urban areas). The social demographic and behavioral characteristics had significance difference among rural and urban MSM. Multivariate logistic regression revealed that, compared to men living in urban areas, MSM living in rural areas MSM were more likely to use dating apps to find sexual partners, were more likely to engage in bisexual behavior, and had lower condom use. 43.0% participants had been tested for HIV in the past year (41.8% in rural areas and 43.6% in urban areas). Multivariate logistic regression also revealed that among participants living in rural areas, having rural health insurance and not accepting HIV intervention were associated with lower HIV testing rates, while a higher monthly income and through use of internet to find sexual partner were associated with higher rates of HIV testing. CONCLUSION: High risk behavior was prevalent, and HIV testing rates were low among MSM living in rural areas compare to urban areas in Zhejiang Province, therefore, preventative intervention measures should be immediately among rural MSM urgently to reduce HIV transmission and to promote HIV testing.

Epidemiological characteristics of newly diagnosed HIV/AIDS cases aged50 years or over in Zhejiang Province from 2015 to 2019 / 预防医学

Objective@#To analyze the epidemiological characteristics of newly diagnosed HIV/AIDS cases aged 50 years or over in Zhejiang Province from 2015 to 2019, so as to provide reference for the development of prevention and control strategies.@*Methods @#The data of newly diagnosed HIV/AIDS cases in Zhejiang Province were collected through the China HIV/AIDS Comprehensive Response Information Management System, and the demographic characteristics, infection routes,regional distribution and time distribution of the cases were analyzed. @*Results@#A total of 6 726 HIV/AIDS patients were recruited in this study, and the number of new patients from 2015 to 2019 showed an increasing trend ( P <0.05 ) . The number of participants diagnosed at the age of 50-59, 60-69 and 70-91 years old were 3 433( 51.04% ), 2 242 ( 33.33% ) and 1 051 ( 15.63% ). The majority of them were males ( 5 180, 77.01% ) , married ( 4 286, 63.72% ) , Zhejiang residents ( 5 304, 78.86% ) , and lived in rural areas ( 4 095, 60.88% ) . In terms of exposure history,6 586 cases ( 97.92% ) were infected by sexual contact. Among the 5 083 males infected by sexual contact, 82.63% were through heterosexual contact, 94.79% had extramarital sex partners, among whom 76.61% were commercial sex partners. The married women patients who confirmed HIV positive accounted for 75.44%. There were increasing trends in the proportion of the cases living in rural areas, male cases infected through heterosexual contact and those with extramarital and commercial sex partners, and female cases with their husbands positive along with age ( P <0.05 ) . @*Conclusions@#The number of newly diagnosed HIV/AIDS cases aged ≥50 years is increasing in Zhejiang Province. Many of them live in rural areas. Commercial sexual contact is the main route of HIV transmission among males and further lead to HIV transmission within couples.

Assessment on the third round of Zhejiang Comprehensive AIDS Response program / 预防医学

Objective@#To evaluate the third round of Zhejiang Comprehensive AIDS Response (CARES) program (nine national areas and three provincial areas) and the control effect of AIDS, so as to provide reference for AIDS prevention and control. @*Methods@#According to the final assessment protocol of the third round of China CARES, the data of 23 assessment items which were collected from online database and field investigation for 12 response areas of Zhejiang in 2014 and 2018 were evaluated. The endemic situation and detection of AIDS in CARES areas was compared with those in non-CARES areas, in order to evaluate the achievement of Zhejiang CARES areas.@*Results@#The rates of reaching the standard ranged from 91.30% to 100.00% in 12 CARES areas. Six indexes in leadership and innovation, fifteen (seventeen in total) indexes in HIV/AIDS control and prevention reached the standard. The items that failed included the awareness rates of AIDS and indicators in “prevention and intervention”. The rates of of reaching the standard in “publicity and education”, “monitoring and testing”, “prevention and intervention”, and “treatment and follow-up” increased from 55.56%, 79.17%, 79.76% and 65.00% in 2014 to 91.67%, 100.00%, 90.48% and 100.00% in 2018, respectively. The proportion of HIV testing people in permanent residents was 30.94% in CARES areas in 2018, which was significantly higher than 20.70% in non-CARES areas (P<0.05). The proportion of new reported HIV/AIDS in CARES areas was 50.87%, and the average increase was 4.48%, which was lower than 9.95% in non-CARES areas.@*Conclusion@#The third round of Zhejiang CARES program has remarkable achievement and plays a positive role in the prevention and control of AIDS.

Prevalence of Active Syphilis Infection and Risk Factors among HIV-Positive MSM in Zhejiang, China in 2015: A Cross-Sectional Study.

OBJECTIVES: To determine the prevalence of active syphilis infection and explore the risk factors for active syphilis in human immunodeficiency virus (HIV)-positive men who had sex with men (MSM) in Zhejiang Province, 2015. DESIGN: Data on HIV-positive MSM living in Zhejiang Province were obtained from the National Center for AIDS/STD Control and Prevention (NCAIDS) reporting system and the Zhejiang provincial AIDS/STD surveillance system between June and December 2015. The information included risky behavior, years with diagnosed HIV, and highly active antiretroviral therapy (HAART). SPSS 19.0 was used for the data analysis. RESULTS: The analysis included 3616 MSM. Of these, 11.3% (407/3616) had active syphilis. Multivariate logistic regression analysis revealed that HAART was significantly associated with an increased risk of active syphilis infection (odds ratio (OR) = 1.760, 95% confidence interval (CI) 1.187-2.611). Compared with participants diagnosed with HIV for <2 years, patients diagnosed with HIV for >5 years had a higher risk of active syphilis infection (OR = 1.707, 95% CI 1.167-2.495). Age and number of sex partners were also independent risk factors for active syphilis infection. CONCLUSIONS: The incidence of active syphilis infection is high among HIV-positive MSM in Zhejiang Province; age, number of sex partners, years with diagnosed HIV, and receiving HAART were risk factors. Patients who are elderly, have lived with HIV for a longer period, have more sex partners, and receive HAART should be the focus of interventions to promote changes in behavior and decrease syphilis infection.

Social support, stigma, and the mediating roles of depression on self-reported medication adherence of HAART recipients in China.

Discrimination of people living with HIV/AIDS (PLWHA) is a persistent issue in China, which affects their psychological health. However, the association between psychological factors and adherence to highly active antiretroviral therapy (HAART) has not been systematically investigated before. Therefore, this study examined the impact of social support, depression, and medication-taking self-efficacy on ART adherence among PLWHA based on Cha et al.'s model, and included "stigma" to the original model to explain the psychological mechanism. Of the 504 participants receiving HAART, 37.8% had mild-to-severe depression. According to structural equation modeling, social support was directly associated with depression, stigma, and adherence; depression partially mediated the positive relationship between social support and adherence self-efficacy and the negative association between stigma and self-efficacy. The modified and extended Cha et al.'s model had a satisfactory fit. Interventions to improve mental health through mental health services, social support, and enhancement of adherence self-efficacy beliefs are required.

Outbreak of HIV Infection Linked to Nosocomial Transmission, China, 2016-2017.

On January 25, 2017, a physician from ZC Hospital in Hangzhou, China, reported to the Zhejiang Provincial Center for Disease Control and Prevention that a potential HIV outbreak might have occurred during lymphocyte immunotherapy (LIT) performed at the hospital on December 30, 2016. We immediately began investigating and identified the index case-patient as an LIT patient's husband who donated lymphocytes for his wife's LIT and later screened HIV-reactive. Subsequent contamination by a technician resulted in the potential exposure of 34 LIT patients. Acute HIV infection was diagnosed in 5 persons. Phylogenetic analysis confirmed that the HIV-1 gag, pol, and env gene sequences from the index and outbreak-related cases had >99.5% similarity. Rapid investigation and implementation of effective control measures successfully controlled the outbreak. This incident provides evidence of a lapse in infection control causing HIV transmission, highlighting the need for stronger measures to protect patients from infectious disease exposure.

New types of drug use and risks of drug use among men who have sex with men: a cross-sectional study in Hangzhou, China.

BACKGROUND: The use of new types of drugs has become more common among men who have sex with men (MSM). The aim of this study was to describe the patterns of the use of new types of drugs, such as methamphetamine, ketamine, ecstasy, and rush poppers, and to examine the factors associated with drug use and HIV infection among MSM in Hangzhou, China. METHODS: This cross-sectional study was conducted between August 2015 and April 2016. We used snowball sampling to recruit MSM; participants were recruited from voluntary counseling and testing centers, baths, bars, Blued (an app for the gay community), QQ groups, clubs, and other types of venues. MSM were included if their previous HIV test results were negative or unknown, or they had not been tested for HIV. MSM were excluded if they were known to be HIV positive before the survey. Face-to-face questionnaires were conducted and a venous blood specimen was drawn from each participant following the interview. RESULTS: In total, 555 MSM were included; 18.2% (101/555) of the participants had used new types of drugs in the past 3 months. Among the users, 65.3% used single-use rush poppers, while the remainder used ketamine, methamphetamine, ecstasy, or other mixed combinations of drugs. The HIV positivity rate was 14.8% (82/555). Factors associated with increased odds of using new types of drugs in the past 3 months were higher education levels (adjusted odds ratio [AOR] 4.45, 95% confidence interval [CI] 2.12-9.37), having multiple sexual partners (AOR 1.76, 95 CI 1.02-3.05), alcohol use before sexual intercourse (AOR 33.44, 95% CI 10.80-103.50), and seeing friends using new types of drugs. CONCLUSION: We revealed the widespread use of new types of drugs, as well as a high diagnosis rate of new HIV infection, among MSM in Hangzhou. The use of new types of drugs was associated with an increased number of sexual partners among MSM; the high-risk sexual behaviors increased the risk of HIV infection. Attention should be given to the use of new types of drugs in MSM, and supervision programs should be strengthened to combat drug use.

Reduction in HIV community viral loads following the implementation of a "Treatment as Prevention" strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China.

BACKGROUND: Previous studies have shown that the increased coverage of antiretroviral therapy (ART) could reduce the community viral load (CVL) and reduce the occurrence of new HIV infections. However, the impact on the reduction of HIV transmission among men who have sex with men (MSM) is much less certain. The frequency of HIV infections in MSM have been rapidly increasing in recent years in Hangzhou, China. The "Treatment as Prevention" strategy was implemented at a population-level for HIV-infected MSM from January 2014 to June 2016 in Hangzhou; it aimed to increase the ART coverage, reduce the CVL, and reduce HIV transmission. METHODS: We investigated a subset of MSM diagnosed with HIV pre- and post-implementation of the strategy, using random sampling methods. Viral load (VL) testing was performed for all enrolled individuals; the lower limits of detection were 20 and 50 copies/mL. The data on infections were collected from the national epidemiology database of Hangzhou. Logistic regression analyses were conducted to identify factors associated with the differences in social demographic characteristics and available VL data. RESULTS: The ART coverage increased from 60.7% (839/1383) during the pre-implementation period to 92.3% (2183/2365) during the post-implementation period in Hangzhou. A total of 940 HIV-infected MSM were selected for inclusion in this study: 490 (52.1%) and 450 (47.9%) MSM in the pre- and post-implementation periods, respectively. In total, 89.5% (841/940) of patients had data available on VL rates. The mean CVL was 579 copies/mL pre-implementation and this decreased to 33 copies/mL post-implementation (Kruskal-Wallis < 0.001). The mean CVL decreased for all variables investigated post-implementation of the treatment strategy (P < 0.05). The undetectable VL (≤400 copies/mL) rate pre-implementation period was 50.0% which increased to 84.7% post-implementation (P < 0.001). The mean CVL at the county level significantly decreased in each county post-implementation (Kruskal-Wallis < 0.05). CONCLUSION: Our study confirmed a population-level association between increased ART coverage and decreased mean CVL; overall 84.7% of HIV infected MSM had an undetectable VL and were no longer infectious.

Highlighting the crucial role of Hangzhou in HIV-1 transmission among men who have sex with men in Zhejiang, China.

In recent years, the population of men who have sex with men (MSM) constitute a major group for HIV transmission in China. A total of 340 newly reported HIV-infected MSM were recruited proportionally from ten prefectures across Zhejiang province between January and December in 2013. Partial pol gene was amplified and sequenced. Phylogenetic relationship, transmission network and genotypic drug resistance analyses were performed on 311 sequences. HIV-1 subtypes including CRF01_AE (55.9%), CRF07_BC (37.6%), subtype B (1.9%), CRF55_01B (1.3%), CRF68_01B (0.3%), CRF08_BC (0.3%) and URFs (2.6%) were identified. A higher proportion of CRF07_BC and other subtypes existed in the >35 years group, while a higher proportion of CRF01_AE was present in the young group (<35 years). Low prevalence of transmitted drug resistance was found (3.9%, 12/311). Strains with Hangzhou imprints were diffused across the full phylogenetic tree. Moreover, Hangzhou represented the dominant proportion of local HIV transmission (72.0%) and cross-regional transmission (62.4%) based on the provincial transmission network and possessed the largest number of nodes with ≥50 edges, accounting for 50.0% (10/20). The complexity of HIV subtypes and an intertwined network was noticed in MSM in Zhejiang province. Hangzhou likely plays a central regional role in the intra-provincial spread of HIV.

HIV cause-specific deaths, mortality, risk factors, and the combined influence of HAART and late diagnosis in Zhejiang, China, 2006-2013.

To examine patterns of human immunodeficiency virus (HIV) cause-specific deaths, risk factors, and the effect of interactions on mortality, we conducted a retrospective cohort study in Zhejiang, China, from 2006 to 2013. All data were downloaded from the acquired immune deficiency syndrome (AIDS) Prevention and Control Information System. The Cox proportional hazards model was used to assess predictors of cause-specific death. The relative excess risk due to interaction and ratio of hazard ratios (RHR) were calculated for correlations between HAART, late diagnosis, and age. A total of 13,812 HIV/AIDS patients were enrolled with 31,553 person-years (PY) of follow-up. The leading causes of death of HIV patients were accidental death and suicide (21.5%), and the leading cause of death for those with AIDS was AIDS-defining disease (76.4%). Both additive and multiplicative scale correlations were found between receiving HAART and late diagnosis, with RERI of 5.624 (95% CI: 1.766-9.482) and RHR of 2.024 (95% CI: 1.167-2.882). The effects of HAART on AIDS-related mortalities were affected by late diagnosis. Early detection of HIV infection and increased uptake of HAART are important for greater benefits in terms of lives saved.

Trends of HIV-1 Subtypes Among Young People in Hangzhou, China.

To investigate the HIV-1 molecular epidemiology among young people (18 to 25 years old) in Hangzhou. Plasma samples from 262 newly diagnosed HIV-1-infected patients were collected between 2009 and 2013 from Hangzhou of Zhejiang province. HIV-1 nucleotide sequences of pol gene regions were amplified using a nested polymerase chain reaction method and sequenced. Phylogenetic and recombination analyses were used to determine the HIV-1 genotypes. Based on all sequences generated, the subtype/circulating recombinant forms (CRFs) distribution was as follows: CRF01_AE (68.70%), CRF07_BC (21.54%), subtype B (3.66%), CRF08_BC (2.44%), 01B (2.03%), BC (0.81%), and C (0.41%). We found that the percentage of CRF07_BC was increasing year by year among young people in Hangzhou. Novel CRFs such as CRF67_01B (HZ2011-15 CD4-4516) and CRF68_01B (HZ2011-20 CD4-4530 and HZ2011-29 CD4-4087) were first discovered in the area in this study. Our study presents a molecular epidemiology investigation describing the structure of HIV-1 strains cocirculating in young people in Hangzhou. Increasing CRF07_BC and new CRFs popular in young people are a challenge for future prevention in Hangzhou.

[Analysis of related factors for HIV transmission among 263 pairs of male spouses with positive HIV antibodies in Zhejiang province].

OBJECTIVE: To identify the status and risk factors of transmission in couples which males was HIV-positive in Zhejiang province. METHODS: A cross-sectional study was conducted among HIV-serodiscordant couple (male positive) and HIV-seroconcordant couple (male first infected). A self-designed questionnaire was complimented containing basic information, the awareness of infection and HIV-testing, sexual relationship power, self-efficacy of condom use, sex. The univariated and multivariate logistic regression methods were used to analyze the influence factors. RESULTS: A total of 263 couples were enrolled in this study, including 210 HIV HIV-serodiscordant couples and 53 HIV-seroconcordant couples. HIV-positive males aged 30-50 accounted for 57.8% (152 cases) and females under junior high school accounted for 79.1% (208 cases). HIV/AIDS accounted for 41.1% (217 cases). The proportion of man who were diagnosed as HIV, MSM and ever heard HIV were 61.9% (130 cases), 38.3% (80 cases) and 81.9% (172 cases), which were higher than that in HIV positive 47.2% (25 cases), 7.5% (4 cases), 64.2% (34 cases); χ(2)=3.80, 18.33, 7.86;P=0.051, 0.001, 0.005. The results revealed that AIDS patients had high risk to infect their spouse than HIV patients (OR=2.93, 95% CI: 1.05-8.21). Male patients who had ever heard " HIV" before were less likely pass virus to their wives than those who had never heard " HIV" (OR=0.13, 95% CI: 0.04-0.41). Compared with heterosexuality man, homosexuality man' wives had high risk to get virus from their husbands (OR=0.14, 95% CI: 0.03-0.73). Female infected with STIs was the independent factors for HIV infection (OR=4.86, 95% CI: 1.23-19.11). CONCLUSION: Among the couples of male HIV-positive in Zhejiang Province, the risk of spouses infected with HIV virus has relationship with male disease progression, sexual orientation and awareness of AIDS knowledge. For females who infected with sexual diseases in last 6 months might be infected by their spouses.

The Factors Related to CD4+ T-Cell Recovery and Viral Suppression in Patients Who Have Low CD4+ T Cell Counts at the Initiation of HAART: A Retrospective Study of the National HIV Treatment Sub-Database of Zhejiang Province, China, 2014.

BACKGROUND: Since China has a unique system of delivering HIV care that includes all patients' records. The factors related to CD4+ T-cell recovery and viral suppression in patients who have low CD4+ T cell counts at the initiation of HAART are understudied in the China despite subsequent virological suppression (viral load < 50 copies/mL) is unknown. METHODS: The authors conducted a retrospective cohort study using data from the national HIV treatment sub-database of Zhejiang province to identify records of HIV+ patients. Patient records were included if they were ≥ 16 years of age, had an initial CD4 count < 100 cells/µL, were on continuous HAART for at least one year by the end of December 31, 2014; and achieved and maintained continued maximum virological suppression (MVS) (< 50 copies/ml) by 9 months after starting HAART. The primary endpoint for analysis was time to first CD4+ T cell count recovery (≥ 200, 350, 500 cells/µL). Cox proportional hazard regression was used to identify the risk factors for CD4+ T cell count recovery to key thresholds (200-350, 350-500, ≥ 500 cells/µL) by the time of last clinical follow-up (whichever occurred first), key thresholds (follow-up date for analysis), with patients still unable to reach the endpoints being censored by the end December 31, 2014 (follow-up date for analysis). RESULTS: Of the 918 patients who were included in the study, and the median CD4+ T cell count was 39 cells/µL at the baseline. At the end of follow-up, 727 (79.2%), 363 (39.5%) and 149 (16.2%) patients had return to ≥ 200, 350, and 500 cells/µL, respectively. Kaplan-Meier analysis demonstrated that the rate of patients with CD4+ count recovery to ≥ 200, 350, and 500 cells/µL after 1 year on HAART was 43.6, 8.6, and 2.5%, respectively, after 3 years on treatment was 90.8, 46.3, and 17.9%, respectively, and after 5 years on HAART was 97.1, 72.2, and 36.4%, respectively. The median time to return to 200-350, 350-500, ≥ 500cells/µL was 1.11, 3.33 and 6.91 years, respectively. Factors of age (aHR = 0.77, 95%CI 0.61-0.97), baseline CD4+ count (aHR = 1.60, 95%CI 1.37-1.86), initial regimens, changes in regimen (aHR = 0.58, 95%CI 0.49-0.69), and inclusion of a cotrimoxazole prophylaxis (aHR = 0.66, 95%CI 0.51-0.85) were associated with CD4+ T cell count recovery. CONCLUSION: The proportion of patients with initially low CD4 counts after nine months of treatment and that achieved continuous virological suppression was greater than 70% for persons with CD4+ count ≥ 350. Conversely, only 35% of patients recovered to levels of 500 cells/µL after 5 years of treatment, and levels continued to rise significantly with further long-term HAART. Early HAART intervention will be necessary for achieving effective CD4+ T cell responses and optimal immunological function in HIV+ patients.

[Incidence rate of HIV transmission in HIV discordant couples in Zhejiang province, 2009-2013].

OBJECTIVE: To identify the HIV transmission in discordant couples and the epidemic characteristics of concordant couples related to HIV infection. METHODS: HIV/AIDS database was down-loaded from AIDS information reported system for analysis. Patients with HIV-negative couples between 2009 and 2013 in Zhejiang province were enrolled in this study. Information included demography characteristics, highly active antiretroviral therapy (HAART), HIV incidence rate and risk factors, characteristics on HIV concordant couples. RESULTS: The HIV incidence rate on HIV-negative couples of 2 575 HIV/AIDS was 3.56 per 1 000 person-year, reducing from 5.49 per 1 000 person-year in 2009 to 3.20 per 1 000 person-year in 2013. There was a slight increase on HIV incidence rate among couples in those HIV-positive men who were heterosexual, while it decreased among couples of HIV-positive women. Initiation of HAART over 1 years (OR = 0.063, 95% CI: 0.019-0.204) seemed to be a preventive factor for HIV transmission between the couples under study. Factors as history of infection longer than 3 years (OR = 3.564, 95% CI: 1.296-9.804) and beingnon-local resident (OR = 2.626, 95% CI: 1.098-6.230) were risky factors. CONCLUSION: The incidence rate of HIV transmission between HIV discordant couples was low but imbalance in different areas. People who were non-local residents under HIV discordant status, would need more attention. HAART, time of infection, status of residency appeared risk factors for HIV transmission within the couples.