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1.
Nat Commun ; 14(1): 3343, 2023 06 08.
Article in English | MEDLINE | ID: mdl-37291137

ABSTRACT

Tripartite motif-containing protein 5α (TRIM5α) is generally known to block the postentry events of HIV-1. Here, we report an uncharacterized role for TRIM5α in the maintenance of viral latency. Knockdown of TRIM5α potentiates the transcription of HIV-1 in multiple latency models, which is reversed by shRNA-resistant TRIM5α. TRIM5α suppresses TNFα-activated HIV-1 LTR-driven as well as NF-κB- and Sp1-driven gene expression, with the RING and B-box 2 domains being the essential determinants. Mechanistically, TRIM5α binds to and enhances the recruitment of histone deacetylase 1 (HDAC1) to NF-κB p50 and Sp1. ChIP‒qPCR analyses further reveal that the association of TRIM5α with HIV-1 LTR induces HDAC1 recruitment and local H3K9 deacetylation. Conserved suppression effects of TRIM5α orthologs from multiple species on both HIV-1 and endo-retroelement HERV-K LTR activities have also been demonstrated. These findings provide new insights into the molecular mechanisms by which proviral latency is initially established and activatable proviruses are resilenced by histone deacetylase recruitment.


Subject(s)
HIV-1 , NF-kappa B , NF-kappa B/metabolism , Histone Deacetylase 1/genetics , Histone Deacetylase 1/metabolism , HIV Long Terminal Repeat/genetics , HIV-1/genetics , HIV-1/metabolism , Promoter Regions, Genetic , Tripartite Motif Proteins/genetics
2.
Front Immunol ; 13: 947272, 2022.
Article in English | MEDLINE | ID: mdl-36032116

ABSTRACT

The newly emerged severe acute respiratory syndrome (SARS) coronavirus-2 (SARS-CoV-2) can result in dysregulated interferon (IFN) responses that contribute to disease severity. The papain-like protease of SARS-CoV-2 (SCoV2-PLpro) has been previously reported to attenuate IFN responses, but the underlying mechanism is not fully understood. In this study, we found that SCoV2-PLpro potently suppressed IFN production and signaling induced by Sendai virus as well as RIG-I-like receptor (RLR) signaling pathway components, including RIG-I, MAVS, TBK1, TRAF3, TRAF6, and IRF3. SCoV2-PLpro exhibited different specificity and efficiency than SARS-CoV PLpro, with the former exerting a greater inhibitory effect on the RIG-I- and TRAF3-mediated IFN response but a weaker effect on the MAVS-mediated IFN response. Furthermore, we showed that SCoV2-PLpro significantly reduced K63-ubiquitination of RIG-I, MAVS, TBK1, TRAF3, TRAF6, and IRF3 and K48-ubiquitination of IκBα, which are known critical for the innate immune signal transduction. The deubiquitinating (DUB) activity of SCoV2-PLpro required a catalytic residue cysteine 111 (C111) but not the UBL domain. Notably, by utilizing the DUB-defective C111 mutant, we demonstrated that SCoV2-PLpro targeted RLR signaling pathway regulators via deubiquitination-dependent and -independent mechanisms, with the inhibitory activities of RIG-I and TBK1 correlating with DUB function, whereas the antagonism effects on MAVS, TRAF3, TRAF6, and IRF3 independent on DUB activity. Overall, our results reveal that SCoV2-PLpro evolves differential IFN antagonism activity from SCoV1-PLpro and it targets multiple key RLR signaling pathway components via various mechanisms, providing insights into SARS-CoV-2 pathogenesis and clues for developing antiviral therapies for COVID-19.


Subject(s)
Coronavirus Papain-Like Proteases , DEAD Box Protein 58 , Receptors, Immunologic , SARS-CoV-2 , Signal Transduction , COVID-19 , Coronavirus Papain-Like Proteases/metabolism , DEAD Box Protein 58/metabolism , Humans , Receptors, Immunologic/metabolism , SARS-CoV-2/enzymology , Ubiquitination
3.
Mol Immunol ; 101: 627-634, 2018 09.
Article in English | MEDLINE | ID: mdl-30170890

ABSTRACT

TRIMCyp generated by retrotransposition of a cyclophilin A inserting into TRIM5 locus, has been identified in owl monkey and most of Old World monkeys (OWM). Owl monkey TRIMCyp (omTRIMCyp) inhibits HIV-1 infection by direct interaction with viral capsid and indirect innate immune induction, whereas most of TRIMCyps from OWM cannot inhibit HIV-1, and the impact of which on immunoregulation is largely unknown. Here we reported that omTRIMCyp induces NF-κB, AP-1 and IFN-ß activation in a dose-dependent manner, while TRIMCyp from northern pig-tailed macaque (npmTRIMCyp) does not activate NF-κB and moderately enhances AP-1 and IFN-ß activities. The Cyclophilin A (CypA) domain plays an important role in omTRIMCyp-mediated NF-κB activation, and RBCC domains have a synergetic effect. We further indicated the mechanism by which npmTRIMCyp unable to activate NF-κB is that npmTRIMCyp hardly phosphorylates IκBα, different from omTRIMCyp which dramatically induces IκBα phosphorylation. Ubiquitination activity of omTRIMCyp was greater than npmTRIMCyp, although both could be ubiquitylated. Given that npmTRIMCyp neither interacts with viral capsid resulting in susceptibility to HIV-1 infection, nor activates NF-κB that is indispensable to HIV-1 provirus transcription, we proposed a model that npmTRIMCyp may play an important role in HIV-1 infected northern pig-tailed macaque with latency.


Subject(s)
Aotidae/metabolism , Carrier Proteins/metabolism , Cyclophilin A/metabolism , Macaca/metabolism , NF-kappa B/metabolism , Adaptor Proteins, Signal Transducing/genetics , Adaptor Proteins, Signal Transducing/metabolism , Animals , Carrier Proteins/chemistry , HEK293 Cells , Humans , Interferon Regulatory Factor-3/metabolism , Interferon-beta/metabolism , NF-KappaB Inhibitor alpha/metabolism , Phosphorylation , Protein Domains , Proto-Oncogene Proteins c-fos/metabolism , Proto-Oncogene Proteins c-jun/genetics , Proto-Oncogene Proteins c-jun/metabolism , RNA, Messenger/genetics , RNA, Messenger/metabolism , Signal Transduction , Transcription Factor AP-1/metabolism , Transcription, Genetic
4.
Sci China Life Sci ; 61(8): 954-965, 2018 08.
Article in English | MEDLINE | ID: mdl-29705873

ABSTRACT

TRIM5α restricts retroviruses in a species-specific manner. Cyclophilin A was independently retrotransposed into the TRIM5 loci in different species, leading to the generation of antiviral TRIM5-cyclophilin A (TRIMCyp) proteins. Previously, we found that assam macaques express a TRIMCyp chimera (amTRIMCyp), along with a TRIM5α allelic protein (amTRIM5α). Herein, we investigated the antiviral activity of amTRIMCyp and amTRIM5α individually, as well as their interaction and joint effects. amTRIMCyp showed a divergent restriction pattern from amTRIM5α. Although both proteins potently restricted the replication of HIV-1, only amTRIM5α inhibited N-MLV. Remarkably, cellular anti-HIV-1 activity increased when amTRIMCyp and amTRIM5α were coexpressed, indicating a synergistic block of HIV-1 replication. Consistently, PMBCs from heterozygous amTRIM5α/TRIMCyp showed stronger resistance to HIV-1 infection than those from amTRIM5α/TRIM5α homozygotes. The anti-HIV-1 synergistic effect was dependent on the amTRIMCyp-amTRIM5α interaction. In contrast, amTRIMCyp completely abrogated the anti-N-MLV activity mediated by amTRIM5α, showing a dominant-negative effect, indicating that the generation of amTRIMCyp was involved in the trade-off between divergent restriction activities. Our results provide a new paradigm to study functional trade-offs mediated by allelic proteins, a theoretical basis for utilizing animal models with various TRIM5 alleles, as well as novel HIV-1 gene therapy strategies.


Subject(s)
HIV-1/immunology , Leukemia Virus, Murine/immunology , Macaca/immunology , Mutant Chimeric Proteins/immunology , Retroviridae Infections/immunology , Animals , Cats , Cell Line , Cyclophilin A/genetics , Cyclophilin A/immunology , Cyclophilin A/metabolism , Gene Expression/immunology , HEK293 Cells , HIV-1/physiology , Humans , Leukemia Virus, Murine/physiology , Leukocytes, Mononuclear/immunology , Leukocytes, Mononuclear/metabolism , Leukocytes, Mononuclear/virology , Macaca/virology , Mice , Mutant Chimeric Proteins/genetics , Mutant Chimeric Proteins/metabolism , Proteins/genetics , Proteins/immunology , Proteins/metabolism , RNA Interference/immunology , Retroviridae Infections/virology , Ubiquitin-Protein Ligases
5.
Microbes Infect ; 19(4-5): 288-294, 2017.
Article in English | MEDLINE | ID: mdl-28104465

ABSTRACT

Heroin use is associated with increased incidence of infectious diseases such as HIV-1 infection, as a result of immunosuppression to a certain extent. Host restriction factors are recently identified cellular proteins with potent antiviral activities. Whether heroin use impacts on the in vivo expression of restriction factors that result in facilitating HIV-1 replication is poorly understood. Here we recruited 432 intravenous drug users (IDUs) and 164 non-IDUs at high-risk behaviors. Based on serological tests, significantly higher prevalence of HIV-1 infection was observed among IDUs compared with non-IDUs. We included those IDUs and non-IDUs without HIV-1 infection, and found IDUs had significantly lower levels of TRIM5α, TRIM22, APOBEC3G, and IFN-α, -ß expression than did non-IDUs. We also directly examined plasma viral load in HIV-1 mono-infected IDUs and non-IDUs and found HIV-1 mono-infected IDUs had significantly higher plasma viral load than did non-IDUs. Moreover, intrinsically positive correlation between type I interferon and TRIM5α or TRIM22 was observed, however, which was dysregulated following heroin use. Collectively, heroin use benefits HIV-1 replication that may be partly due to suppression of host restriction factors and type I interferon expression.


Subject(s)
HIV-1/growth & development , Heroin/pharmacology , Interferon-alpha/blood , Interferon-beta/blood , Viral Load/drug effects , Virus Replication/drug effects , APOBEC-3G Deaminase/blood , Adult , Antiviral Restriction Factors , Carrier Proteins/blood , Female , HIV Infections/virology , Heroin Dependence/physiopathology , Humans , Immunosuppression Therapy , Male , Minor Histocompatibility Antigens/blood , Repressor Proteins/blood , Tripartite Motif Proteins/blood , Ubiquitin-Protein Ligases
6.
Sci Bull (Beijing) ; 62(19): 1315-1324, 2017 Oct 15.
Article in English | MEDLINE | ID: mdl-36659293

ABSTRACT

Viral reservoirs of HIV-1 are a major obstacle for curing AIDS. The novel animal models that can be directly infected with HIV-1 will contribute to develop effective strategies for eradicating infections. Here, we inoculated 4 northern pig-tailed macaques (NPM) with the HIV-1 strain HIV-1NL4.3 and monitored the infection for approximately 3years (150weeks). The HIV-1-infected NPMs showed transient viremia for about 10weeks after infection. However, cell-associated proviral DNA and viral RNA persisted in the peripheral blood and lymphoid organs for about 3years. Moreover, replication-competent HIV-1 could be successfully recovered from peripheral blood mononuclear cells (PBMCs) during long-term infection. The numbers of resting CD4+ T cells in HIV-1 infected NPMs harboring proviruses fell within a range of 2- to 3-log10 per million cells, and these proviruses could be reactivated both ex vivo and in vivo in response to co-stimulation with the latency-reversing agents JQ1 and prostratin. Our results suggested that NPMs can be infected with HIV-1 and a long-term viral reservoir was formed in NPMs, which might serve asa potential model for HIV-1 reservoir research.

7.
Arch Virol ; 161(11): 3019-27, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27491414

ABSTRACT

HIV-1-infected macrophages are long-lived and act as human immunodeficiency virus 1 (HIV-1) virus reservoirs. Lipopolysaccharide (LPS) has been demonstrated to suppress HIV-1 replication in macrophages, but the mechanism is not clear. Previous research suggested that downregulation of CD4 and CCR5 as well as blockage of the interaction of HIV-1 with cells are major causes of inhibition of HIV-1 replication in macrophages by LPS. In order to study whether LPS blocks the post-entry event of HIV-1 replication, we developed a macrophage HIV-1 infection model by using VSV-G pseudotyped HIV-1-luciferase virus to infect THP-1 differentiated macrophage-like cells. We found that LPS can suppress HIV-1 replication at post-entry steps. Further study suggested that HIV-1 reverse transcription was blocked by LPS, but addition of exogenous deoxyribonucleosides led to only partial recovery of HIV-1 replication. However, the inhibition of pro-inflammatory pathway completely rescued HIV-1 replication. Thus, our study shows that LPS can suppress the events of HIV-1 replication post-entry, including reverse transcription, and this restriction is mediated by more than one mechanism.


Subject(s)
Antiviral Agents/metabolism , HIV-1/drug effects , HIV-1/physiology , Immunologic Factors/metabolism , Lipopolysaccharides/metabolism , Macrophages/virology , Reverse Transcription/drug effects , Cell Line , Humans , Vesiculovirus/physiology
8.
J Med Virol ; 88(6): 987-95, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26519943

ABSTRACT

Host restriction factors and type I interferon are important in limiting HIV and HCV infections, yet the role of HIV, HCV mono- and co-infection in regulating these antiviral genes expression is not clear. In this study, we measured the levels of TRIM5α, TRIM22, APOBEC3G, and IFN-α, -ß mRNA expression in peripheral blood mononuclear cells of 43 HIV mono-infected, 70 HCV mono-infected and 64 HIV/HCV co-infected patients along with 98 healthy controls. We also quantified HIV and HCV viral loads in mono- and co-infected patients. The results showed that HCV, HIV mono- and co-infection differentially increased TRIM22, APOBEC3G, and IFN-α, -ß mRNA expression while the mRNA expression of TRIMα was upregulated only by HCV-mono infection. HIV/HCV co-infection was associated with higher viral load, compared to either HIV or HCV mono-infection. Additionally, we showed TRIMα and TRIM22 positively correlated with IFN-α, -ß, which could be dysregulated by HIV, HCV mono- and co-infection. Furthermore, we found TRIM22 negatively correlated with HCV viral load in mono-infected patients and APOBEC3G positively correlated with HCV viral load in co-infected patients. Collectively, our findings suggest the potential role of restriction factors in restricting HIV, HCV mono- and co-infection in vivo, which appears to be a therapeutic target for potential drug discovery.


Subject(s)
Coinfection/genetics , HIV Infections/genetics , Hepatitis C, Chronic/genetics , Hepatitis C/genetics , Host-Pathogen Interactions/genetics , Interferon Type I/genetics , APOBEC-3G Deaminase/genetics , Adult , Antiviral Restriction Factors , Carrier Proteins/genetics , Coinfection/blood , Coinfection/virology , Cross-Sectional Studies , Drug Discovery , Female , Gene Expression Regulation , Genotype , HIV/physiology , HIV Infections/complications , HIV Infections/immunology , HIV Infections/virology , Hepacivirus/physiology , Hepatitis C/complications , Hepatitis C/immunology , Hepatitis C/virology , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/immunology , Hepatitis C, Chronic/virology , Humans , Interferon Type I/immunology , Interferon-alpha/genetics , Leukocytes, Mononuclear/immunology , Male , Middle Aged , Minor Histocompatibility Antigens/genetics , Repressor Proteins/genetics , Tripartite Motif Proteins/genetics , Ubiquitin-Protein Ligases , Viral Load
9.
PLoS One ; 10(3): e0121666, 2015.
Article in English | MEDLINE | ID: mdl-25822622

ABSTRACT

TRIMCyp is a fusion protein consisting of the TRIM5 gene product and retrotransposed Cyclophilin A (CypA). Two primate TRIMCyp fusion proteins with varying anti-HIV-1 activities independently evolved in owl monkeys and Old World monkeys. In addition, Old World monkey TRIMCyps lack exon7, which encodes amino acids in the Linker2 region. Previous studies on TRIM5α indicated that this region affects anti-retroviral activity, cytoplasmic body formation, and multimerization. The effects of exon7 deletion on the functions of the TRIMCyp are unclear. In this study, we found that the cytoplasmic bodies and multimers of owl monkey TRIMCyp (omTRIMCyp) are different from those of northern pig-tailed macaque TRIMCyp (npmTRIMCyp). In addition, we demonstrated that exon7 deletion affected cytoplasmic body formation and multimerization. Moreover, we unexpectedly found two chimeric proteins of omTRIMCyp and npmTRIMCyp that failed to block HIV-1 replication, despite the presence of CypA in omTRIMCyp. Further studies indicated that the cytoplasmic bodies and spontaneous multimerization were not responsible for TRIMCyp anti-HIV-1 activity. Moreover, potent viral restriction is associated with higher amounts of monomeric TRIMCyp when the CypA domain is able to recognize and bind to the HIV-1 capsid. Our results suggested that the deletion of exon7 during the evolution of TRIMCyp affected its function.


Subject(s)
Carrier Proteins/genetics , Cyclophilin A/genetics , HIV-1/physiology , Animals , Aotidae/genetics , Aotidae/virology , Carrier Proteins/chemistry , Carrier Proteins/physiology , Cats , Cell Line , Cyclophilin A/chemistry , Cyclophilin A/physiology , Cytoplasm/genetics , Cytoplasm/virology , Evolution, Molecular , Exons , HEK293 Cells , HIV-1/pathogenicity , Host Specificity , Humans , Macaca nemestrina/genetics , Macaca nemestrina/virology , Protein Multimerization , Recombinant Fusion Proteins/chemistry , Recombinant Fusion Proteins/genetics , Sequence Deletion , Virulence , Virus Assembly , Virus Replication
10.
Mol Biol Evol ; 31(11): 2985-97, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25135944

ABSTRACT

The origin of novel genes and their evolutionary fates are long-standing questions in evolutionary biology. These questions become more complicated for genes conserved across various lineages, such as TRIM5, an antiretroviral restriction factor and a retrovirus capsid sensor in immune signaling. TRIM5 has been subjected to numerous pathogenic challenges and undergone dynamic evolution, making it an excellent example for studying gene diversification. Previous studies among several species showed that TRIM5 gained genetic and functional novelty in a lineage-specific manner, either through gene duplication or a cyclophilin A retrotransposing into the TRIM5 locus, creating the gene fusion known as TRIM5-Cyclophilin A (TRIMCyp). To date, the general pattern of TRIM5 across the mammalian lineage remains elusive. In this study, we surveyed 36 mammalian genomes to verify a potentially novel TRIM5 pattern that uniquely seems to have occurred in tree shrews (Tupaia belangeri), and found that both gene duplication and retrotransposition worked jointly to form a specific TRIM5/TRIMCyp cluster not found among other mammals. Evolutionary analyses showed that tree shrew TRIMCyp (tsTRIMCyp) originated independently in comparison with previously reported TRIMCyps and underwent strong positive selection, whereas no signal of positive selection was detected for other tree shrew TRIM5 (tsTRIM5) genes. Functional assay results suggest a functional divergence between tsTRIMCyp and its closest paralog TRIM5-4, likely reflecting different fates under diverse evolutionary forces. These findings present a rare example of novel gene origination resulting from a combination of gene duplication, retrotransposition, and exon shuffling processes, providing a new paradigm to study genetic innovations and evolutionary fates of duplicated genes.


Subject(s)
Carrier Proteins/genetics , Cyclophilin A/genetics , Gene Duplication , Mutant Chimeric Proteins/genetics , Retroelements , Tupaia/genetics , Amino Acid Sequence , Animals , Base Sequence , Carrier Proteins/metabolism , Cyclophilin A/metabolism , Evolution, Molecular , Exons , Frameshift Mutation , Gene Expression , Introns , Molecular Sequence Data , Mutant Chimeric Proteins/metabolism , Selection, Genetic , Sequence Alignment , Tupaia/metabolism , Zinc Fingers
11.
Dongwuxue Yanjiu ; 35(3): 186-95, 2014 May.
Article in English | MEDLINE | ID: mdl-24866489

ABSTRACT

The northern pig-tailed macaque (Macaca leonina) has been identified as an independent species of Old World monkey, and we previously found that PBMCs from M. leonina were susceptible to human immunodeficiency virus type 1 (HIV-1), which may be due to the absence of a TRIM5 protein restricting HIV-1 replication. Here we investigated the infection potentials of six laboratory adapted HIV-1 strains and three primary HIV-1 isolates in PBMCs from M. leonina. The results indicate that these strains are characterized by various but low replication levels, and among which, HIV-1NL4-3 shows the highest replication ability. Based on the abundant evidence of species-specific interactions between restriction factors APOBEC3 and HIV/SIV-derived Vif protein, we subsequently examined the replication potentials of vif-substituted HIV-1 (HSIV) in M. leonina PBMCs. Notably, HSIV-vifmac and stHIV-1SV chimeras, two HIV-1NL4-3-derived viruses encoding the viral infectivity factor (Vif) protein from SIVmac239, replicated robustly in cells from M. leonina, which suggests that HSIV could effectively antagonize the antiviral activity of APOBEC3 proteins expressed in cells of M. leonina. Therefore, our data demonstrate that M. leonina has the potential to be developed into a promising animal model for human AIDS.


Subject(s)
HIV-1/physiology , Leukocytes, Mononuclear/virology , Macaca , Simian Immunodeficiency Virus/genetics , Virus Replication/physiology , Animals , Cells, Cultured , Genetic Variation , HIV-1/genetics , Humans , Mutation , Reassortant Viruses , Simian Immunodeficiency Virus/physiology
12.
Hum Immunol ; 75(3): 234-8, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24374042

ABSTRACT

Alternatively spliced isoforms of the major histocompatibility complex (MHC) class I genes have been reported in many different species and therefore alternative splicing has been observed to be an additional layer of diversity in the MHC class I region. Here we show the characterization of a HLA-A splice variant in the human peripheral blood mononuclear cells (named "HLA-AΔE3"). This transcript is characterized by the deletion of exon 3 that encodes the α2 domain of the full-length HLA-A protein. Cell surface biotinylation experiments indicated that HLA-AΔE3 is able to be transported to the cell surface, as a 34-KDa glycoprotein that is totally sensitive to endoglycosidase-H treatment. Under nonreducing conditions, HLA-AΔE3 can form disulfide-linked homodimers on the cell surface. Furthermore, co-immunoprecipitation studies revealed that HLA-AΔE3 could interact with full-length HLA-A, forming a heterodimeric complex. These findings suggest that the splice variants of HLA-A under steady-state conditions may have an important function in regulating immune homeostasis.


Subject(s)
HLA-A Antigens/genetics , Leukocytes, Mononuclear/physiology , Membrane Glycoproteins/genetics , Protein Isoforms/genetics , Alternative Splicing , Amino Acid Sequence , DNA Mutational Analysis , Dimerization , Exons/genetics , Humans , Molecular Sequence Data , Sequence Deletion/genetics
13.
PLoS One ; 7(8): e42937, 2012.
Article in English | MEDLINE | ID: mdl-22916185

ABSTRACT

OBJECTIVE: To estimate the prevalence of HIV, HCV, HBV and co-infection with 2 or 3 viruses and evaluate risk factors among injecting drug users (IDUs) in Yunnan province, China. METHODS: 2080 IDUs were recruited from 5 regions of Yunnan Province, China to detect the infection status of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). Statistical analysis was performed to evaluate risk factors related to HIV, HCV and HBV infections. RESULTS: The infection rates among all participants were 25.5% for HIV, 77.7% for HCV, 19.2% for HBV, 15% for HIV/HCV, 0.3% for HIV/HBV, 7.8% for HCV/HBV and 7.1% for HIV/HCV/HBV. The prevalence of virus infection varied widely by region in Yunnan of China. Statistical analyses indicated that high prevalence of HIV and HCV among IDUs was positively associated with the duration of drug injection and sharing needles/syringes; besides, HCV infection was associated with the frequency of drug injection. CONCLUSIONS: HIV, HCV, HBV infections and co-infections were still very prevalent among IDUs in Yunnan province because of drug use behaviors.


Subject(s)
HIV Infections/epidemiology , Hepatitis B/epidemiology , Hepatitis C/epidemiology , Substance Abuse, Intravenous/epidemiology , China/epidemiology , Cross-Sectional Studies , HIV Infections/complications , Hepatitis B/complications , Hepatitis C/complications , Humans , Prevalence , Risk Factors , Substance Abuse, Intravenous/complications
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