Analysis of the immune-inflammatory indices for patients with metastatic hormone-sensitive and castration-resistant prostate cancer.

BACKGROUND: Inflammation plays a pivotal role in the progression of prostate cancer (PCa). Several immune-inflammatory indices, including neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), lymphocyte to monocyte ratio (LMR) and platelet to lymphocyte ratio (PLR), lung immune prognostic index (LIPI), systemic inflammation response index (SIRI) and systemic immune inflammation index (SII), have demonstrated their prognostic values in several solid malignancies. However, Comparisons of superiority with these seven indices' predictive efficacy within metastatic hormone-sensitive PCa (mHSPC) and metastatic castration-resistant PCa (mCRPC) remain uncertain. METHODS: We retrospectively included 407 patients diagnosed with mHSPC and 158 patients with mCRPC at West China Hospital from 2005 to 2022. The seven immune-inflammatory indices were computed based on hematological data of mHSPC at initial diagnosis and mCRPC at progression to CRPC. Prognostic value for castration-resistant prostate cancer-free survival (CFS), overall survival (OS), prostate-specific antigen progression-free survival (PSA-PFS) and prostate-specific antigen (PSA) response was assessed using Kaplan-Meier curves, Cox regression models, and chi-square tests. The predictive performance of each immune-inflammatory index was assessed using the area under the curve (AUC) in time-dependent receiver operating characteristic curve (ROC) analysis and C-index calculation. RESULTS: All seven immune-inflammatory indices were significantly associated with CFS and OS in the mHSPC cohort, as well as with PSA response, PSA-PFS, and OS in the mCRPC cohort. In the mHSPC cohort, LIPI consistently exhibited higher AUC values compared to NLR, dNLR, LMR, PLR, SII, and SIRI for predicting CFS and OS. This indicates that LIPI had a superior discriminative ability compared to the other indices (C-index of LIPI: 0.643 and 0.686 for CFS and OS, respectively). Notably, the predictive advantage of LIPI over other indices in the mHSPC stage diminished in the mCRPC stage. CONCLUSIONS: This study firstly confirmed the prognostic value of SII, SIRI and LIPI in mHSPC and mCRPC, and revealed that LIPI had a higher predictive power than NLR, dNLR, LMR, PLR, SII and SIRI in mHSPC. These non-invasive indices can enable clinicians to quickly assess the prognosis of patients.

The efficacy and safety of PARP inhibitors in mCRPC with HRR mutation in second-line treatment: a systematic review and bayesian network meta-analysis.

BACKGROUND: Poly (ADP- ribose) polymerase inhibitors (PARPi) has been increasingly adopted for metastatic castration-resistance prostate cancer (mCRPC) patients with homologous recombination repair deficiency (HRD). However, it is unclear which PARPi is optimal in mCRPC patients with HRD in 2nd -line setting. METHOD: We conducted a systematic review of trials regarding PARPi- based therapies on mCRPC in 2nd -line setting and performed a Bayesian network meta-analysis (NMA). Radiographic progression-free survival (rPFS) was assessed as primary outcome. PSA response and adverse events (AEs) were evaluated as secondary outcomes. Subgroup analyses were performed according to specific genetic mutation. RESULTS: Four RCTs comprised of 1024 patients (763 harbored homologous recombination repair (HRR) mutations) were identified for quantitative analysis. Regarding rPFS, olaparib monotherapy, rucaparib and cediranib plus olaparib showed significant improvement compared with ARAT. Olaparib plus cediranib had the highest surface under cumulative ranking curve (SUCRA) scores (87.5%) for rPFS, followed by rucaparib, olaparib and olaparib plus abiraterone acetate prednisone. For patients with BRCA 1/2 mutations, olaparib associated with the highest probability (98.1%) of improved rPFS. For patients with BRCA-2 mutations, olaparib and olaparib plus cediranib had similar efficacy. However, neither olaparib nor rucaparib showed significant superior effectiveness to androgen receptor-axis-targeted therapy (ARAT) in patients with ATM mutations. For safety, olaparib showed significantly lower ≥ 3 AE rate compared with cediranib plus olaparib (RR: 0.72, 95% CI: 0.51, 0.97), while olaparib plus cediranib was associated with the highest risk of all-grade AE. CONCLUSION: PARPi-based therapy showed considerable efficacy for mCRPC patients with HRD in 2nd -line setting. However, patients should be treated accordingly based on their genetic background as well as the efficacy and safety of the selected regimen. TRIAL REGISTRATION: CRD42023454079.

A miniaturized mesoscope for the large-scale single-neuron-resolved imaging of neuronal activity in freely behaving mice.

Exploring the relationship between neuronal dynamics and ethologically relevant behaviour involves recording neuronal-population activity using technologies that are compatible with unrestricted animal behaviour. However, head-mounted microscopes that accommodate weight limits to allow for free animal behaviour typically compromise field of view, resolution or depth range, and are susceptible to movement-induced artefacts. Here we report a miniaturized head-mounted fluorescent mesoscope that we systematically optimized for calcium imaging at single-neuron resolution, for increased fields of view and depth of field, and for robustness against motion-generated artefacts. Weighing less than 2.5 g, the mesoscope enabled recordings of neuronal-population activity at up to 16 Hz, with 4 µm resolution over 300 µm depth-of-field across a field of view of 3.6 × 3.6 mm2 in the cortex of freely moving mice. We used the mesoscope to record large-scale neuronal-population activity in socially interacting mice during free exploration and during fear-conditioning experiments, and to investigate neurovascular coupling across multiple cortical regions.

High-intensity interval training versus moderate-intensity continuous training for localized prostate cancer under active surveillance: a systematic review and network meta-analysis.

BACKGROUND: High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) have been increasingly adopted for localized prostate cancer (PCa) under active surveillance (AS). However, it is unclear which training modality is the most favorable in terms of cardiorespiratory fitness and biochemical progression. METHODS: We searched PubMed, Cochrane and Embase for relevant RCTs. PRISMA guideline was adopted to ensure optimal conduct of this study. Serum prostate specific antigen (PSA) and peak VO2 were selected as primary outcomes and PSA doubling time (PSADT) and testosterone were selected as secondary outcomes. Only articles written in English were included. Cochrane risk-of-bias tool was used for risk of bias evaluation. RESULTS: A total of 501 studies were selected. Six RCTs with 222 patients were included for data extraction and analysis. High-intensity interval training (HIIT) group demonstrated significantly lower PSA compared with usual care (UC) (MD = -1.4; 95%CI = -2.77 to -0.03) and moderate-intensity continuous training (MICT) group (MD = -1.67; 95%CI = -3.30 to -0.05). Both HIIT and MICT showed significantly improved peak VO2 compared with UC. No significant difference was observed in PSADT and testosterone among different training modalities and UC. Regarding peak VO2, MICT had the highest surface under cumulative ranking curve (SUCRA) scores (98.1%). For serum PSA, HIIT had the highest probability (97.8%) to be the training with the highest efficacy. The potential source of bias mainly came from poorly performed allocation concealment and blinding strategies. CONCLUSIONS: The present study indicated that HIIT and MICT showed considerable cardiorespiratory benefits for localized PCa. HIIT was preferred over MICT in biochemical progression control in terms of decreasing serum PSA levels. However, MICT was favored over HIIT regarding cardiorespiratory benefits. The findings of this study may facilitate future lifestyle intervention, particularly in the form of physical training, for individuals diagnosed with localized PCa under AS.

HIV Infection and Associated Factors Among Out-of-School MSM Aged 16-24 Years - 6 Cities and Tianjin Municipality, China, 2022-2023.

What is already known about this topic?: Approximately 80% of newly diagnosed human immunodeficiency virus (HIV) cases among individuals aged 15-24 years in China are attributed to out-of-school youth. What is added by this report?: This study presents findings on HIV prevalence and comprehensive insights into HIV service utilization, risky behaviors, and prevention knowledge among young out-of-school men who have sex with men (MSM) aged 16-24 years in China. This population exhibits a disproportionately high burden of HIV, with only 51.6% of HIV cases previously diagnosed. What are the implications for public health practice?: HIV services should be expanded to include these key populations. Tailored interventions are needed to remove barriers to regular HIV services faced by young key populations.

Seasonal characteristics of groundwater discharge controlled by precipitation and its environmental effects in a coal mining subsidence lake, eastern China.

Many regions have formed subsidence lakes due to underground mining in the world. However, seasonal variations of lacustrine groundwater discharge (LGD) rate and solute fluxes in the coal mining subsidence were rarely reported. In this study, we conducted four seasonal samplings in a coal mining subsidence, during which samples for stable water (δ18O) and radioactive (222Rn) isotopes were collected to quantify the seasonal dynamics of LGD rates. The LGD rates estimated from the 222Rn mass balance model were 10.2 ± 8.7, 5.5 ± 3.2, 11.5 ± 7.8, and 7.8 ± 4.5 mm d-1 in summer, autumn, winter and spring, respectively. According to the 18O mass balance model, the corresponding LGD rates were 15.1, 7.3, 15.6, and 11.3 mm d-1 in summer, autumn, winter and spring, respectively. We found a significant correlation between precipitation and LGD rates, suggesting precipitation was recognized as the main control factor for seasonal variations of LGD rates. Based on this correlation, the extrapolated LGD rates over a year ranged from 3.1 to 12.7 mm d-1 with an average of 8.8 mm d-1. Moreover, the fluxes of dissolved silicon (DSi), iron (Fe), and manganese (Mn) from LGD in autumn were (1.6 ± 0.9) × 105, (1.9 ± 1.1) × 104, and (1.1 ± 0.6) × 104 mol a-1, respectively. Correspondingly, in winter they were (3.5 ± 2.4) × 105, (4.1 ± 2.8) × 103, and (2.8 ± 1.9) × 103 mol a-1, respectively. This study demonstrated significantly seasonal variations of LGD, with precipitation being the main control factor of LGD in the coal mining subsidence lake. The fluxes of dissolved substance (DSi, Fe, Mn) from LGD need to be emphasized because they may have important impacts on the ecological stability in coal mining subsidence lakes.

Geochemical characteristics and migration patterns of rare earth elements in coal mining subsidence lakes under the influence of multiple factors.

Mining activities cause surface subsidence and the formation of subsidence lakes, which dynamically change with the continuous coal mining activities. Under the combined influence of various human activities such as agriculture, aquaculture, and floating photovoltaic (FPV), the lake environment undergoes continuous changes, thereby altering the geochemical characteristics of rare earth elements (REEs) in the sediment. This study focused on the subsidence lakes in the Huainan coalfield in eastern China to examine the REEs content in the sediment, elucidated the temporal variations and geochemical characteristics of REEs distribution, explored the main controlling factors of REEs in the sediment, and revealed the migration and transformation behavior of REEs during dynamic subsidence processes. The study revealed that the migration pattern of REEs in the sediment was closely related to the duration of subsidence. The average content of REEs in lake sediments with subsidence duration <5 years increased from 219 µg·g-1 to 248 µg·g-1 compared to the soil, showing an enrichment model primarily driven by rainwater runoff, groundwater input retention, and mineral dissolution. With further subsidence, the processes of reduction dissolution of Fe-Mn oxides/hydroxides, organic colloid adsorption, and hydraulic disturbance gradually replaced the aforementioned enrichment behavior as the main migration pathways, resulting in a decrease in the average REEs content in the sediment to 179 µg·g-1 for subsidence durations exceeding 10 years. There was no strong correlation between REEs fractionation and subsidence duration. Artificial activities, such as FPV, are important factors causing Cerium and Erbium anomalies in some subsidence lake sediments. This study was not only of significant importance for understanding the migration, distribution, and environmental behavior of pollutants in aquatic environments under the interference of human activities but also provided a solid theoretical foundation for the future management of coal mining subsidence lakes.

Association Between Urinary Bisphenols and Body Composition Among American Adults: Cross-Sectional National Health and Nutrition Examination Survey Study.

BACKGROUND: Bisphenol A (BPA), bisphenol S (BPS), and bisphenol F (BPF) are widely used in various consumer products. They are environmental contaminants with estrogenic properties that have been linked to various health outcomes. Understanding their impact on body composition is crucial for identifying potential health risks and developing preventive strategies. However, most current studies have only focused on their relationship with BMI. OBJECTIVE: This study aimed to investigate the association between urinary levels of BPA, BPS, and BPF and body composition, including BMI, lean mass, and fat mass, in a large population-based sample. METHODS: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey 2003-2016. Body composition data were assessed using dual-energy X-ray absorptiometry, which provided precise measurements of lean mass, fat mass, and other indicators. We used multivariate linear regression models to estimate the associations, adjusting for potential confounders such as age, gender, race, socioeconomic factors, and lifestyle variables. RESULTS: The results revealed significant associations between bisphenol exposure and body composition. After adjusting for covariates, BPS showed a positive association with BMI, with quartiles 3 and 4 having 0.91 (95% CI 0.34-1.48) and 1.15 (95% CI 0.55-1.74) higher BMI, respectively, compared with quartile 1 (P<.001). BPA was negatively associated with total lean mass (TLM) and appendicular lean mass, with quartiles 2, 3, and 4 having -7.85 (95% CI -11.44 to -4.25), -12.33 (95% CI -16.12 to -8.54), and -11.08 (95% CI -15.16 to -7.01) lower TLM, respectively, compared with quartile 1 (P<.001). BPS was negatively associated with TLM, with quartiles 3 (ß=-10.53, 95% CI -16.98 to -4.08) and 4 (ß=-11.14, 95% CI -17.83 to -4.45) having significantly lower TLM (P=.005). Both BPA and BPS showed a positive dose-response relationship with trunk fat (BPA: P=.002; BPS: P<.001) and total fat (BPA: P<.001; BPS: P=.01). No significant association was found between BPF and any body composition parameter. CONCLUSIONS: This large-sample study highlights the associations between urinary levels of BPA and BPS and alterations in body composition, including changes in lean mass, fat mass, and regional fat distribution. These findings underscore the importance of understanding the potential health risks associated with bisphenol exposure and emphasize the need for targeted interventions to mitigate adverse effects on body composition.

Implementing Routine HIV Screening in Hospitals: An Effective Practice to Expand HIV Testing - Xishuangbanna Prefecture, Yunnan Province, China, 2019-2020.

What is already known about this topic?: Research evidence is insufficient to suggest whether routine human immunodeficiency virus (HIV) screening in healthcare settings is effective in promoting greater awareness of HIV-positive status. What is added by this report?: This study found that, following the implementation of routine HIV screening in hospitals in Xishuangbanna Prefecture, Yunnan Province, there was a significant increase in the number of HIV screenings, positive results, and the positive rate of HIV screening in primary-level hospitals. What are the implications for public health practice?: Routine hospital-based HIV screening is effective in identifying HIV infections in areas with concentrated epidemics.

Optimizing Respondent-Driven Sampling Survey to Identify Factors Associated With HIV Risk Behaviors Among Student MSM Aged 15 to 19.

Male homosexual behavior dominates the mode of HIV infection among students in China. This study aims to identify factors associated with HIV risk behaviors among male students who have sex with men (student MSM) aged 15 to 19 in China. The online sampling used the standard respondent-driven sampling (RDS) method, with recruitment support from community-based organizations (CBOs) in Tianjin and Guangzhou. Multivariate logistic regression models were performed to identify factors associated with multiple HIV risk behaviors. A total of 449 subjects were recruited in this study, including 206 in Tianjin and 243 in Guangzhou. The presence of multiple HIV risk behaviors among student MSM, in many cases, was found to positively correlate with parental or friends' awareness of their same-sex sexual behavior or sexual orientation, with some geographical differences. The prevalence of HIV risk behaviors among student MSM aged 15 to 19 was high and associated with the disclosure of their sexual orientation or their sex with males to parents and friends. These findings highlight the importance of addressing social support in HIV prevention among student MSM when delivering HIV-related education or services.

Spatiotemporal Analysis of Online Purchase of HIV Self-testing Kits in China, 2015-2017: Longitudinal Observational Study.

BACKGROUND: Since the introduction of HIV self-testing by UNAIDS in 2014, the practice has been extensively implemented around the world. HIV self-testing (HIVST) was developed in China around 2015, and the online purchase of HIVST kits through e-commerce platforms has since become the most important delivery method for self-testing, with advantages such as user-friendliness, speed, and better privacy protection. OBJECTIVE: Understanding the spatiotemporal characteristics of online HIVST kit purchasing behavior and identifying potential impacting factors will help promote the HIV self-testing strategy. METHODS: The online retail data of HIVST kits from the 2 largest e-commerce platforms in China from 2015 to 2017 were collected for this study. The Bayesian spatiotemporal hierarchical model was used to investigate the spatiotemporal characteristics of online purchased HIVST kits. Ordinary least squares regression was used to identify potential factors associated with online purchase, including GDP per capita, population density, road density, HIV screening laboratory density, and newly diagnosed HIV/AIDS cases per 100,000 persons. The q statistics calculated by Geodetector were used to determine the interactive effect of every 2 factors on the online purchase. RESULTS: The online purchase of HIVST kits increased rapidly in China from 2015 to 2017, with annual peak sales in May and December. Five economically superior regions in China, Pearl River Delta, Yangtze River Delta, Chengdu and surrounding areas, Beijing and Tianjin areas, and Shandong Peninsula, showed a comparatively higher spatial preference for online purchased HIVST kits. The GDP per capita (P<.001) and the rate of newly diagnosed HIV/AIDS cases per 100,000 persons (P<.001) were identified as 2 factors positively associated with online purchase. Among the factors we investigated in this study, 2 factors associated with online purchase, GDP per capita and the rate of newly diagnosed HIV/AIDS cases per 100,000 persons, also displayed the strongest interactive effect, with a q value of 0.66. CONCLUSIONS: Individuals in better-off areas are more inclined to purchase HIVST kits online. In addition to economic status, the severity of the HIV epidemic is also a factor influencing the online purchase of HIVST kits.

Identification of Pyruvate Carboxylase as the Cellular Target of Natural Bibenzyls with Potent Anticancer Activity against Hepatocellular Carcinoma via Metabolic Reprogramming.

Cancer cell proliferation in some organs often depends on conversion of pyruvate to oxaloacetate via pyruvate carboxylase (PC) for replenishing the tricarboxylic acid cycle to support biomass production. In this study, PC was identified as the cellular target of erianin using the photoaffinity labeling-click chemistry-based probe strategy. Erianin potently inhibited the enzymatic activity of PC, which mediated the anticancer effect of erianin in human hepatocellular carcinoma (HCC). Erianin modulated cancer-related gene expression and induced changes in metabolic intermediates. Moreover, erianin promotes mitochondrial oxidative stress and inhibits glycolysis, leading to insufficient energy required for cell proliferation. Analysis of 14 natural analogs of erianin showed that some compounds exhibited potent inhibitory effects on PC. These results suggest that PC is a cellular target of erianin and reveal the unrecognized function of PC in HCC tumorigenesis; erianin along with its analogs warrants further development as a novel therapeutic strategy for the treatment of HCC.

HIV-Related Knowledge, Attitude, and Practices Research Among College Students - Six Chinese Cities, 2021.

What is already known about this topic?: The number of newly diagnosed human immunodeficiency virus (HIV) cases among Chinese youth 15-24 years of age shows an upward trend between 2010 and 2019. What is added by this report?: This survey is on a larger scale as compared to previous studies. It shows inadequate HIV knowledge - especially on HIV treatment, self-testing, and post-exposure prophylaxis - among college students. A significant gap exists between knowledge and behavior as indicated by the low condom use rate despite a high knowledge level. What are the implications for public health practice?: Findings suggest priorities for future HIV education and awareness creation of existing services. A low condom use rate at sexual debut suggests that HIV prevention education should start early.

Effect of metformin on adiponectin in PCOS: A meta-analysis and a systematic review.

BACKGROUND: Conflicting results have been reported regarding the effect of metformin on adiponectin levels in women with polycystic ovary syndrome (PCOS). This meta-analysis reviewed all studies comparing adiponectin levels before and after metformin treatment in PCOS women. Additionally, changes in other indicators, including long-term complications associated with PCOS, such as inflammatory, metabolism factors and hormonal profile, were investigated following metformin treatment. We conducted subgroup analysis based on body mass index (BMI) stratification and appropriate pooling. METHODS: We searched literature in PUBMED, EMBASE, the Cochrane Library, and CNKI databases. The main meta-analysis included 11 studies containing data on 353 subjects. RESULTS: Metformin treatment was associated with significantly increased serum adiponectin concentrations [10 studies, random-effects SMD (95% CI) -0.58 [-1.03, -0.13]; I2 = 86%; P = 0.01]. Additionally, the meta-analysis revealed that circulating tumor necrosis factor-α(TNF-α) and C-reactive protein (CRP) concentrations were significantly decreased after metformin treatment, with corresponding SMDs of 1.01 (95% CI: 0.74-1.28, P＜0.00001) and 0.48(95% CI: 0.35-0.60, P＜0.00001). CONCLUSION: Following metformin administration, serum adiponectin concentrations of PCOS women were found to be significantly increased, accompanied by a significant improvement in other indicators. Further investigation with a larger sample size should be conducted to validate optimal dose and duration of metformin.

Development and external validation of a prognostic model for survival of people living with HIV/AIDS initiating antiretroviral therapy.

Background: Most existing prognostic models for people living with HIV/AIDS (PLWHA) were derived from cohorts in high-income settings established a decade ago and may not be applicable for contemporary patients, especially for patients in developing settings. The aim of this study was to develop and externally validate a prognostic model for survival in PLWHA initiating ART based on a large population-based cohort in China. Methods: We obtained data for patients from the Chinese National Free Antiretroviral Treatment Program database. The derivation cohort consisted of PLWHA treated between February 2004 and December 2019 in a tertiary center in Guangzhou, South China, and validation cohort of patients treated between February 2004 to December 2018 in another tertiary hospital in Shenyang, Northeast China. We included ART-naive patients aged above 16 who initiated a combination ART regimen containing at least three drugs and had at least one follow-up record. We assessed 20 candidate predictors including patient characteristics, disease characteristics, and laboratory tests for an endpoint of death from all causes. The prognostic model was developed from a multivariable cox regression model with predictors selected using the least absolute shrinkage and selection operator (Lasso). To assess the model's predictive ability, we quantified the discriminative power using the concordance (C) statistic and calibration accuracy by comparing predicted survival probabilities with observed survival probabilities estimated with the Kaplan-Meier method. Findings: The derivation cohort included 16481 patients with a median follow-up of 3·41 years, among whom 735 died. The external validation cohort comprised 5751 participants with a median follow-up of 2·71 years, of whom 185 died. The final model included 10 predictors: age, body mass index, route of HIV acquisition, coinfection with tuberculosis, coinfection with hepatitis C virus, haemoglobin, CD4 cell count, platelet count, aspartate transaminase, and plasma glucose. The C-statistic was 0·84 (95% confidence interval 0·82-0·85) in internal validation after adjustment of optimism and 0·84 (0·82-0·87) in external validation, which remained consistently above 0·75 in all landmark time points within five years of follow up when using time-updated laboratory measurements. The calibration accuracy was satisfactory in both derivation and validation cohorts. Interpretation: We have developed and externally validated a model to predict long-term survival in PLWHA on ART. This model could be applied to individualized patient counseling and management during treatment, and future innovative trial design. Funding: Natural Science Foundation of China Excellent Young Scientists Fund, Natural Science Foundation of China International/Regional Research Collaboration Project, Natural Science Foundation of China Young Scientist Fund, the National Science and Technology Major Project of China,National Special Research Program of China for Important Infectious Diseases, 13th Five-Year Key Special Project of Ministry of Science and Technology, and the Joint-innovation Program in Healthcare for Special Scientific Research Projects of Guangzhou.

A New Strategy to Quantitatively Identify Hot-Spot Areas in Growth of New HIV Infections for Targeted Interventions.

Background: Previous geographic studies of HIV infection have usually used prevalence data, which cannot indicate the hot-spot areas of current transmission. To develop quantitative analytic measures for accurately identifying hot-spot areas in growth of new HIV infection, we investigated the geographic distribution features of recent HIV infection and long-term HIV infection using data from a whole-population physical examination in four key counties in Liangshan prefecture, which are most severely affected by HIV in China. Methods: Through a whole-population physical examination during November 2017- June 2018 in the four key counties, a total of 5,555 HIV cases were diagnosed and 246 cases were classified as recently infected by laboratory HIV recency tests. The geospatial patterns of recent and long-term HIV infected cases were compared using ordinary least squares regression and Geodetector. Further, geospatial-heterogeneity was quantified and indicated using a residual map to visualize hot-spot areas where new infection is increasing. Results: The geographic location of HIV cases showed an uneven distribution along major roads and clustered at road intersections. The geographic mapping showed that several areas were clustered with more recently infected HIV cases than long-term infected cases. The quantitative analyses showed that the geospatial asymmetry between recent and long-term HIV infection was 0.30 and 0.31 in ordinary least squares regression and Geodetector analysis, respectively. The quantitative analyses found twenty-three townships showing an increase in the number of recent infections. Conclusions: Quantitative analysis of geospatial-heterogeneous areas by comparing between recent and long-term HIV infections allows accurate identification of hot-spot areas where new infections are expanding, which can be used as a potent methodological tool to guide targeted interventions and curb the spread of the epidemic.

Fifteen years of the proficiency testing program for HIV-1 viral load testing laboratories in China, 2005-2019.

BACKGROUND: HIV-1 viral load (VL) testing is essential for monitoring the effects of antiretroviral therapy in HIV-infected patients. In order to identify factors that impact testing performance of HIV-1 VL testing laboratories, this study performed a retrospective analysis on data from the domestic HIV-1 VL proficiency testing (PT) program in China during 2005 to 2019. METHODS: Analysis was conducted on testing results of 155 PT panel specimens that were distributed to HIV-1 VL testing laboratories nationwide during 2005 to 2019. Follow-up on-site inspection records on unqualified laboratories were also analyzed. RESULTS: By 2019, 267 HIV-1 VL testing laboratories in China enrolled in the national PT assessment. Overall, HIV-1 VL testing performance has been consistently good after 2012, with less than 5% of participants reporting an unqualified score. Unsatisfactory equipment conditions and poor laboratory administration were the two main reasons causing unqualified scores in the PT assessment. Interestingly, we found that HIV-1 VL testing laboratories had better performance in the CDC system than in hospitals. In analysis on the variance of specimen testing results by different assays, we found that variation in results existed across different assay platforms, and HIV-1 VL testing assays based on real-time PCR technology showed comparatively smaller inter-laboratory variability. CONCLUSIONS: To maintain high performance in HIV-1 VL testing laboratories, it is important to strengthen laboratory management and preserve equipment conditions. Due to the variation of testing results among different assay platforms, we suggest using the same assay platform for longitudinal monitoring of patient viral load.

Identifying major drivers of incident HIV infection using recent infection testing algorithms (RITAs) to precisely inform targeted prevention.

BACKGROUND: Recent infection testing algorithms (RITAs) incorporating clinical information with the HIV recency assay have been proven to accurately classify recent infection. However, little evidence exists on whether RITAs would help in precisely identifying major drivers of the ongoing HIV epidemic. METHODS: HIV recency test results and clinical information were collected from 1152 newly diagnosed HIV cases between 2015 and 2017 in Dehong prefecture of Yunnan province, and the efficacy of four different RITAs in identifying risk factors for new HIV infection was compared. RESULTS: RITA 1 uses the recency test only. RITA 2 and RITA 3 combine the recency test with CD4+ T cell count and viral load (VL), respectively. RITA 4 combines both CD4+ T cell count and VL. All RITAs identified the MSM group and young people between 15 and 24 years as risk factors for incident HIV infection. RITA 3 and RITA 4 further identified the Dai ethnic minority as a risk factor, which had not been identified before when only the HIV recency test was used. CONCLUSIONS: By comparing different RITAs, we determined that greater accuracy in classifying recent HIV infection could help elucidate major drivers impacting the ongoing epidemic and thus inform targeted interventions.