[Risk behavioral networks of newly reported HIV infections in Taizhou prefecture, Zhejiang province].

OBJECTIVE: To understand the risk behavioral networks of newly reported HIV infections in Taizhou prefecture, Zhejiang province. METHODS: Newly reported HIV infections from May 2008 through March 2010 in Taizhou prefecture were invited to participate in a cross-sectional survey which requested numbers and contact information of individuals with whom they had had high risk contacts as well as risk behavioral acts with them. Persons having had risky contacts with HIV-infected cases were thereof approached to participate in this survey and to receive HIV testing. Those who tested positive for HIV were subject to further round of the surveys. RESULTS: A total of 267 HIV cases were newly reported during this study period. Among them, 191 participated in the survey and served as 'index cases', including 158 cases identified from routine HIV surveillance programs and 33 cases identified from the present survey. Heterosexual transmission was the primary transmission route (74.9%, or 143/191), followed by homosexual transmission (19.4%, or 37/191) and injection drug use (5.8%, or 11/191). These 191 HIV cases reported a total of 1152 individuals with whom they had had risky contacts. They were able to provide contact information of 461 risk contacts. Of them, 129 received HIV testing and 61 (47.3%) tested positive for HIV. HIV prevalence was the highest among spouses or long-term sex partners of HIV cases (45.6%, or 47/103) and male sex partners of HIV-infected men having sex with men (MSM) (60.0%, or 12/20). Condom use was very low among them, with only 33.9% consistently using condoms for sex. CONCLUSION: Newly reported HIV infections in Taizhou prefecture reported a large and complicated risk behavioral networks and low condom use, suggesting a potential risk of HIV among these connected people, especially among MSM. Much efforts are needed to intervene these high risk subgroups and high risk behavioral networks.

[Study on herpes simplex virus 2 infection and risky sexual behavior among HIV-infected patients in a county of Yunnan province].

OBJECTIVE: To explore the sero-prevalence and risk factors for herpes simplex virus 2 (HSV-2) infection and unprotected sexual behavior in an ethnically diverse population of HIV-infected subjects in a county of Yunnan province. METHODS: HIV-infected individuals attending for routine follow-up by local Center for Disease Control and Prevention (CDC) were recruited to participate in the study under 'informed consent'. A face-to-face questionnaire interview was administered to each participant. Blood was drawn for HSV-2 testing by HerpeSelect HSV-2 ELISA (Focus Diagnostics) and CD(4)(+) T counting. RESULTS: A total of 300 HIV-infected individuals participated in the study. The mean age of the subjects was 37.6 years with 76.7% as males. Ethnically, Han, Dai and Jingpo accounted for 44.3%, 37.3% and 16.0% of the sample, respectively. Half of the subjects reported HIV acquisition through injection drug use. The sero-prevalence of HSV-2 was 35.0%. Results from multiple logistic regression analysis indicated that individuals who acquired HIV through heterosexual contact were more likely to be HSV-2 positive than those who acquired HIV through injection drug use (OR = 4.244, 95%CI: 1.924 - 9.364), whereas Dai (OR = 0.300, 95%CI: 0.152 - 0.593) and Jingpo (OR = 0.376, 95%CI: 0.167 - 0.850) were less likely to be HSV-2 positive than the Hans. Among 105 people who were co-infected with HIV/HSV-2, 60 had sexual intercourses in the past 3 months and 41.7% of them reported no or inconsistent use of condoms. Most unprotected sexual contacts occurred within married couples. CONCLUSION: HSV-2 infection was highly prevalent among HIV-infected individuals in this county, and a significant proportion of HIV/HSV-2 co-infected subjects engaged in unprotected sex. HSV-2 testing, behavioral and biomedical interventions among HIV-infected individuals and their sexual partners should be involved in the local HIV prevention and control programs.

[Human immunodeficiency virus/sexually transmitted infection, risk behavior and sexual networks among men who have sex with men in Taizhou city, Zhejiang province].

OBJECTIVE: To study the prevalence of human immunodeficiency virus (HIV), sexually transmitted infection (STI), risk behavior and the sexual networks among men who have sex with men (MSM) in Taizhou city, Zhejiang province. METHODS: A cross-sectional study was applied with venue-based sampling in 2 MSM gathering sites in Taizhou. 'Informed Consent' principle was applied and MSM were studied through a structured questionnaire. Blood samples were collected from those who accepted free and confidential HIV/STI counseling and then tested for HIV, syphilis, HCV and HSV-2 antibodies with ELISA. HIV positive sera were certified with western blot. RESULTS: 106 MSM were investigated and 97 qualified questionnaires were collected. 25.0% (23/92) of these MSM have ever had 1 female sex partner while 47.8% (44/92) had 2 or more. 14.3% (13/91) of them reported having had 1 male partner who had engaged in anal sex and 80.2% (73/91) had 2 or more. 22.1% (19/86) of them had participated in group sex but 62.5% (55/88) of them did not always use condom when having anal intercourse. 15.1% (14/93) of them had 1 oral sex partner while 75.3% (70/93) having 2 or more. 38.9% (37/95) of them had sex with female sex worker, and 35.5% (33/93) had sex with male-to-male sex worker. 15.3% (13/85) of them had once been male-to-male sex worker themselves. 3.9% (3/77) of them were found HIV positive in blood tests, with 24.7% (18/73) positive of syphilis, 15.1% (11/73) positive of HSV-2 but HCV appeared to be negative. 46 cases reported their egocentric recognition networks, with mean degree of 5.91 (ranging 0 - 10), and mean density of 0.548 (ranging 0.000 - 1.000). 43 sexual networks were identified, with mean degree of 2.70 (ranging 0 - 10), and mean density of 0.246 (ranging 0.000 - 1.000). CONCLUSION: Risk behaviors, such as multiple sex partners, low proportion of condom use and commercial sex engagement, both with heterosexuals and homosexuals, were extensively existed among MSM in Taizhou, and the prevalence of HIV/STI was relatively high. Their sexual networks seemed complicated but there might be in place of some substantially isolated MSM groups with high risk of HIV/STI infection. More study should be applied to identify the relationship between sexual networks and HIV/STI transmission.

[Survival and immune response of rural HIV/AIDS patients after free antiretroviral therapy].

OBJECTIVE: To assess the adherence, immunologic and survival responses in HIV-infected patients receiving free antiretroviral therapy (ART). METHODS: All adult HIV-infected patients in Wenxi county who started antiretroviral treatment (ART) between 01 July 2001 and 31 December 2006 and aged above 18 years were included in this study. Epidemiological survey and laboratory tests were performed before, 0.5 months after, 1 months after, 2 months after and every 3 months after initiation of ART to recognize the adherence, efficacy (CD(4)(+) T cell counts) and survival to the regimens. RESULTS: The median follow-up time period was 16.5 months (Interquartile: 15.5 - 20.8 months). At baseline, the median of CD(4)(+) T cell counts were 154 cells/microl (Interquartile: 81 - 212 cells/microl). Treatment was effective in most of the patients, the CD(4)(+) T cell count of patients increased after the initiation of ART. The maximum increase was recorded at month 3, from the median of 154 cells/microl to 220 cells/microl (P < 0.001), and thereafter the count remained stable. When comparing with patients with baseline CD(4)(+) T cell count > or = 100 cells/microl, those with baseline CD(4)(+) T cell count < 100 cells/microl showed a higher mean increase in the first three months of treatment. The cumulative probability rates of remaining alive were 0.94, 0.88 and 0.87 at 3, 12, 24 months, respectively. In multivariate Cox's proportional hazard models, after adjustment for the type ofinitial regimens (NVP vs. EFV/IDV), CD(+)(4) T cell count of less than 50 cells/microl (vs. 50 cells/microl or more) was strongly associated with death hazard ratio 0.21 (95%CI: 0.06 - 0.68). CONCLUSION: Our data showed that ART was effective for improving immunologic response of adult patients with HIV/AIDS. CD(4)(+) T cell count at initiation was associated with survival time in patients starting ART, suggesting that monitoring of CD(4)(+) T count should be strengthened to early initiate antiretroviral therapy for HIV-infected patients.

[Correlates of and willingness to participate in HIV voluntary counseling and testing among migrants in a city of Shanxi province].

OBJECTIVE: To determine the correlates of and willingness to participate(WTP) in HIV voluntary counseling and testing (VCT) among migrants in Shanxi province. METHODS: Through quota sampling, a total of 1280 migrants were recruited from 6 different venues where migrants were most likely employed to administer a face-to-face anonymous interview. RESULTS: Knowledge of VCT among migrants was low. Only 56.6% of migrants had heard of HIV voluntary counseling and testing. 64.5% reported willingness to accept VCT after participants were informed that HIV counseling and testing was offered free of charge Centers for Disease Prevention and Control (48.7%), hospital (27.0%) and home (18.5%) were most preferred places for VCT service. Logistic regression analysis indicated that the willingness was associated with having a history of HIV test, having better knowledge of HIV, no discrimination against people with HIV, and high HIV/AIDS perception. CONCLUSION: Community-based health education programs for improving HIV/AIDS knowledge, promoting acceptance of VCT and eliminating discrimination to HIV-infected persons were called for.

[Investigating the correlation between polymorphisms with couple sharing rate of TAP gene and hypertensive disorder complicating pregnancy].

OBJECTIVE: To investigate and clarify whether the genetic susceptibility to women with hypertensive disorder complicating pregnancy or pre-eclampsia is associated with polymorphisms and couple sharing rate of transporter associate with antigen processing genes(TAP). METHODS: One hundred and two severe pre-eclampsia women and their spouses served as study group, and 200 normal pregnant women and their spouses were selected as control group. All pregnant women were primipara with single fetus. Genomic DNA was extracted from 2 mL cubital venous blood. We used the amplification refractory mutation system polymerase chain reaction(ARMS-PCR) to characterize TAP gene locus 333, 637, 379, 565, 665. RESULTS: We observed eleven TAP haplotypes. There were four kinds of haplotypes(1A-1D) existing in TAP1, and seven kinds of haplotypes(2A-2G) existing in TAP2. The gene frequencies of TAP2B(Chi2=9.19, P<0.01, RR=4.18) and TAP2F(Chi2=5.34, P<0.05, RR=4.63) of patient group with pre-eclampsia were significantly higher as compared with control group. The analyses of some TAP haplotypes such as TAP1B(Chi2=4.87, P<0.05, RR=3.14), TAP1C(Chi2=5.42, P<0.05, RR=4.90), TAP2B(Chi2=9.65, P<0.01, RR=5.39) showed that the couple sharing rate of pre-eclampsia women and their spouses had statistically a highly significant increase in comparison with that of controls. CONCLUSION: Our data suggest that the presence of TAP2B or TAP2F haplotypes should be considered as a risk increased to pregnant women being susceptible to hypertensive disorder complicating pregnancy; and also the elevated couple sharing rates of TAP1B, TAP1C and TAP2B genes will increase the opportunity or possibility of pregnant women suffering from pre-eclampsia disease.

[Detection and analysis of partial sequences isolated from human and swine in rural area of southern China].

OBJECTIVE: To study the genotype of swines isolated from humans and their relationships with hepatitis E virus (HEV) in the rural areas of southern China. METHODS: Specimens collected from normal people with HEV-IgM positive, acute hepatitis E patients and from swine in the same area were detected for HEV RNA using RT-nPCR with ORF2 primers. The positive PCR products were cloned and sequenced. RESULTS: 13 out of the 132 samples from swine stool, 4 of 26 HEV-IgM positive sera of normal people and 1 of 4 acute hepatitis E patients' stool sample and sera were tested positive for HEV RNA. Data from sequence analysis showed that the identity at nucleotide level was 89.3%-100.0% among the 10 isolates which shared 78.7% - 84.7%, 83.3% - 85.3%, 76.0% - 80.0% and 84.7% - 95.3% nucleotide sequence identity with HEV genotype I, II, III and IV respectively in the region (nt6317- 6466). CONCLUSION: HEV circulating in humans and swine in the area belonged to genotype IV.

[Study on the identification of HIV/AIDS and its surveillance system in rural areas of central China].

OBJECTIVE: To explore the effective strategies for human immunodeficiency virus (HIV) surveillance and identification in rural areas of central China. METHODS: In a selected rural prefecture area of central China, an epidemiological investigation was conducted for all reported HIV/AIDS cases. A historical and analytic review was performed, with particular interests in examining the HIV epidemic reporting and identification system. RESULTS: Among all 626 reported HIV-infected individuals in the selected prefecture, 86.1% (539/626) of them were infected through commercial plasma donation or clinically operated blood transfusion. With respect to disease surveillance and identification in the area, 52.2% (327/626) of all the cases were reported by hospitals or clinics. The number and proportion of HIV/AIDS cases identified or reported at county, prefecture, and provincial levels were 207 (33.1%), 303 (48.4%) and 116 (18.5%), respectively. The number and proportion of HIV/AIDS identified through specific epidemiological investigations and/or voluntary testing had been increased in recent years. In addition, among HIV/AIDS cases that were clinically identified, the proportion of those who were identified as outpatients had steadily increased,with the highest proportion (59.3%) observed in 2004. CONCLUSIONS: In rural areas of central China where the major mode of HIV transmission was through commercial plasma donation or clinically operated blood transfusion, hospitals and clinics seemed to have played and would continue to play important roles regarding HIV identification and surveillance. The role of institutions or settings at the prefecture level regarding HIV identification and surveillance should not be ignored.

[Evaluation of the reliability of three different hepatitis E diagnosis reagents on the clinical acute hepatitis E].

OBJECTIVE: To evaluate the reliability of different hepatitis E diagnosis reagent tests on the acute hepatitis E. METHODS: Three acute hepatitis E diagnosis tests, E2-IgM (Wantai, China), GL-IgM and GL-IgG (Genelabs, Singapore) were compared for their reliability in a sera panel composed by 273 healthy individuals and 525 hepatitis. RESULTS: The specificity of E2-IgM on the diagnosis of acute hepatitis E was 100.0%, it was significantly higher than GL-IgM (96.7%) and GL-IgG (85.4%). The sensitivity of E2-IgM and GL-IgG were 97.9% and 93.8% respectively, both significantly higher than GL-IgM (72.9%). Among 65 acute hepatitis cases being positive on GL-IgM test but negative on E2-IgM, 58 (89.2%) cases were found to be positive with anti-hepatitis A virus IgM, it indicated that the GL-IgM test might be interfered by other IgM antibodies on serum. CONCLUSION: E2-IgM is a good test for the diagnosis of acute hepatitis E.