Impact factors of Blastocystis hominis infection in persons living with human immunodeficiency virus: a large-scale, multi-center observational study from China.

BACKGROUND: Blastocystis hominis (Bh) is zoonotic parasitic pathogen with a high prevalent globally, causing opportunistic infections and diarrhea disease. Human immunodeficiency virus (HIV) infection disrupts the immune system by depleting CD4+ T lymphocyte (CD4+ T) cell counts, thereby increasing Bh infection risk among persons living with HIV (PLWH). However, the precise association between Bh infection risk and HIV-related biological markers and treatment processes remains poorly understood. Hence, the purpose of the study was to explore the association between Bh infection risk and CD4+ T cell counts, HIV viral load (VL), and duration of interruption in antiviral therapy among PLWH. METHODS: A large-scale multi-center cross-sectional study was conducted in China from June 2020 to December 2022. The genetic presence of Bh in fecal samples was detected by real-time fluorescence quantitative polymerase chain reaction, the CD4+ T cell counts in venous blood was measured using flowcytometry, and the HIV VL in serum was quantified using fluorescence-based instruments. Restricted cubic spline (RCS) was applied to assess the non-linear association between Bh infection risk and CD4+ T cell counts, HIV VL, and duration of interruption in highly active antiretroviral therapy (HARRT). RESULTS: A total of 1245 PLWH were enrolled in the study, the average age of PLWH was 43 years [interquartile range (IQR): 33, 52], with 452 (36.3%) being female, 50.4% (n = 628) had no immunosuppression (CD4+ T cell counts > 500 cells/µl), and 78.1% (n = 972) achieved full virological suppression (HIV VL < 50 copies/ml). Approximately 10.5% (n = 131) of PLWH had interruption. The prevalence of Bh was found to be 4.9% [95% confidence interval (CI): 3.8-6.4%] among PLWH. Significant nonlinear associations were observed between the Bh infection risk and CD4+ T cell counts (Pfor nonlinearity < 0.001, L-shaped), HIV VL (Pfor nonlinearity < 0.001, inverted U-shaped), and duration of interruption in HARRT (Pfor nonlinearity < 0.001, inverted U-shaped). CONCLUSIONS: The study revealed that VL was a better predictor of Bh infection than CD4+ T cell counts. It is crucial to consider the simultaneous surveillance of HIV VL and CD4+ T cell counts in PLWH in the regions with high level of socioeconomic development. The integrated approach can offer more comprehensive and accurate understanding in the aspects of Bh infection and other opportunistic infections, the efficacy of therapeutic drugs, and the assessment of preventive and control strategies.

[Study on HIV-1 drug resistance profile of 257 AIDS patients with failure on the first-line antiretroviral treatment in Henan].

OBJECTIVE: To understand the current situation related to genotypic resistance in patients receiving the first-line antiretroviral treatment, but with with virologic failure, in Henan province and to compare the patterns of drug resistance in patients from different areas. METHODS: 276 patients with virologic failure on first-line antiretroviral treatment were selected in three different areas of Henan, in 2010. CD4(+)T cells, virus load and genotypic resistance were measured and tested. Prevalence and mutations related to drug-resistant were analyzed. RESULTS: The overall prevalence of drug-resistance was 68.48% in 257 patients, with non-nucleoside reverse transcriptase inhibitor (NNRTIs) as 67.70%. Rate of nucleoside reverse transcriptase inhibitor (NRTIs) was 54.09%, and protease inhibitors (PIs) was 1.18%. The prevalence rates of drug-resistance in A, B and C groups were 82.35%, 97.47% and 52.80%, respectively, and withs significant differences (χ2=50.624, P=0.000). The Prevalence rates related to resistance of NNRTIs and NRTIs were also significantly different (χ2=48.771, P=0.000 and χ2=33.912, P=0.000). 26.46% of the samples had M184V/I mutation which was the highest NRTIs mutation among the 257 patients. The prevalence rates on resistance of A and B were 47.06% and 49.37%, higher than that of C (13.04%, χ2=39.905, P=0.000) followed by TAMs, TAMs-1 and TAMs-2 which were 8.56% and 4.28%. C had the lower prevalence of TAMs-1 than A and B (χ2=13.499, P=0.001). 40.47% of the samples harbored≥1 TAM, with T215Y/F having the most, as 33.85%. 31.13% of 257 patients appeared most NNRTIs mutation K103N in this study, with the prevalence rates also significant different (χ2=14.213, P=0.001) in the three areas. Two PIs mutations were detected in 257 patients: M46I/L, (1.17%) and V82F (0.39%). However, none was detected in area A. CONCLUSION: Different patterns of drug resistance were found in different areas of Henan province and should be treated differently. The work related to AIDS second-line antiretroviral therapy in Henan should be more opportune, rigorous and standardized.

[Clinical features of 66 children with acquired immunodeficiency syndrome].

OBJECTIVE: To study the clinical features of pediatric acquired immunodeficiency syndrome(AIDS). METHODS: The epidemiological, clinical and laboratory data of 66 children with AIDS were retrospectively studied. RESULTS: Of the 66 patients, 46 (69.7%) were male and 20 (30.3%) were female, with a mean age of 8.7 years (ranged 2-16 years). The mean age at diagnosis was 7.7 years (ranged 2-15 years). Vertical transmission as the route of infection was documented in 48 cases (72.7%). Fourteen children (21.2%) were infected through blood or blood products. The route of infection could not be identified in 4 cases (6.1%). Body weight loss was noted in 43 cases (65.2%), anemia in 42 cases (63.7%), fever in 40 cases (60.6%), fatigue in 38 cases (57.6%), rash in 31 cases (47.0%), chronic cough in 28 cases (12.1%), chronic diarrhea in 24 cases (36.4%), CNS involvement in 16 cases (24.2%), oral thrush in 13 cases (19.7%), and hepatosplenomegaly in 12 cases (18.2%). Body height of 30 cases (45.4%) and body weight of 26 cases (39.4%) ranked the lower level. The immune system was severely suppressed in 59 cases (89.4%) and moderately suppressed in 7 cases (10.6%). CONCLUSIONS: Vertical transmission remained the most common route of pediatric HIV infection. There were various clinical manifestations in children with AIDS. The immune systems of the majority of children with this disorder were severely suppressed.

[A retrospective cohort study on reduction of AIDS mortality among patients enrolled in national-free antiretroviral treatment programme in two cities in China].

OBJECTIVE: To determine the effect of national free highly active antiretroviral treatment (HAART) on reduction of mortality and relevant risk factors among adult Acquired immunodeficiency syndrome (AIDS) patients. METHODS: A retrospective cohort study was conducted and all AIDS patients diagnosed before Aug. 30th, 2008 in Zhumadian, Henan province, and Fuyang, Anhui province were enrolled in this study, where HAART initiated in early time. The data and information were collected such as AIDS progress, diagnosis, treatment, death and et al. RESULTS: Among 10,394 AIDS patients, the mean age was (41.7 +/- 9.3) year-old, 50.3% (5233/10,394) were male, 85.0% (8808/10,394) were married, 95.1% (9880/10,394) were farmers, and 81.2% (8438/10,394) were former plasma donors (FPDs). The coverage of HAART increased from 5.2% in 2002 to 66.5% in 2008. Conversely, the overall mortality declined from 35.4/100 person-years in 2002 to 5.9/100 person-years in 2008. In a multivariate Cox proportional hazards analysis, the greatest risk factor for mortality was non-HAART, with a hazard ratio (HR) 4.3 (95%CI: 4.0 - 4.7). Among treated patients, compared with higher CD(4)(+) T cell counts (> 200 cells/microl), those initiating therapy with lower CD(4)(+) T cell counts, were at greater risk to death (< 50 cells/microl, HR = 7.9; 50 - 199 cells/microl, HR = 2.8). Number of opportunistic infections (OIs) was risk to mortality (HR = 2.1). In addition, other risk factors included male, age (>or= 50 years old), and other infection way except FPDs (HR were 1.4, 1.6 and 1.8). CONCLUSION: The national free treatment program has significantly reduced the AIDS mortality rate among HIV-infected FPDs through the use of generic antiretroviral drugs in rural clinical settings. The effective reduction of AIDS mortality could be realized through increased coverage of therapy.

[An ambispective cohort study of the natural history of HIV infection among former unsafe commercial blood and plasma donors].

OBJECTIVE: Discussing the natural history and the influencing factors of HIV infection among former commercial blood and plasma donors engaged in unsafe blood donation practices in China. METHODS: Using ambispective cohort study, with data obtained from ten counties (districts) from six provinces in the National AIDS Control Demonstration Area. HIV/AIDS cases were found and confirmed prior to July 24, 2006 being former commercial blood. Plasma donors were selected and data regarding infection, incidence, death, and influencing factors was collected. Analysis was performed using SPSS 12.0 statistical analysis software. RESULTS: (1) In 7551 cases of HIV infection, there were 6533 typical progressors (86.52%, 4757 cases of AIDS), 108 rapid progressors (1.43%), 910 long-term non-progressors (12.05%) with 4865 cases progressed to AIDS (64.43%). The median incubation period for HIV progression to AIDS was nine years (95% CI:8.96-9.04). (2) According to data, from a total of 1157 AIDS cases without ARV therapy (23.78% of total AIDS cases), there were 283 confirmed AIDS-related deaths, of which the median survival time was 6 months (95% CI:4-7) and the two and three year fatality rates were 95% and 99%, respectively. (3) The duration of HIV incubation period was irrespective to gender and age at the time of HIV infection (P > 0.05). Length of survival for untreated AIDS showed correlation to gender (P < 0.05) but no correlation with culture, marital status or age at the time of diagnosis of AIDS (P > 0.05). CONCLUSION: Compared with the UNAIDS theory regarding slow disease progressors among adults, our study showed a longer AIDS incubation period and shorter outlook for untreated survival, but a similar incubation period for other routes of HIV infection.

[Survival analysis of 530 HIV infected former unsafe commercial blood and plasma donors].

OBJECTIVE: To investigate HIV survival time and it's influencing factors among former commercial blood and plasma donors engaged in unsafe blood donation practices in China. METHODS: HIV/AIDS cases from 8 counties (districts) in 4 provinces confirmed prior to January 24, 2006 related with former commercial blood and plasma donors were selected and data regarding infection, AIDS progression, death, and influencing factors were retrospectively collected. RESULTS: In 530 cases of HIV infection, 334 (63.0%) cases had developed AIDS, 168 (50.3%) had received antiretroviral therapy (ART), and 152 (29.0%) had died. For the 530 cases, there was an average (10.1 +/- 1.8) years of observation from time of infection. Among 166 AIDS patients not receiving ART, average survival was 9.1 years (95% CI: 9.1 - 9.4), with an 8 year survival rate of 52.0%. Among 168 AIDS patients receiving ART, average survival was 12.1 years (95% CI: 11.9 - 12.3), with a 12-year survival rate of 80.0%. In 3 years of ART, average survival was longer in the treatment group as compared to the no treatment group with a hazard ratio for death of 12.2. Univariate analysis showed a significant difference (P < 0.05) in AIDS patient average survival based on gender, age, location, ART status, and baseline CD(4)(+) T cells count. Results from multivariate COX-regression showed that highly active ant iretroriral therapy (HAART) was the strongest protective factor for prolonging AIDS patients' survival (HR = 13.3, P = 0.00). CONCLUSION: Although there are many factors influencing AIDS patients survival, intervention with HAART is the principle measure to prolong survival and decrease the risk of death.

[Epidemiology of pediatric HIV infection in six provinces of China].

OBJECTIVE: To investigate the epidemiology of pediatric human immunodeficiency virus (HIV) infection in six provinces of China. METHODS: A cross-sectional study was conducted in six provinces with the highest HIV prevalence. Surveys on demographics and HIV-related questions (transmission modes, time of diagnosis, clinical stage, laboratory test) were distributed to clinicians in these provinces. Descriptive and bivariate analyses were performed on the completed surveys. RESULTS: Survey results of 650 children [405 males and 245 females; average age: (7.9 +/- 3.2) years] were eligible for analysis. The interval between possible transmission and diagnosis was (7.1 +/- 3.2) years. The location distribution was as follows: 570 cases (87.7%) in Henan Province, 23 cases (3.5%) in Guangxi Province, 21 cases (3.2%) in Yunnan Province, 19 cases (2.9%) in Hubei Province, 10 cases (1.5%) in Anhui Province, and 7 cases (1.1%) in Shanxi Province. Transmission routes included mother-to-child transmission (75.1%), blood transfusion/ plasma donation (15.7 %), and injecting drug use (IDU, 0.5%). Former plasma donation (FPD) was the main transmission route in some provinces (Henan, Shanxi, Hubei, and Anhui), while IDU was the main transmission route in other provinces (Guangxi and Yunnan). The average age in the FPD provinces was significantly higher than that in IDU provinces [(8.1 +/- 3.2) vs. (5.4 +/- 2.2) years, P <0.001]. Among 178 patients in all six provinces who required treatment (on the basis of CD4 count or WHO staging), 133 (74.7%) did not receive treatment and 45 (25.3%) received antiretroviral therapy. CONCLUSION: Mother-to-child transmission is the main transmission mode in pediatric patients. Efforts should be made to strengthen the diagnosis and treatment of pediatric HIV/AIDS patients.