[Analysis on late HIV diagnosis among newly reported human immunodeficiency virus/acquired immunodeficiency syndrome cases between 2009 and 2017 in medical institutions].

Objective: To analyze the proportion of late HIV diagnosis and the factors associated with late HIV diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) cases newly reported by medical institutions in China from 2009 to 2017. Methods: Data of adult HIV/AIDS cases newly reported by medical institutions in China from 2009 to 2017 were downloaded from the AIDS prevention and control information system of China's disease prevention and control information system. The basic information, sample source, transmission route, flow of HIV/AIDS patients and the first CD4(+) T lymphocyte count were analyzed in 293 187 cases who had been tested for CD4(+) T lymphocyte count within 91 days of diagnosis. The multivariate logistic regression was used to analyze the late HIV diagnosis relevant factors. Results: A total of 293 187 newly reported HIV/AIDS cases in medical institutions were analyzed, and the mean age was (44.7±15.6) years. The proportion of late diagnosis in all cases was 68.4% (200 503 cases). From 2009 to 2017, the proportions of late diagnosis were 71.7% (6 263/8 737), 69.5% (8 283/11 917), 69.2% (13 230/19 116), 67.0% (17 186/25 669), 66.5% (21 833/32 834), 66.4% (26 541/39 944), 67.2% (31 257/46 536), 69.6% (35 920/51 646) and 70.4% (39 990/56 789) respectively. Compare with female cases, the OR (95%CI) of male cases with late diagnosis was 1.18 (1.15-1.20). Compared with the 18 to 29 years old group, the 30 to 39 years, 40 to 49 years, 50 to 59 years and 60 years old and over groups have higher risk of late diagnosis with OR (95%CI) values about 1.65 (1.61-1.69), 2.13 (2.08-2.19), 2.25 (2.18-2.31) and 2.33 (2.26-2.39) respectively. Compared with the college education level and above group, OR (95% CI) values of junior middle school and below group was 1.11 (1.08-1.14); and OR (95%CI) values of senior high school and equal level education group was 1.08 (1.04-1.11). Compared with the migrant population, the resident population has higher risk of late diagnosis (OR=1.06, 95%CI: 1.04-1.08). Compared with other national minorities, Han nationality has higher risk of late diagnosis (OR=1.33, 95%CI: 1.30-1.36). Compared with divorce, widowed and other marital status, married spouse have higher risk of late diagnosis (OR=1.08, 95%CI: 1.06-1.10). Compared with patients receiving other testing services, the OR (95%CI) values of examination before blood transfusion or blood products, pregnancy and childbirth examination, STD clinic and preoperative examination were 1.16 (1.08-1.25), 0.52 (0.50-0.54), 0.63 (0.61-0.64), 0.66 (0.65-0.68) respectively. Conclusion: The proportion of late HIV diagnosis of newly reported HIV/AIDS cases in medical institutions in China was relatively high from 2009 to 2017 and the factors associated with late HIV diagnosis included male, Han nationality, old age group, low educational level, married spouse, other testing services and resident population.

Prevalence of hepatitis C virus and hepatitis B virus infections in HIV-positive Chinese patients.

To evaluate the prevalence of hepatitis C virus (HCV) and/or hepatitis B virus (HBV) infections in HIV-infected patients in China, an epidemiological serosurvey was conducted from May 2007 to September 2008 using a random cluster sampling design of infectious disease hospitals in seven high HIV-prevalent provinces (municipalities). Univariate analysis and logistic regression were used to study the determinants of HIV and HBV and/or HCV co-infection. The overall prevalence was 41·83% (95% CI 40·36-43·30) for anti-HCV and 12·49% (95% CI 11·50-13·48) for HBsAg, respectively. The prevalence of anti-HCV and HBsAg varied according to the route of HIV transmission. Compared to those with sexually acquired HIV infection, intravenous drug users and blood donors/recipients had the greatest risk of carrying anti-HCV. Needle sharing and unprotected sexual exposures are important modes of transmission for HBV. Further interventions including health education and harm reduction strategies should be implemented in high-risk populations.

[Analysis of inter-provincial movement and the effect of antiretroviral therapy of HIV/AIDS cases after first follow up in China, 2016-2018].

Objective: To analyze the interprovincial movement of newly reported HIV/AIDS cases after the first follow up in China and understand their movement characteristics and the effect of antiretroviral therapy (ART) after adjustment of ART inclusion criteria. Methods: The data of HIV/AIDS cases, including the effects of ART, were extracted from the information system for HIV/AIDS prevention and control. Descriptive analysis and χ2 test was used to explore the characteristics of the movement of HIV/AIDS cases and its relationship with ART effect and viral suppression. Results: In 289 218 HIV/AIDS cases, 22 426 (7.8%) cases experienced inter-provincial movement after the first follow up. Higher prevalence of inter-provincial movement was found in males (8.3%, 18 557/223 713), those with education level of senior high school (9.6%, 4 317/44 877) and college degree and above (9.5%, 4 792/45 858), the unmarried (11.5%, 10 538/91 572), those diagnosed in detention center (16.0%, 1 268/7 927) and those infected by homosexual behavior (11.4%, 9 069/79 735). The rates of ART initiation within 1 year of diagnosis and viral suppression were lower in HIV/AIDS cases with inter-provincial movement (77.1%, 17 296/22 426 and 70.7%, 15 858/22 426) than in those without inter-provincial movement (86.7%, 231 293/266 792 and 78.6%, 209 760/266 792). After the first follow-up, 41.4% (18 887/45 570) of HIV/AIDS cases diagnosed in non-native provinces experienced inter-provincial movement, of which 92.9% (17 538/18 887) went back to native province. The top five provinces (municipalities) with outflows of HIV/AIDS cases were Guangdong, Zhejiang, Shanghai, Beijing and Sichuan. The top five provinces with inflows of HIV/AIDS cases were Sichuan, Guizhou, Guangdong, Anhui and Hunan. Conclusions: The inter-provincial movement affects ART effect and viral suppression of HIV/AIDS cases. It is necessary to pay more attention to the discovery and management of HIV/AIDS in floating population and eliminate policy barriers to ensure the timeliness and effectiveness of ART.

[Clinical study of Chinese Medicine fumigation combined with "Zhuyuan Decoction" in the treatment of chronic rhinosinusitis].

Objective:To investigate the clinical efficacy of "Zhuyuan soup" by combination with fumigation and oral administration on chronic rhinosinusitis（CRS）, further exploring effective Chinese medicine for the disease, and giving full play to the unique advantages of external treatment of traditional Chinese medicine. Method:By using randomized and positive drug controlled methods, patients with moderate-to-severe chronic rhinosinusitis were randomly divided into western medicine group and traditional Chinese medicine group, 30 cases in each group. In the western medicine group, the nasal spray hormone Budesonide was used, and the patients in the traditional Chinese medicine group were treated with the traditional Chinese medicine prescription"Zhuyuan soup"by combination with fumigation and oral administration. All of the above patients were followed up for 2 weeks, and 1 course for 1 month. Visual analogue scores were taken at each follow-up, and CT and nasal endoscopy were performed before and after treatment. Result:The total effective of "Zhuyuan soup" group was 67.1%, which was higher than that of western medicine group（59.6%）, but there was no statistically significant difference（P>0.05）. After treatment, there were no significant differences between the two groups with regard to the symptom of nasal congestion, dizziness, facial pain or fullness, dysosmia, nasal discharge or postnasal drip, total sensation, total symptom score（P>0.05）. According to the total symptom score, the effect of the two groups of patients was not significantly correlated with the gender, age, course of disease, alcohol and tobacco hobbies, previous medication and surgery（P>0.05）. Based on the results of the study, we found that the Chinese medicine group is superior to the western medicine group in improving the total feeling of the disease, dizziness or headache, facial pain or fullness, and postnasal drip, olfactory disorder. Conclusion:Both traditional Chinese medicine and western medicine are effective methods for treating chronic rhinosinusitis. Clinically, individualized comprehensive treatment should be carried out according to the patient's condition. The above methods may be applied alone or in combination with Chinese and Western medicine. Further optimization and improvement of the combination of traditional Chinese and Western medicine in chronic sinusitis can help improve the clinical efficacy and satisfaction of patients, which deserves further study.

[Situation and reasons for missed follow-up services among newly reported HIV/AIDS cases transmitted by homosexual behavior in China, 2008-2015].

Objective: To determine the prevalence and relative factors on those who missed the follow-up service among newly reported HIV/AIDS cases that were infected by homosexual behavior. Methods: Data were extracted from both HIV/AIDS case-reporting and follow-up cards on HIV/AIDS in the Comprehensive Response Information Management System, between December 2008 and December 2015. Data was analyzed, using the generalized estimating equations (GEE) to explore the relative factors of influence. Results: Among the newly reported HIV infection among MSM, the proportion of those who missed the follow-up services was 5.06% (6 037/119 358), and decreased dramatically, from 37.57% (1 261/3 356) to 0.84% (267/31 935) (trend χ(2)=103.43, P<0.01). In MSM population, the younger than 20-year olds (OR=1.30, 95%CI: 1.11-1.52), 20-year olds (OR=1.52, 95%CI: 1.36-1.69), 30-year olds (OR=1.22, 95%CI: 1.12-1.34), 40-year olds (OR=1.10, 95%CI: 1.01-1.20) were receiving less follow-up services than those 50-year olds. Those who had received either junior (OR=1.52, 95%CI: 1.37-1.69) or senior high school education (OR=1.35, 95%CI: 1.23-1.49) were receiving less follow-up service than those who were more educated. MSM with the following characteristics as unspecified occupation (OR=2.06, 95%CI: 1.49-2.87),unemployed (OR=1.54, 95%CI: 1.30-1.83), working in commercial service (OR=1.31, 95%CI: 1.15-1.49) or being student (OR=1.34, 95%CI: 1.18-1.52) were more difficult to be traced or followed than the cadres. Cases being identified on site (OR=2.99, 95%CI: 2.26-3.95) or under special investigation (OR=1.43, 95%CI: 1.29-1.59) had received less follow-up service than those being identified through voluntary counsel testing service. Floating population (OR=1.46, 95%CI: 1.28-1.66) were getting less follow-up service than local residents. Conclusions: The prevalence of those who had missed the follow-up services in the newly discovered MSM HIV cases declined dramatically. Among the MSM HIV cases, those having the following characteristics as: younger than 50-year old, with less school education, with unspecified occupation or unemployment, working in commercial service, being student, having history of incarceration, recruited from special investigation, and floating population were prone to miss the follow-up program, suggesting that the follow-up service should be targeting on these patients.