Health economic analysis and medical cost analysis of children with severe hepatitis B in China: A retrospective study from 2016 to 2022.

BACKGROUND: Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China. METHODS: Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran's I  analysis. RESULTS: The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603,) of total cases and cirrhosis cases accounted for 11.23% (180/1603,). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (GDP, Moran's I <0) and percentage of urban population (Moran's I <0), and positively correlated with the number of pediatric beds per million population (Moran's I >0). CONCLUSION: The number of severe hepatitis B cases is low in areas with high GDP levels and high urban population ratios, and health care costs have been declining over the years.

Peripheral CD8+CD28+ T lymphocytes predict the efficacy and safety of PD-1/PD-L1 inhibitors in cancer patients.

Background: Programmed cell death protein-1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors works by reactivating immune cells. Considering the accessibility of noninvasive liquid biopsies, it is advisable to employ peripheral blood lymphocyte subsets to predict immunotherapy outcomes. Methods: We retrospectively enrolled 87 patients with available baseline circulating lymphocyte subset data who received first-line PD-1/PD-L1 inhibitors at Peking Union Medical College Hospital between May 2018 and April 2022. Immune cell counts were determined by flow cytometry. Results: Patients who responded to PD-1/PD-L1 inhibitors had significantly higher circulating CD8+CD28+ T-cell counts (median [range] count: 236 [30-536] versus 138 [36-460]/µL, p < 0.001). Using 190/µL as the cutoff value, the sensitivity and specificity of CD8+CD28+ T cells for predicting immunotherapy response were 0.689 and 0.714, respectively. Furthermore, the median progression-free survival (PFS, not reached versus 8.7 months, p < 0.001) and overall survival (OS, not reached versus 16.2 months, p < 0.001) were significantly longer in the patients with higher CD8+CD28+ T-cell counts. However, the CD8+CD28+ T-cell level was also associated with the incidence of grade 3-4 immune-related adverse events (irAEs). The sensitivity and specificity of CD8+CD28+ T cells for predicting irAEs of grade 3-4 were 0.846 and 0.667, respectively, at the threshold of CD8+CD28+ T cells ≥ 309/µL. Conclusions: High circulating CD8+CD28+ T-cell levels is a potential biomarker for immunotherapy response and better prognosis, while excessive CD8+CD28+ T cells (≥ 309/µL) may also indicate the emergence of severe irAEs.

Damage Characterization of Carbon Fiber Composite Pressure Vessels Based on Modal Acoustic Emission.

This study characterized the damage characteristics of carbon fiber composite pressure vessels by the modal acoustic emission (MAE) method. The study showed how to use the extracted damage modal features and established MAE parameters to determine the damage mode of composite pressure vessels. First, the A0 and S0 Lamb modes of the AE signal were split through mode separation, and the time window was selected to establish the MAE characteristic parameters. Subsequently, based on the MAE parameters and the damage mode characteristics established from single damage experiments, a damage mode discrimination method was established. A bending test of carbon fiber composite laminates proved that the modal separation method and the MAE parameters establishment are reasonable and effective. The results from the hydraulic test of the graded loading performed on 20 MPa carbon fiber composite pressure vessels showed the accuracy of the damage mode discrimination method, and the damage state of the pressure vessel could be analyzed using the fiber fracture damage threshold according to the MAE parameters.

Deep Learning Approach for Damage Classification Based on Acoustic Emission Data in Composite Materials.

Damage detection and the classification of carbon fiber-reinforced composites using non-destructive testing (NDT) techniques are of great importance. This paper applies an acoustic emission (AE) technique to obtain AE data from three tensile damage tests determining fiber breakage, matrix cracking, and delamination. This article proposes a deep learning approach that combines a state-of-the-art deep learning technique for time series classification: the InceptionTime model with acoustic emission data for damage classification in composite materials. Raw AE time series and frequency-domain sequence data are used as the input for the InceptionTime network, and both obtain very high classification performances, achieving high accuracy scores of about 99%. The InceptionTime network produces better training, validation, and test accuracy with the raw AE time series data than it does with the frequency-domain sequence data. Simultaneously, the InceptionTime model network shows its potential in dealing with data imbalances.

Study on Delamination Damage of CFRP Laminates Based on Acoustic Emission and Micro Visualization.

This study investigated the mechanism of delamination damage in the double cantilever beam (DCB) standard test by the use of the strain energy release rate. The curve of the strain energy release rate was verified by the Rise Angle (RA) method. For this purpose, 24-layer carbon fiber/epoxy multidirectional laminates with interface orientations of 0°, 30°, 45°, and 60° were fabricated according to the standard ASTM D5528(13). In the course of this test, acoustic emission (AE) was used for real-time monitoring, and combined with micro visualization, the damage mechanism of composite multidirectional laminates was studied at multiple scales. Combining the AE detection results with micro visualization, it is found that the AE parameters and the damage to multidirectional laminates could realize a one-to-one correspondence. Through the study of the variation of the RA value, load, and strain energy release rate with the crack length, it is proved that the AE parameters can effectively characterize the initiation of delamination damage.

Incidence of hypertension among persons living with HIV in China: a multicenter cohort study.

BACKGROUND: Life expectancy among persons living with HIV (PLWH) has improved with increasing access to antiretroviral therapy (ART), however incidence of chronic comorbidities has simultaneously increased. No data are available regarding the incidence of hypertension among Chinese PLWH. METHODS: We analyzed data collected from patients enrolled in two prospective longitudinal multicenter studies of PLWH initiating ART in China. Incidence rate of hypertension per 100 person-years (PYs) among PLWH was calculated, and Cox proportional hazards models was used to evaluate the association between incident hypertension and traditional and HIV-associated risk factors. RESULTS: Of 1078 patients included in this analysis, 984 ART-naïve patients were hypertension-free at baseline, and contributed 2337.7 PYs of follow up, with a median follow-up period of 1.8 years (range: 1.2-3.2) after initiation of ART. Incidence of hypertension was 7.6 [95% confidence interval (CI): 6.5-8.7] per 100 PYs. In the Cox regression analysis, incidence of hypertension was positively associated with body mass index [adjusted hazard ratio (aHR) 1.07 (1.01,1.13), p = 0.02] and recent viral load (aHR 1.28, 95% CI:1.08-1.51, p < 0.01), and negatively associated with recent CD4+/CD8+ ratio (aHR 0.14, 95% CI:0.06-0.31, p < 0.001), zidovudine exposure (aHR 0.15, 95% CI: 0.10-0.24, p < 0.001) and tenofovir disoproxil fumarate exposure (aHR 0.13, 95% CI: 0.08-0.21, p < 0.001). CONCLUSIONS: The incidence of hypertension was relatively high among Chinese PLWH initiating ART. Recent low CD4+/CD8+ ratio and detectable HIV viremia were associated with incident hypertension, whereas receipt of ART was associated with reduced risk. Hypertension may be mitigated, in part, by excellent HIV care, including viral suppression with ART. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00872417 registered on 31 March, 2009, and NCT01844297 registered on 1 May, 2013.

Association of Body Composition and Other Clinical Factors with Incomplete Immune Response after Highly Active Antiretroviral Therapy.

Objective To explore whether baseline body composition and other clinical factors are associated with incomplete immune response after highly active antiretroviral therapy(HAART)in Chinese men with human immunodeficiency virus(HIV)or acquired immunodeficiency syndrome(AIDS).Methods A retrospective study was conducted among HIV/AIDS male patients who achieved viral suppression(maintained HIV-1 RNA levels<400 copies/ml)after a year of HAART between 2007 and 2015.Clinical,immunological,and virological data were collected from patients' files,including weight,height,and whole body composition measured within one month prior to staring HAART.Body mass index(BMI),lean mass index(LMI),fat mass index(FMI),and body bone mineral content/height were adjusted by height.According to whether the patients experienced incomplete immune responses(CD4 cell count<350 cells/µl)after a year of HAART,the patients were divided into two groups:the complete immune response(CD4 cell count≥350 cells/µl)and the incomplete immune response(CD4 cell count<350 cells/µl),respectively.Student's t test,chi-square test,and Wilcoxon rank test were used to assess differences between these two groups.Multiple Logistic regression analysis was used to assess factors associated with an incomplete immune response in patients with sustained viral suppression.Results Totally 84 HIV/AIDS male patients with viral suppression were included in this study.There were statistical differences between these two groups in terms of age(Z=-2.479,P=0.013),baseline BMI(t=2.030,P=0.045),LMI(t=2.200,P=0.029),and CD4 cell count(Z=6.416,P=0.000).However,there was no statistical differences in viral load,FMI,body bone mineral content/height,HAART duration,and HAART regimen(all P>0.05).BMI[OR=0.742,95% confidence interval(CI)=0.554-0.993,P=0.044],LMI(OR=0.459,95% CI=0.249-0.844,P=0.012),HAART duration(OR=10.161,95% CI=1.110-93.052,P=0.040),baseline CD4 cell count(OR=80.051,95% CI=8.396-762.563,P=0.000)were significantly associated with incomplete immune response.Age(OR=1.497,95% CI=0.213-10.505,P=0.685),viral load(OR=0.333,95% CI=0.071-1.572,P=0.164),FMI(OR=0.797,95% CI=0.546-1.164,P=0.240),body bone mineral content/height(OR=1.145,95% CI=0.037-35.676,P=0.938)and HAART regimen(OR=0.430,95% CI=0.159-1.159,P=0.095)were not associated with incomplete immune response.Conclusions Baseline CD4 cell count and HAART duration may affect immune response.Patients with higher baseline BMI or higher LMI may be less likely to develop incomplete immune response.Baseline FMI and body bone mineral content/height ratio are not associated with incomplete immune response.

WITHDRAWN: Association of Baseline Body Composition With Incomplete Immune Response After Highly Active Antiretroviral Therapy in Chinese HIV-Infected Adults.

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Cardiovascular disease risk among Chinese antiretroviral-naïve adults with advanced HIV disease.

BACKGROUND: Cardiovascular disease (CVD) is an important cause of mortality among HIV-infected patients, however little is known about the burden of CVD among this population in Asia. We sought to quantify prevalence of CVD risk factors, 10-year CVD risk, and patterns of CVD risk factor treatment in a group of individuals with HIV in China. METHODS: We retrospectively analyzed baseline data from treatment-naïve HIV-infected adults enrolled in two multicenter clinical trials in China. Data regarding CVD risk factors such as smoking, hypertension, diabetes, dyslipidemia and obesity were assessed. The Framingham Risk Score (FRS) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk scores were calculated to estimate 10-year CVD risk. The American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score was used to identify individuals meeting criteria for lipid-lowering therapy. RESULTS: In total, 973 patients were included in the analysis. Mean age was 36.0 ± 10.2 years and 74.2% were men. The most common CVD risk factors were dyslipidemia (51.7%) and smoking (23.7%). Prevalence of hypertension, diabetes and obesity were 8.4%, 4.6% and 1.0%, respectively. Over 65% of patients had at least one CVD risk factor. The prevalence of 10-year risk of CVD ≥10% was 4.5% based upon FRS and was 3.3% based upon D:A:D risk score. Few patients with dyslipidemia, hypertension or diabetes were on treatment. CONCLUSIONS: CVD risk factors are common but under-treated among Chinese treatment-naïve individuals with HIV. Future interventions should focus on training HIV providers to appropriately recognize and manage CVD risk factors during routine clinical assessments.

Baseline Naive CD4+ T-cell Level Predicting Immune Reconstitution in Treated HIV-infected Late Presenters.

BACKGROUND: Among HIV-infected patients initiating antiretroviral therapy (ART), early changes in CD4+ T-cell subsets are well described. However, HIV-infected late presenters initiating treatment present with a suboptimal CD4+ T-cell reconstitution and remain at a higher risk for AIDS and non-AIDS events. Therefore, factors associated with CD4+ T-cell reconstitution need to be determined in this population, which will allow designing effective immunotherapeutic strategies. METHODS: Thirty-one adult patients with baseline CD4+ T-cell count <350 cells/mm3 exhibiting viral suppression after ART initiation were followed in the HIV/AIDS research center of Peking Union Medical College Hospital in Beijing, China, from October 2002 to September 2013. Changes in T-cell subsets and associated determinants were measured. RESULTS: Median baseline CD4+ T-cell count was 70 cells/mm3. We found a biphasic reconstitution of T-cell subsets and immune activation: a rapid change during the first 6 months followed by a more gradual change over the subsequent 8 years. Baseline CD4+ T-cell count >200 cells/mm3 in comparison to CD4+ T-cell count ≤200 cells/mm3 was associated with more complete immune Reconstitution (77.8% vs. 27.3% respectively; P = 0.017) and normalized CD4/CD8 ratio. We showed that the baseline percentage of naive CD4+ T-cell was a predictive marker for complete immune reconstitution (area under receiver operating characteristic curve 0.907), and 12.4% as cutoff value had a sensitivity of 84.6% and a specificity of 88.2%. CONCLUSIONS: Baseline naive CD4+ T-cell percentage may serve as a predictive marker for optimal immune reconstitution during long-term therapy. Such study findings suggest that increasing thymic output should represent an avenue to improve patients who are diagnosed late in the course of infection.

Combination Antiretroviral Therapy Is Associated With Reduction in Liver Fibrosis Scores in HIV-1-Infected Subjects.

HIV increases the risk of liver disease as do two common coinfections, hepatitis B and C viruses (HBV and HCV). However, whether combination antiretroviral therapy (cART) reverses or exacerbates hepatic fibrosis remains unclear.This was an observational retrospective study. cART-naïve HIV-infected subjects without a history of substance abuse (including alcohol) had liver disease stage determined by aspartate aminotransferase-to-platelet ratio indices (APRIs) and fibrosis-4 (FIB-4) before and 24 and 48 weeks after cART. All the data were retrieved from previously established cohorts. Values before and after cART were compared using Wilcoxon test for paired samples. Regression analyses were used to determine factors associated with moderate-to-severe liver disease.Of the 1105 HIV-infected subjects, 120 were HBV coinfected and 64 were HCV coinfected. About 20% of HIV monoinfected participants had APRI and FIB-4 scores consistent with moderate-to-significant fibrosis compared to ∼36% of HIV-HBV coinfected and 67% to 77% of HIV-HCV coinfected participants. In adjusted analyses compared with HIV monoinfection, HBV coinfection was associated with 1.18-fold higher APRI (P < 0.001) and a 1.12-fold higher FIB-4 (P = 0.007) prior to cART; while HCV coinfection was associated with 1.94-fold higher APRI (P < 0.001) and a 1.43-fold higher FIB-4 (P < 0.001). After 48 weeks of cART, both fibrosis scores decreased in all subjects; however, HCV coinfection was still associated with higher fibrosis scores at week 48 compared to HIV monoinfection.cART was associated with improvement in hepatic fibrosis scores in the majority of HIV-hepatitis coinfected and HIV-monoinfected Chinese participants.

Lamivudine Monotherapy-Based cART Is Efficacious for HBV Treatment in HIV/HBV Coinfection When Baseline HBV DNA <20,000 IU/mL.

BACKGROUND: Although combination antiretroviral therapy (cART) including tenofovir (TDF)+lamivudine (3TC) or emtricitabine (FTC) is recommended for treatment of HIV/HBV coinfected patients, TDF is unavailable in some resource-limited areas. Some data suggest that 3TC monotherapy-based cART may be effective in patients with low pretreatment HBV DNA. METHODS: Prospective study of 151 Chinese HIV/HBV coinfected subjects of whom 60 received 3TC-based cART and 91 received TDF+3TC-based cART. Factors associated with HBV DNA suppression at 24 and 48 weeks, including anti-HBV drugs, baseline HBV DNA, and baseline CD4 cell count, were evaluated overall and stratified by baseline HBV DNA using Poisson regression with a robust error variance. RESULTS: Baseline HBV DNA ≥20,000 IU/mL was present in 48.3% and 44.0% of subjects in the 3TC and TDF groups, respectively (P = 0.60). After 48 weeks of treatment, HBV DNA suppression rates were similar between these 2 groups (96.8% vs. 98.0% for 3TC and TDF+3TC, P > 0.999) in subjects with baseline HBV DNA <20,000 IU/mL; whereas in those with baseline HBV DNA ≥20,000 IU/mL, TDF+3TC was associated with higher suppression rates (34.5% vs. 72.5% in 3TC and TDF+3TC groups, respectively, P = 0.002). In stratified multivariate regression, TDF use (RR 1.98, P = 0.010) and baseline HBV DNA (per 1 log increase in International Units Per Milliliter, RR 0.74, P < 0.001) were associated with HBV DNA suppression only when baseline HBV DNA ≥20,000 IU/mL. CONCLUSION: This study suggests that 3TC monotherapy-based cART is efficacious for HBV treatment through 48 weeks in HIV/HBV coinfection when baseline HBV DNA <20,000 IU/mL. Studies with long-term follow-up are warranted to determine if this finding persists.

[The clinical characteristics of twenty-five cases of acute HIV-1 infection in China].

OBJECTIVE: To summarize the clinical features, immunological and virological characteristics of HIV-1 infected patients in the acute phase for the sake of improving the understanding of acute HIV-1 infection and early diagnosis. METHODS: To retrospectively analyze the clinical manifestation and laboratory data of 25 patients with acute HIV infection, who were admitted to the Department of Infectious Diseases, Peking Union Medical College Hospital from 2006 to 2013. RESULTS: Among the total 25 patients, 19 (76%) patients were sexually transmitted, including 17 (68%) of whom were homosexual. Twenty two (88%) patients presented significant symptoms. Common symptoms consisted of fever (15 patients, 60%), cervical lymphoadenopathy (8 patients, 32%), skin rashes (6 patients, 24%), diarrhea (5 patients, 20%), shortness of breath (3 patients, 12%), sore throat (3 patients, 12%), and cough (3 patients, 12%), while only one case represented as Guillain-Barr syndrome, upper arm cellulitis, headache and vomiting, and perianal abscess. Laboratory examination indicated elevated peripheral lymphocytes (13 patients, 52%), abnormal liver function (11 patients, 44%), thrombocytopenia (1 patients, 4%). Notably, 2 patients (8%) revealed negative results of HIV antibody, who were diagnosed with positive plasma viral load. The average viral load was (4.68 ± 0.83) lg copies/ml. CD(+)(4) T cell count was 473 (343,621) cells/µl. CD(+)(8) T cell count was 1 296 (997, 2 177) cells/µl with maximal value of 7 984 cells/µl. The CD4/CD8 ratio was 0.33 (0.22, 0.53) including 24 (96%) patients with obvious inverted ratio. The positive rates of immune activation markers HLA-DR and CD38 on the surface of CD(+)(8) T cells were (74.9 ± 16.1) % and (84.9 ± 12.5) % respectively. The viral load had a significant positive correlation with the expression of HLA-DR and CD38. CONCLUSIONS: The most common symptoms of acute HIV-1 infection are fever, cervical lymphadenopathy, skin rashes and diarrhea. Significantly elevated CD(+)(8) T cell count, inverted CD4/CD8 ratio and abnormal immune activation markers contribute to the early diagnosis of acute HIV infection.

Prevalence of thrombocytopenia among Chinese adult antiretroviral-naïve HIV-positive patients.

BACKGROUND: The prevalence of thrombocytopenia among Chinese antiretroviral therapy (ART)-naïve HIV-infected adults has not been well-described. The aim of this study was to investigate the prevalence and associated risk factors of thrombocytopenia among Chinese ART-naïve HIV-infected adults. METHODS: We performed a cross-sectional study of Chinese adult ART-naïve HIV-infected patients from September 2005 through August 2014. Socio-demographic variables and laboratory results including platelets, CD4+ cell count, and viral load were obtained from medical records. Factors and outcomes associated with thrombocytopenia were assessed using logistic regression. RESULTS: A total of 1730 adult ART-naïve HIV-infected patients was included. The mean age was 38 years. The prevalence of thrombocytopenia was 4.5%. There were significant differences in the prevalence of thrombocytopenia between patients <30 years of age (2.8%) and 30-39 years (4.0%) compared with patients greater than 50 years (7.0%) (P = 0.006 and P = 0.044, respectively). The prevalence of thrombocytopenia was also significantly different between patients with CD4+ counts of 200-349 cells/mm 3 (3.3%) and >350 cells/mm 3 (2.8%) compared with patients with CD4+ counts of 50-199 cells/mm 3 (7.1%) (P = 0.002 and P = 0.005, respectively). The prevalence of thrombocytopenia was significantly different by hepatitis C virus antibody (HCV-Ab) seropositivity (10.2% for HCV-Ab positive vs. 3.9% for HCV-Ab negative, P = 0.001). We observed differences in prevalence of thrombocytopenia by mode of transmission of HIV infection: Blood transmission (10.7%) versus men who have sex with men (3.9%) (P = 0.002) and versus heterosexual transmission (3.9%) (P = 0.001). In binary logistic regression analyses, age ≥ 50 years, HCV-Ab positivity and having a CD4+ cell count of 50-199 cells/mm 3 were significantly associated with thrombocytopenia with adjusted odds ratio of 2.482 (95% confidence interval [CI]: 1.167, 5.281, P = 0.018), 2.091 (95% CI: 1.078, 4.055, P = 0.029) and 2.259 (95% CI: 1.028, 4.962, P = 0.042), respectively. CONCLUSIONS: Thrombocytopenia is not common among adult ART-naïve HIV-infected patients in China. Older age (age over 50 years), HCV-Ab positivity and lower CD4+ cell count are associated with an increased risk of thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.

Multicenter cohort study of diabetes mellitus and impaired fasting glucose in HIV-infected patients in China.

BACKGROUND: As life expectancy increases, HIV-infected patients are facing a wide array of metabolic complications, including diabetes mellitus (DM) and impaired fasting glucose (IFG). However, little is known about the incidence of and risk factors for glycemic disorders in Chinese HIV-infected patients. METHODS: Longitudinal data were pooled from a multicenter clinical trial of combination antiretroviral regimens between 2009 and 2010 across Mainland China. DM was defined as fasting glucose level ≥7.0 mmol/L and IFG as between 5.6 and 6.9 mmol/L on 2 separate measurements. We calculated the incidence densities of DM and IFG. Risk factors for DM and IFG were also identified. RESULTS: Four hundred fifteen patients contributed 457.35 person-years of follow-up. The incidence densities of DM and IFG were 2.62 and 35.64 per 100 person-years, respectively. In a multivariate analysis, advanced age [adjusted hazard ratio (HR): 1.03, 95% confidence interval (CI): 1.01 to 1.04], hepatitis B virus coinfection (adjusted HR: 1.59, 95% CI: 1.06 to 2.38), and baseline fasting glucose (adjusted HR: 1.28, 95% CI: 1.00 to 1.63) were associated with DM and IFG. CONCLUSIONS: A high incidence of DM and IFG was detected in Chinese HIV-infected patients receiving combination antiretroviral therapy. Clinicians should be aware of the potential for an increased risk of glycemic disorders in Chinese HIV-infected patients, particularly those of advanced age, with hepatitis B virus coinfection or high baseline fasting glucose.

[To evaluate the changes in body composition in male human immunodeficiency virus-related lipodystrophy after different treatment regimens by dual-energy X-ray absorptiometry].

OBJECTIVE: To evaluate the changes of body composition in male patients with human immunodeficiency (HIV)-related lipodystrophy (LD) syndrome (HIV-LD) switching from stavudine (d4T) to zidovudine (AZT) or tenofovir (TDF) by Dual-energy X-ray absorptiometry (DXA). METHODS: A total of 47 men with HIV-LD who had been exposed to stavudine (d4T) were enrolled in our study from May 2007 to September 2013 in Peking Union Medical College Hospital. Twice DXA assessments were administrated with interval of at least 12 months. All patients were divided into two different treatment regimens, either AZT group switching from d4T to zidovudine (AZT) or TDF group switching from d4T to TDF. Parameters of body composition in two groups were evaluated by DXA. RESULTS: Compared with baseline level, lower limb lean mass increased significantly after treatment [(15.4 ± 1.7) kg vs (16.0 ± 1.7) kg, t = 2.781, P < 0.01] and lower limb fat mass had a small decrease(P = 0.05) in AZT group. In TDF group, there were significant increases both in upper limb fat mass [(0.6 ± 0.3) kg vs (1.0 ± 0.7) kg, t = 2.422, P < 0.05] and lower limb fat mass [(1.8 ± 0.8) kg vs (2.6 ± 1.7) kg, t = 2.369, P < 0.05]. In AZT group, change of lower limb fat mass was generally small (median -0.04 kg, -4.55%). In TDF group, increase of lower limb fat mass and percentage of lower limb fat gain were even greater (median 0.46 kg, 27.41%). In a visual comparison of DXA results between AZT and TDF recipients, more fat gain of leg fat mass was seen in patients who switched from d4T to TDF (U = 2.954, P < 0.01). CONCLUSIONS: Compared with AZT group, TDF group led to a more increase in leg fat mass. Replacing d4T with TDF translates into an improvement of lipodystrophy. Although fat mass did not show a significant increase in AZT group, lean mass had improved after switching treatment, indicating AZT as a possible alternative agent of d4T. Body composition in men patients with HIV-LD can help to adjust the treatment regimen.

Prospective echocardiographic assessment of cardiac structure and function in Chinese persons living with HIV.

BACKGROUND: Persons living with human immunodeficiency virus (HIV) are at increased risk of developing cardiovascular disease. Few studies have focused on echocardiographic abnormalities in this population. METHODS: China AIDS Clinical Trial 0810 is a prospective, multicenter cohort study of persons living with HIV (PLWH). We performed an echocardiography substudy of 325 PLWH. We examined the prevalence of left ventricular systolic dysfunction (LVSD), diastolic dysfunction (DD), pulmonary arterial hypertension (PAH), and increased left ventricular mass (ILVM) in antiretroviral therapy (ART)-naive PLWH at baseline and week 48 after initiation of ART. RESULTS: Compared with age- and sex-matched healthy controls, PLWH had a higher prevalence of DD (16.5% vs 7.2%, P < .027) and a marginally significant higher prevalence of LVSD (7.3% vs 2.1%, P = .056). The increase in the prevalence of DD from baseline to week 48 in PLWH was marginally significant (P = .056). No significant difference was observed in the prevalence of LVSD, PAH, or ILVM at baseline and week 48 in PLWH. In logistic regression analysis of all participants, age was significantly associated with LVSD; HIV infection, age, and hypertension were associated with DD whereas HIV infection and hypertension were associated with ILVM at baseline. Logistic regression analysis of PLWH showed that only age was significantly associated with LVSD and DD. CONCLUSIONS: The prevalence of echocardiographic abnormalities was significantly higher in ART-naive PLWH than in controls. HIV infection was significantly associated with cardiac abnormalities. No significant change in echocardiographic abnormalities was observed after 48 weeks of ART. Longer-term prospective studies are warranted.

An antiretroviral regimen containing 6 months of stavudine followed by long-term zidovudine for first-line HIV therapy is optimal in resource-limited settings: a prospective, multicenter study in China.

BACKGROUND: An zidovudine (AZT)-substitution regimen containing 24-week stavudine (d4T) followed by long-term AZT for HIV therapy is potential to trade off short-term AZT-related anemia and long-term risks associated with d4T in resource-limited settings. However, evidence is scarce. This study aims to assess the efficacy and safety of AZT-substitution regimen, aiming to find a regimen with better efficacy, less adverse events, and more affordability in resource-limited settings. METHODS: This prospective, multicenter study enrolled 499 (190 on d4T regimen, 172 on AZT regimen, and 137 on AZT-substitution regimen) HIV-1-infected subjects who initiated combined antiretroviral therapy and attended follow-up visits over 96 weeks from 2009 to 2011. Lamivudine (3TC) and either nevirapine (NVP) or efavirenz (EFV) were the other two drugs in the antiretroviral regimens. Virologic and immunologic responses and adverse events were monitored at baseline and at weeks 4, 12, 24, 36, 48, 60, 72, 84, and 96. RESULTS: In terms of hematological adverse effects, AZT-substitution group had similar safety profiles to d4T group and was superior to AZT group. In comparison with AZT-substitution group, AZT group was associated with higher risk of developing anemia (adjusted hazard ratio (aHR) for anemia ≥ grade II, 8.44, 95% CI 1.81-39.46) and neutropenia (aHR for neutropenia ≥ grade II, 1.86, 95% CI 1.19-2.93). The prevalence of lipodystrophy in d4T group was 19.5%, while that in AZT-substitution group was zero. As to antiretroviral efficacy, these three groups showed no differences. CONCLUSION: AZT-substitution regimen provides a relatively safe and effective first-line antiretroviral strategy in resource-limited settings.