Prevalence of HCV Antibody and its Associated Factors: A Study from Sentinel Hospitals in China.

Objective: The prevalence and related factors of serum anti-HCV in different regions and hospitals have not been studied extensively in China. We used routine screening data to determine the prevalence of HCV antibody in hospital patients, evaluate the epidemic trend of hepatitis C and formulate screening strategies. Methods: Patient information and HCV antibody testing results were collected from January 2017 to December 2019 in 77 HCV sentinel hospitals in China. Univariate and multivariate logistic regression was used to determine the characteristics and associations. Results: HCV antibody prevalence rates were distinct among patients in different departments, with a range of 0.33%-6.93%. Patients who were admitted to the liver disease-related departments (a OR = 10.76; 95% CI, 10.27-11.28), Internal Medicine (a OR = 2.87; 95% CI, 2.75-3.00), and Department of Surgery (a OR = 1.95; 95% CI, 1.87-2.04), were more likely to be tested for HCV antibody positive. HCV antibody prevalence was associated with patients aged 45 years and older (a OR = 2.74; 95% CI, 2.69-2.80), testing in infetious disease hospitals (a OR = 2.33; 95% CI, 2.26-2.40) and secondary hospitals (a OR = 1.72; 95% CI, 1.69-1.75). Patients in sentinel hospitals of the Northeast (a OR = 12.75; 95% CI, 12.40-13.11), the Central (a OR = 1.65; 95% CI, 1.61-1.70), and the West (a OR = 1.78; 95% CI, 1.73-1.83) China had higher HCV prevalence than those who were in the Eastern coastal area. Conclusion: Those who were over 45 years old and saw doctors for liver diseases, and invasive diagnosis and treatment should be referred to HCV antibody testing.

[Specific causes of death among 381 AIDS patients who died in hospitals].

OBJECTIVE: In this study, researchers investigated the demographic and clinical characteristics of AIDS patients who died in hospitals, analyzed the specific causes of death, and looked for the correlation between specific cause of death and their clinical characteristics. METHODS: Data of clinical characteristics of patients and their specific causes AIDS of death who died in the seven hospitals from 2009 to 2010 were collected retrospectively. All the specific causes of death were classified according to the Cause of Death (CoDe) project protocol. Univariate analysis and multivariate logistic regression analysis were used to find the association between some categorical variables and the risk for AIDS patients died from AIDS related illnesses. RESULTS: Clinical characteristics and the cause of death of the 381 deceased in seven hospitals in this study were collected. 82.4% were male, with priority as 30-45 years old. 123 (32.3%) death patients had received ART before death. In all death cases, the cause of death of 252 patients (66.1%) were due to AIDS related diseases, with opportunistic infections the most (92.4%). Tubercle bacillus, infection of Penicillium marneffei and Pneumocystis jiroveci were the three leading causes of opportunistic infection deaths. Of 129 patients who died of non-AIDS related disease, non-AIDS infection (29.5%), hepatitis (22.5%), and non-AIDS malignancy(10.1%)were the first three causes of death. The cause of death in patients who had injecting drug use behavior within one year, had not received ART or not long enough, with opportunistic infections, without hepatitis, with the last low CD4 cell counts before death etc. were tend to due to AIDS related disease. CONCLUSION: Opportunistic infections, non-AIDS related infections and hepatitis were the three leading causes of death in this study. The duration of time on ART had impact on the patient's cause of death. The HIV infected patients who had received ART before death had more risk to die of non-AIDS related disease, compared to patients who had not. The longer time they had accessed to ART, the less likely they would die on non-AIDS related illnesses.

[Acceptability and relevant impact factors of provider initiated testing counseling in Liangshan Yi autonomous prefecture of Sichuan province].

OBJECTIVE: To understand the acceptability and relevant impact factors of provider initiated testing counseling (abbreviated as PITC) in Liangshan Yi autonomous prefecture, so as to promote strategies for the sustainable development of PITC in AIDS epidemic areas. METHODS: Four medical institutions were selected with rates of acceptance counted. Multi-factors logistic regression was used to analyze the impact factors from the completed questionnaires. RESULTS: Among the 413 respondents, 197 patients accepted the PITC, with an acceptance rate as 47.7% (95%CI: 42.9% - 52.3%). Factors as being female (OR = 7.283, 95%CI: 3.933 - 13.465), acceptance of publicity (OR = 1.855, 95%CI: 1.013 - 3.395), worried about being infected of HIV/AIDS (OR = 2.699, 95%CI: 1.616 - 4.506) etc. were protect factors of PITC, while those who previously received HIV testing (OR = 0.226, 95%CI: 0.124 - 0.409), afraid of taking blood test (OR = 0.052, 95%CI: 0.024 - 0.106), knowing more AIDS related knowledge (OR = 0.446, 95%CI: 0.258 - 0.773) would significantly reduce the rate of acceptance. CONCLUSION: Nearly half of the outpatients from medical institutions were willing to accept PITC in Liangshan Yi prefecture, thus provided important chance for HIV screening. Ways as strengthening related counseling before and after HIV test, launching effective HIV/AIDS-related publicity and advocating correct knowledge on blood testing, etc. need to be promoted, in order to improve the acceptability of PITC.

Expansion of China's free antiretroviral treatment program.

BACKGROUND: In 2003, China's National Free Antiretroviral Treatment Program (NFATP) was initiated as a pilot, which covered only 100 HIV/AIDS patients. By 2011, the pilot had evolved into a nationwide program and had provided free treatment for over 150 000 patients. The objective of this study was to report and evaluate the progress of China's free antiretroviral treatment program. METHODS: The NFATP Database was systematically reviewed and a total of 150 692 HIV/AIDS patients were included in this study. Program progress indicators including the number of treated HIV/AIDS patients, follow-up visit rate, CD4 test rate, and viral load test rate were summarized and examined over a calendar year to evaluate the progress of NFATP quantitatively and qualitatively. RESULTS: By the end of 2011, a total of 150 692 HIV/AIDS patients had been treated through the NFATP and 122 613 of them were still on treatment. Of all patients, about 72% were enrolled during the past four years. The dominant transmission route was blood related in the early phase of the NFATP, but gradually changed to sexual contact. Besides quantitative improvements, progress indicators also demonstrated significant qualitative improvements that the program had made during the past 9 years. CONCLUSIONS: Great achievement has been made by China's NFATP. China's experience indicates the importance of a comprehensive response to the success of its treatment program. However, to ensure the quality and sustainability of treatment in the long term, more attention and resources should be paid towards program management.

[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.