Characteristics of Long-term Nonprogressors and Viremia Controllers Infected with HIV-1 via Contaminated Blood Donations or Transfusions Conducted 20 Years Earlier / 生物医学与环境科学（英文）

To characterize long-term nonprogressors (LTNPs) and viremia controllers (VCs), infected with HIV-1 through contaminated blood donation or transfusion between 1992 and 1996 in Henan, China. LTNPs and VCs were defined by CD4+T lymphocyte (CD4) count and viral load (VL). Of 29,294 patients infected with HIV-1 via contaminated blood donation or transfusion that had conducted for more than 20 years, 92 were LTNPs/VCs. There were 70 LTNPs (0.24%), 43 VCs (0.15%), and 48 LTNPs+VCs- (0.16%). VCs had a significantly lower CD4 nadir, compared to LTNPs and LTNPs+VCs-, and no significant differences for the highest VL and HIV-1 DNA. Cases P4 and P5 were LTNPs, while their VL reached approximately 4.3 log copies/mL. P6 was a VC, but with CD4 < 500 cells/μL constantly. Data from the LTNPs/VCs cohort provided valuable information, future research is needed.

A cross-sectional study on the prevalence of HIV drug resistance in patients receiving antiretroviral treatment in Shenqiu county, Henan province / 中华流行病学杂志

Objective To understand the prevalence of drug resistance in AIDS patients who had been receiving HAART in a long run,in Shenqiu county,Henan province.Methods This crosssectional study included 120 HIV infected patients who began receiving ART (antiretroviral therapy) in 2003.Viral loads and CD4 +T cells counts were measured,and In-house drug resistance test was performed in VL ＞ 1000 copies/ml patients.Results 114 cases out of 120 patients had complete viral load data.Among them,33 cases having viral loads less than 50 copies/ml,and the remaining viral loads showed an average of lg (4.09 ± 1.10) copies/ml.The average of CD4+ T cell counts was (377 ±2 1 8) cells/ml,with 64 (53.3％) cases showing their CD4+ T cell counts higher than 350 cells/ml.In 67 patients,58 of them showed genotypic resistance,and 40 cases showed reverse transcriptase inhibitors (RTIs) resistance.The ratios of nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) resistance were 53.4％ (31/58) and 67.2％ (39/58),respectively.There were no differences of drug resistance ratio in the three treatment programs.The highest drug resistance rates in NRTIs and NNRTIs were zidovudine,lamivudin,nevirapine.However,protease inhibitors (PIs) resistance variants were not found.Conclusion The prevalence of drug-resistant strains seemed to be high in Shenqiu country,Henan province.Long-term follow-up monitoring strategy should be developed to optimize the timely treatment programs.

Epidemiological characteristics of hepatitis C in Henan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the epidemiological characteristics of hepatitis C in Henan province.</p><p><b>METHODS</b>Multistage sampling was used to investigate a group of 1-75 year-old general population, living in 30 districts of 18 cities, Henan province. Blood samples were collected and tested for anti-HCV and hepatitis C virus(HCV), from April to July 2012.</p><p><b>RESULTS</b>32 203 persons were investigated. Among the general population aged 1 to 75 years old, the overall prevalence rates of anti-HCV and HCV RNA were 0.64% and 0.35% respectively. The prevalence rates of anti-HCV among males and females were 0.60%, and 0.68% respectively, with the rates of HCV RNA as 0.37%, and 0.33% respectively. The prevalence rates of anti-HCV and HCV RNA were increasing with age. The prevalence rates of anti-HCV and HCV RNA in urban area were 0.58% and 0.32%, and in rural area as 0.41%, and 0.19% respectively.</p><p><b>CONCLUSION</b>After the implementation of comprehensive measures for HCV control and prevention, Henan province became low prevalent for HCV infection. Our data revealed that the overall prevalence remained low, but the epidemic was severe in some geographical regions in Henan province.</p>

Epidemiological survey on the hepatitis C virus and its genotyping analysis in Henan province in 2012 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the prevalence and distribution of hepatitis C virus (HCV) genotypes in Henan province in 2012.</p><p><b>METHODS</b>A total of 32 203 permanent residents (1 to 74 years old) in Henan were recruited using multi-stage random samping method from March to June 2012. All participants were asked to complete a questionnaire to collect demographic information, past medical history and the exposure history of risk factors. A blood sample of 5 ml was collected at the same time. The condition of anti-HCV and HCV RNA was determined through the ELISA test and nested RT-PCR. HCV RNA positive samples were further subject to the nonstructural protein 5 region (NS5B) gene amplification and sequencing. The sequence was amplified for the phylogenetic tree and genetic analysis. The differences of the positive rate of anti-HCV and HCV RNA and the HCV genetic subtype distribution in different respondents'characteristics were analyzed.</p><p><b>RESULTS</b>Among 32 203 subjects, the overall positive rate of anti-HCV and HCV RNA were 0.48% (153/32 203) and 0.24% (78/32 203), in which men were 0.42% (65/15 634), and 0.23% (36/15 634), and women were 0.53% (88/16 569) and 0.25% (42/16 596). The differences between men and women were not statistically significant (χ(2) values were 2.26, 0.18, respectively, both P values > 0.05). The results of NS5B genotyping and molecular evolution analysis showed that there were six subtypes in the 71 HCV RNA positive samples.In those six subtypes, the proportion of genotypes 1b, 6a, 3a, 2a, 3b and 1a were 56.3% (40/71), 19.7% (14/71), 11.3% (8/71), 8.5% (6/71), 2.8% (2/71) and 1.4% (1/71), respectively. The HCV genetic subtypes of infestor were mainly present with two branches of 1b and 6a, and the two subtypes Bootstrap values were 0.95.</p><p><b>CONCLUSION</b>The prevalence of HCV infection was high in Henan. The major HCV genotypes in patients with HCV infection were 1b and 6a.</p>

Follow-up study on 84 AIDS patients having received the replaced therapy program for six months in one county of Henan, China / 中华流行病学杂志

Objective To analyze the situation of AIDS patients who had received replaced therapy program in Henan province.Methods 84 AIDS patients had been enrolled into the national free first-line antiretroviral treatment for more than 5 years and would soon be replaced with another antiretroviral treatment program,were selected to a follow-up program to be carried out six months later Data on CD4+ tlymphocyte count,viral load and genotypic resistance were included in the study.Results The DDI + AZT + NVP treatment program was used by all the 84 patients at baseline.A replacement by 3TC + AZT + NVP (post first-line) in 31 patients and 3TC + TDF + LPV/r (second-line) in another 53 patients were taken place within a week.All the patients were followed for six months.Results showed that:all of the 84 patients appeared an amelioration of CD4 1 tlymphocyte count median from the baseline of 374.00 cell/μl to 406.50 cell/μl(P=0.005).Those patients who had changed to second-line treatment program also showed an improvement of CD4 + tlymphocyte count median from the baseline of 267.00 cell/μl to 365.00 cell/μl (P=0.015),while patients who were on the post first-line program with their CD4 + tlymphocyte count mean did not show significant change as compared to the baseline (P=0.158) data.All the 84 patients showed a decrease of virus load median from the baseline of 3.61 Iog10copies/ml to 0.00 log10 copies/ml (P=0.000).Both of the two types of patients who had been changed to different programs,had a lower virus load median in the end of the tollow-up period (for post first-line:P=0.007 ；for second-line:P=0.000).13 patients kept their viral load more than 1000 copies/ml,including 5 cases bore more than three thymidine analogue mutations (TAMs) a the end of the follow-up program.Another 4 patients had no resistance mutations detected and no significant variation of viral load (less than 3 times) in the pre-or post- surveys.Conclusion AIDS patients who had received long-term first-line antiretroviral treatment program,showed an amelioration six months after changing of the treatment program.Timely and effective testing on drug resistance as well as the strengthening of the follow-up program still seemed to be the link to those patients who were receiving first-line treatment that should not be ignored.

Men who have sex with men and its relationship with HIV-1 strains prevailing in the paid blood donors from Zhengzhou city, Henan / 中华流行病学杂志

Objective To clarify the genetic characteristics of human immunodeficiency virus (HIV) circulated in the population of men who have sex with men (MSM) in Zhengzhou,Henan and to analyze its relationship with HIV-1 prevailing in the paid blood donors (PBDs).Methods Thirty-one MSM who were confirmed as HIV positive individuals in 2010 together with 41 HIV-positive former PBDs were enrolled in the study.Information on related epidemiological characteristics and their plasma were collected.RT-PCR was used to amplify HIV-1 full length gag (1584 bp),pol (3147 bp) genes and partial env gene (C2V3 segment,558 bp) followed by sequencing on those subjects.Online software available at LosAlamos HIV Database was used to identify the HIV subtypes based on the findings of the sequences.Phylogenetic tree was used to identify thc possible relationship of transmission.Results Fifty-three full length gag,38 full length pol and 48 partial env (C2V3) genes were collected from 72 participants.Among the 31 HIV ( + )MSM individuals,14 CRF01_AE strains,5 CRF07BC_ strains and 12 subiype B ( 1 subtype B and 11B' ) strains were identified respectively.All of the 41 strains identified from former PBDs were infected by B' strains.The CRF01_AE strains identified in MSM showed a close relationship to those identified from both Hebei and Liaoning provinces.The CRF07 BC strains showed a close relationship with those from Shijiazhuang and Beijing cities.Among the 12 subtype B strains,8 sequences grouped into 1 cluster with 1 sequence from the former PBDs.Two sequences grouped with 02HNseq4 suggested that B' had been prevailed in the MSM population might come from the former PBDs and were closely related to the strains identified in the MSM population.Conclusion Complicated genetic background and multiple introductions of HIV in the MS population in Zhengzhou,were found.This was also the first report which noticed that the subtype B epidemic among Zhengzhou MSM was mainly originated from the B' among the former PBDs.

The primary HIV drug resistance in partial region of Henan province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the prevalence of primary HIV drug resistance in antiretroviral therapy (ART) areas of Henan province.</p><p><b>METHODS</b>A total of 121 drug-naive long-term infected individuals and 154 patients with newly diagnosed from January 2011 to March 2012 were recruited, the questionnaires were surveyed and whole blood were collected to analyze the CD4(+)T cell counts and viral load. In-house method for genotypic resistance test was determined in those with viral load > 1000 copies/ml samples, the differences of demographic characteristics, immunological parameters and primary drug resistance were compared between the two groups.</p><p><b>RESULTS</b>A total of 121 cases of long-term individuals who had infected (12.50 ± 3.21) years were mainly previous paid blood donors, and the age was (46.61 ± 9.32) years old. The infection route of the newly diagnosed were diversity, including blood, sexual transmission and others, the cases were 73, 73, 8, respectively, the confirmatory year was (0.91 ± 0.28) years, and average age was (22.21 ± 3.11) years old. The difference were statistically significant in the route of transmission, age and infection time from demographic analysis of the two groups (P < 0.05). The absolute M(P(25)-P(75)) counts of CD4(+)T lymphocytes of long-term group was 322 (217 - 422) cell/µl, which was lower than the newly diagnosed was 434(308 - 578) cell/µl (P < 0.05), and viral load was 4.0 (2.96 - 4.64) copies/ml, 3.77 (2.94 - 4.53) copies/ml, the difference was not significant (P > 0.05). The prevalence of primary drug resistance in long-term group and newly diagnosed was 5.79% (7/121), 9.09% (14/154), respectively, and the difference was statistically different (P < 0.05), and one PI-resistant strain was found in the newly diagnosed group.</p><p><b>CONCLUSION</b>The primary drug resistant strains in untreated patients were found in Henan province of ART areas, and there was difference in degree of resistance between long-term infected individuals and newly diagnosed.</p>

Subtype analysis of gp41 gene of HIV-1 among men who have sex with men in Zhengzhou / 中华预防医学杂志

<p><b>OBJECTIVE</b>This study aimed to investigate the subtype distribution of gp41 gene of human immunodeficiency virus-1 (HIV-1) among men who have sex with men (MSM) in Zhengzhou.</p><p><b>METHODS</b>Thirty blood samples were collected from men who have sex with men infected by HIV. The complete gp41 gene was amplified by RT-PCR and nested-PCR and sequenced. All sequences were edited by Bioedit and subtyped with HIV sequence library US Los Alamos National Laboratory and online genotyping software provided by American National Center of Biotechnology Information. Phylogenetic analysis of gp41 gene was performed using the MEGA 3.1 software, and the genic dispersion rates among subtype of gp41 gene were analyzed.</p><p><b>RESULTS</b>A total of eighteen gene sequences of HIV-1 gp41 gene were obtained from thirty men who have sex with men infected by HIV, which belonged to subtype CRF15-01B (50% (9/18)), CRF01-AE (22% (4/18)), CRF07-B (22% (4/18)) and B (6% (1/18)), respectively. The intersubtype HIV-1 strains aggregate with according reference strains. The genetic distance inter-subtype of subtype CRF15-01B, CRF01-AE and CRF07-B were 0.050 ± 0.007, 0.052 ± 0.009 and 0.082 ± 0.012, respectively.</p><p><b>CONCLUSION</b>The prevalent subtypes of HIV-1 among among MSM in Zhengzhou was complicated and recombinant HIV-1 strains were the most prevalent strains.</p>

Subtype and sequence analysis of gag gene of HIV-1 among men who have sex with men in Zhengzhou, Henan Province / 病毒学报

To investigate the subtype distribution of human immunodeficiency virus-1(HIV-1) infection among men who have sex with men (MSM) in Zhengzhou, Henan Province, forty blood samples were collected from HIV-1 carriers, who acknowledged to have sex with men. The complete gag gene was amplified by RT-PCR and nested-PCR and sequenced. All sequences were edited by BioEdit and subtyped by genotyping software. Phylogenetic analysis of gag gene were then performed using the MEGA 3.1 software, the gene distances were calculated by Distance program. There were three different HIV-1 subtypes including B, CRF01-AE and CRF07-BC present among twenty four MSMs in Zhengzhou. Genotyping results showed that 33.33% (8/24) were B, 41.67% (10/24) were CRF01-AE and 25% (6/24) were CRF07-BC, and subtype CRF01-AE had become the most prevalent HIV-1 subtype in Zhengzhou, Henan province. In conclusion, recombinant HIV-1 strains are circulating in Henan province and the epidemiology is complicated.

Study on the situation of antiretroviral therapy against HIV/AIDS in Henan province based on he CD4+ T cells count and virus load / 中华流行病学杂志

Objective To analyze the CD4 +T cells and virus load in HIV/AIDS affected population and to evaluate the HIV/AIDS antiretroviral therapy programs in Henan province.Methods "Henan HIV/AIDS Testing Laboratory Network Database" was used to collect the data on CD4+ T cells and virus load (VL) value and corresponding information in HIV/AIDS population of Henan in 2009. Cross-sectional studies was used to study the constituent ratio of CD4 + T cells and virus load value in individuals who had not received antiretroviral-treated (ART) and had joined first-line ART between the year of 2005 to 2008 among HIV/AIDS population of Henan. Results As to these people living with HIV/AIDS that had not received ART in the first half and the second half year of 2009, the constituent ratio of individuals whose CD4+T cells were less than 200 cells/μl both accounted for more than 20% (χ2=2.059, P=0.151). The constituent ratio of individuals whose CD4+T cells were in 200-350 cells/μl and more than 350 cells/μl increased from 27.61% to 29.41%(χ2=4.636, P=0.031 ) and decreased from 51.49% to 48.60% (χ2=9.767, P=0.002), respectively.Meanwhile, we saw 34.53% and 19.65% of the patients whose virus load was ＞10 000 copy/mland ＞30 000 copy/ml in this population. Patients that joined first-line ART during 2005-2008 showed the following results: the longer of the therapy time, the higher constituent ratio of individuals whose CD4+ T cells were more than 350 cells/μl (χ2= 148.689, P＜0.001) and the lower constituent ratio of individuals of whose CD4+T cells were less than 200 cells/μl (χ2=46.686,P＜0.001).Simultaneously, the lower constituent ratio of individuals whose viral load was less than 500 copy/ml (χ2=9.066, P=0.003) and the higher constituent ratio of individuals whose virus load was more than 10 000 copy/ml (χ2=6.597, P=0.010). Conclusion Significant curative effect had been achieved in AIDS first-line ART of Henan, but along with the increasing treatment time, the risk of treatment failure also increased. Drug resistance test and changing of treatment protocols were needed. To reach better and more efficient effects on therapy, factors as more detections and investments on ART, expanding the scope of treatment etc. were needed on those people living with HIV/AIDS that had not received ART.

Evaluation of BED-CEIA assay with dried blood spot specimens in China / 中华流行病学杂志

Objective To study the feasibility of using dried blood spot (DBS) specimens in BED-CEIA assay and to estimate the HIV-1 incidence with DBS in China. Methods 10 313 participants from 27 voluntary counseling and testing(VCT) sites were enrolled in this study. Both plasma and DBS specimens were collected. 349 eligible pairs of HIV-1 positive specimens confirmed by Western Blot were available for BED-CEIA and the results compared. Negative control, low positive control, high positive control and calibrator in DBS were used to evaluate the stability and repeatability of the detection results of DBS specimens. Results Of the total HIV positives, 294 and 53 participants were tested as long-term or recent HIV infections by both DBS and plasma specimens. Two participants showed different results from DBS and plasma specimens, but their final An values were close to the cutoff value of BED-CEIA assay. The concordance rate between the two types of specimens was 99.43% and the R2 linear of the stability and repeatability results of DBS specimens reached 0.9551 and 0.95, respectively. Conclusion Although some individual specimens showed different results, the incidence rates calculated from both types of specimen were equivalent. DBS specimens were suitable for estimating the HIV incidence and could be popularized in China. However, further studies regarding window period and adjustment coefficients of BED-CEIA assay are needed.