[New progress on the clinical study of antiviral therapy for chronic hepatitis B in children].

Diagnosis and treatment of hepatitis B virus (HBV) infection in children is a hotspot of concern in the field of HBV infection. This article reviews the current status and progress of antiviral treatment for children with chronic hepatitis B (CHB) in recent years, focusing on clinical issues such as the choice of antiviral treatment regimen for children with HBeAg-positive CHB (immune-clearance phase), the necessity of antiviral treatment for children with HBeAg-positive HBV infection (immune-tolerance phase), and the timing of antiviral treatment for infants with HBV infection, to explore the relevant factors that may affect the clinical cure of children with CHB. At the same time, based on the expert consensus on the prevention and treatment of children with CHB just published by Chinese experts, relevant diagnosis and treatment plans are proposed, with a view to providing reference and basis for clinical decision-making in children with CHB.

[Survey of prevalence of hepatitis C in people aged 1-69 years in Henan Province, 2020].

Objective: To understand the infection status and epidemiological characteristics of hepatitis C in people aged 1-69 years in Henan Province in 2020. Methods: The estimated sample size was 5 827. From August to December 2020, multistage sampling was used to select 8 counties (districts) in Henan, and two survey sites were selected in each county (district), and a questionnaire survey was conducted in local people aged 1-69 years, blood samples were collected from them for anti-HCV, HCV RNA and genotype detections. Results: A total of 5 165 people aged 1-69 years completed the questionnaire survey. Men accounted for 44.76% (2 312/5 165), women accounted for 55.24% (2 853/5 165). In the people aged 1-69 years, the overall prevalence rates of anti-HCV and HCV RNA were 0.69% (95%CI: 0.68%-0.70%) and 0.20% (95%CI: 0.19%-0.21%) respectively. The prevalence rates of anti-HCV and HCV RNA were 0.48% (95%CI: 0.46%-0.50%), 0.09% (95%CI: 0.08%-0.10%) in men and 0.86% (95%CI: 0.85%-0.87%), 0.30% (95%CI: 0.28%-0.32%) in women. The prevalence rates of anti-HCV and HCV RNA increased with age. The prevalence rates of anti-HCV and HCV RNA were 0.87% (95%CI: 0.86%-0.88%), 0.28% (95%CI: 0.26%-0.30%) in urban residents and 0.53% (95%CI: 0.51%-0.55%), 0.14% (95%CI: 0.13%-0.15%) in rural residents. The genotyping results of 10 HCV RNA positive samples ware genotype 1b (4/10), genotype 2 (3/10), genotype 1b/3 (1/10), genotype 1b/3/6 (1/10) and genotype 2/6 (1/10). Conclusions: The prevalence of hepatitis C was low in Henan in 2020. It is necessary to strengthen hepatitis C surveillance in people aged 40 years and above. The major HCV genotypes were 1b and 2, and mixed genotype infection existed.

[Epidemiological characteristics of newly reported HIV-infected cases aged 50 years and above in Henan province, 1995-2020].

Objective: To analyze the epidemiological characteristics of newly reported HIV-infected cases aged 50 years and above in Henan province during 1995-2020, and to provide evidence for strategies on HIV/AIDS prevention and control. Methods: Information about newly reported HIV-infected cases aged 50 years and above in Henan between 1995 and 2020 were collected from the National Comprehensive HIV/AIDS Information System. The demographic and behavioral characteristics of HIV-infected cases aged ≥50 were analyzed, and the mixed linear model based on CD4+ T lymphocyte (CD4) counts back calculation was used to estimate the years, time and age of the HIV infection. Results: During 1995-2020, a total of 25 038 HIV-infected cases aged 50 years and above were newly reported, accounting for 25.8% (25 038/96 867) of the total number of newly reported HIV-infected cases in Henan. The proportion of newly reported cases over 50-years-old gradually increased from 4.5% (18/396) in 1995-2000 to 35.5% (9 666/27 239) in 2016-2020, with statistically significant difference (χ2=3 105.53, P<0.001). Among them, the proportion of HIV-infected cases aged 60 years and above were increasing year by year. The proportion of male cases were increasing along with ageing. The proportion of HIV-infected cases detected by medical institutions also showed an upward trend. The newly reported HIV-infected cases aged 50 years and above were mainly transmitted through sexual contact. The proportion of heterosexual transmission increased from 5.5% (1/18) in 1995-2000 to 86.2% (8 334/9 666) in 2016-2020, and the proportion of MSM-behavior-related transmission increased from 0.0% in 1995-2000 to 13.5% (1 304/9 666) in 2016-2020. The majority of cases had extra-marital and/or non-commercial heterosexual behavior (48.1%, 4 007/8 334) and the proportion showed an upward trend. The majority of male cases had commercial heterosexual behavior (54.9%, 3 169/5 775), and with increasing proportion along with the increase of age. The majority of female cases had extra-marital and/or non-commercial heterosexual behavior (62.5%, 1 600/2 559), with increasing proportion of extra-marital and/or non-commercial heterosexual behavior. The proportion of heterosexual behavior with spouse or stable sexual partners showed a downward trend. The estimations based on CD4 counts back calculation model showed that among the newly reported HIV-infected cases aged 50 years and above, the average age being infected was (54.8±10.2) years, with 33.8% (4 263/12 621) infected before 50. The interval between infection and diagnosis was (5.7±6.2) years, of which 52.6% (6 636/12 621) were infected for 5 years or longer and 34.7% (4 384/12 621) were in the last 3 years. There was no linear correlation trend in the composition of infection years among the newly reported HIV-infected cases over 50-years-old. Conclusions: In Henan, from 1995 to 2020, the number of newly reported HIV-infected cases aged 50 years and above was increasing and sexual transmission becoming the main transmission route. The increase of prevalence was mostly seen in 60-years-old men, low education level and detected mainly by medical institutions. For this age group, the focus of HIV/AIDS prevention and control should target on those who were transmitted through extra-marital and/or non-commercial heterosexual, commercial heterosexual and MSM behavior and it is necessary to strengthen the HIV testing and detection in this population and in the elderly floating group.

[Research progress on the characteristics of immune tolerant phase and antiviral therapy in children with chronic hepatitis B].

Whether or not children with chronic hepatitis B (CHB) in the immune-tolerant phase need to be treated is one of the hot clinical issues that have not yet been clarified. Thus, in order to make clinical antiviral treatment decisions in children with an immune tolerant phase, a comprehensive understanding of the natural history of HBV infection, as well as its relationship with disease progression and whether prompt treatment can alter the natural history and prognosis, is very important. To that end, this article reviews the research progress of clinical antiviral therapy in the immune-tolerant phase for children with chronic hepatitis B over the last decade, while also discussing the treatment's safety, effectiveness, and related immunological mechanisms, so as to clarify the next key step in research orientation, provide direct evidence-based medical evidence for hepatologists to better diagnose and treat, and ultimately improve the clinical cure rate.

[Characteristics and trends of HIV/AIDS cases with the non-martial and non-commercial heterosexual transmission in Henan province, 2015-2020].

Objective: To analysis the characteristics and trends of non-martial and non-commercial heterosexual transmission of HIV/AIDS cases in Henan province between 2015 and 2020. Methods: Information of newly reported HIV/AIDS through non-martial and non-commercial heterosexual transmission was collected from National Comprehensive HIV/AIDS Information system, using SPSS 22.0 to analyze the characteristics and tend of cases. Results: During 2015-2020, a total of 10 877 HIV/AIDS cases infected by non-martial and non-commercial heterosexual transmission were newly reported in Henan province. This mode of infection increased from 32.6% in 2015 to 35.5% in 2020 (trend χ2=81.880,P<0.01). The male to female ratio was 1.9∶1 (7 105∶3 772). The mean age was (45.5±15.8) years, increasing annually (F=5.184,P<0.01). For female cases, the proportion of aged 15-50 years group was decreased annually (trend χ2=69.888, P<0.01). Most HIV/AIDS cases were distributed in the early HIV epidemic areas and Zhengzhou city, the same as the cases of the first CD4+T cells counts (CD4) below 200 cells/µl. The median (P25, P75) first CD4 count was 298 (143, 462) cells/µl. The proportion of the first CD4<200 cells/µl was no significant change annually, while the proportion of the first CD4≥500 cells/µl was decreasing annually (trend χ2=18.961,P<0.01). Conclusions: The reported cases through non-martial and non-commercial heterosexual transmission increased, with most of them were male, married, junior, farmer, migrant laborer, and aged 40-59 years. It is needed to focus on the rural district and the middle-aged population, combined with biological and social factors to control the prevalence of AIDS through comprehensive prevention and control measures.

[Characteristics of newly reported HIV/AIDS cases in Henan province, 2010-2018].

Objective: To analyze the epidemiological characteristics of newly reported HIV/AIDS cases in Henan province during 2010-2018, and to provide theoretical evidence for strategies on prevention and control. Methods: Information about newly reported HIV/AIDS cases in Henan between January 1, 2010 and December 31, 2018 were collected from the National Comprehensive HIV/AIDS Information System. Excel 2010 and software SPSS 23.0 were used for data cleaning and statistical analysis. Results: During 2010-2018, a total of 41 223 HIV/AIDS cases were newly reported in Henan, and the number of newly reported HIV/AIDS cases increased from 3 087 in 2010 to 5 910 in 2018. Sexual contact was the predominant transmission route in newly reported HIV/AIDS cases, and the proportion of sexual transmission increased from 50.6% (1 564/3 087) in 2010 to 98.8% (5 839/5 910) in 2018. The proportion of heterosexual transmission firstly increased from 44.9% (1 387/3 087) in 2010 and then declined to 65.7% (3 885/5 910) in 2018, and the proportion of MSM behavior related transmission increased from 5.7% (177/3 087) in 2010 to 33.1% (1 954/5 910) in 2018. Among the newly reported heterosexual transmitted cases, the proportion of cases with non-marital heterosexual behaviors increased from 69.4% (962/1 387) in 2010 to 91.7% (3 562/3 885) in 2018 (χ(2)=657.802, P<0.001). The number of newly reported HIV/AIDS cases in young people aged 15-24 years and old people aged ≥60 years increased year by year. The youth cases were mainly infected by MSM behavior transmission (52.7%, 2 561/4 856), and heterosexual transmission was the main infection route of the elder cases (86.4%, 5 907/6 833). Among the elder cases infected by heterosexual transmission, cases with non-marital heterosexual behaviors were mainly males, the number of male cases increased from 122 in 2010 to 738 in 2018, and sex composition ratio was between 82.2% and 91.0%, while the sex composition ratio of female cases was increased from 9.0% (12/134) in 2010 to 17.8% (160/898) in 2018. Conclusions: From 2010 to 2018, the number of newly reported HIV/AIDS cases in Henan increased. Sexual transmission had become the main transmission route. AIDS prevention and control should focus on the control of non-marital heterosexual transmission and MSM behavior transmission, and to pay more attention to young people and people aged 60 years and above.

Preventing arteriovenous shunt failure in hemodialysis patients: a population-based cohort study.

Essentials Uncertainty remains about antiplatelets for vascular access patency in hemodialysis patients. 95 971 people under hemodialysis were followed in a claims database in Taiwan. Aspirin reduced vascular access failure rate and did not increase major bleeding rate. Clopidogrel, Aggrenox, and warfarin might increase major bleeding rate. SUMMARY: Background Dialysis adequacy is a major determinant of survival for patients with end-stage renal disease. Good vascular access is essential to achieve adequate dialysis. Objectives This study evaluated the impacts of different drugs on the vascular access failure rate of an arteriovenous fistula or an arteriovenous graft and the rate of major bleeding in hemodialysis patients. Patients and methods We studied patients with end-stage renal disease registered in the Taiwan National Health Insurance program from 1 January 1997 to 31 December 2012. A total of 95 971 patients were enrolled in our study. Vascular access dysfunction was defined as the need for thrombectomy or percutaneous angioplasty. Major bleeding was defined as emergency department visits or hospitalization with a primary diagnosis of gastrointestinal bleeding or intracerebral hemorrhage. The adjusted odds ratios between person-quarters with or without antiplatelet or oral anticoagulant use were calculated using a generalized estimating equation. Results The odds ratio of vascular access failure was 0.21 (0.11-0.39) for aspirin, 0.76 (0.74-0.79) for clopidogrel, 0.67 (0.59-0.77) for dipyridamole, 0.67 (0.53-0.86) for Aggrenox and 0.96 (0.90-1.03) for warfarin. The highest odds ratio for intracerebral hemorrhage was 5.33 (1.25-22.72) in younger patients using Aggrenox. The highest odds ratio for gastrointestinal bleeding was 1.34 (1.10-1.64) for clopidogrel. Conclusion Antiplatelet agents, but not warfarin, might reduce the vascular access thrombosis rate. The gastrointestinal bleeding rate was increased in the group using clopidogrel. Aggrenox should be used with caution in young individuals because it might increase the rate of intracerebral hemorrhage.

[A qualitative study on high risk behaviors and related factors of reported HIV/AIDS cases aged 60 years and above in some areas of Henan province].

Objective: To understand the major high risk behaviors and related factors among reported HIV/AIDS cases aged ≥60 years in some areas of Henan province. Methods: In Dengzhou, Xunxian county of Hebi and Xiangcheng county of Xuchang, where the reported number and proportion of HIV/AIDS cases aged ≥60 years were high, a face to face interview was conducted among the cases aged ≥60 years during July-August in 2016. The information about the high risk behaviors before HIV infection confirmation were collected by using a semi-structured questionnaire. Results: A total of 33 HIV/AIDS cases aged ≥60 years were interviewed, including 28 males and 5 females. Their average age was 67.4 years. The infection route was sexual contact. The main findings revealed that the main factor for HIV infection in elder males was commercial heterosexual behavior with local female sex workers. The condom use rate was low. The poor awareness of the knowledge about AIDS prevention could explain why the elderly could not recognize the risk of HIV infection. There were also homosexual and bisexual behaviors in elder male HIV/AIDS patients. Late detection of HIV transmission among couples was the main cause of HIV infection in elder women. Conclusions: The major epidemiological related factors for HIV infection in the elderly in some areas of Henan were unsafe sex behavior and the poor awareness of knowledge about AIDS prevention. A targeted strategy should be taken to control the spread of HIV in the elderly.

[Effectiveness of prevention of mother to child HIV transmission in Henan province, 2002-2013].

Objective: To evaluate the effectiveness of the intervention on preventing mother to child transmission of HIV and identify the influencing factors. Methods: The data regarding the pregnant women and their infants were collected, including demographic characteristics, pregnancy and delivery, access to antiviral therapy, HIV infection status at age 18 months and survival of infants between 2002 and 2013 through follow-up, Multivariate logistic regression model were used to identify the influencing factors. Results: By the end of 2013, a total of 8 621 554 pregnant women received HIV test, among them 2 264 were infected with HIV. The positive rate of HIV is 0.03%. The HIV positive rate decreased year by year (χ(2) =4.871, P=0.027). A total of 1 530 infants were born from 2002 to 2013, among them 1 384 survived and 92 died at age of 18 months, and 54 were lost for follow up. Sixty infants were tested to be HIV-positive, 1 324 infants were tested to be HIV-negative. The mother to child transmission rate was 4.34%, the corrective mother to child transmission rate was 6.33%. Receiving HIV prevention service in early pregnancy (OR=0.26, 95% CI: 0.09-0.77), standardized antiviral therapy (OR=0.42, 95% CI: 0.21-0.82), artificial feeding (OR=0.06, 95% CI: 0.02-0.21) might be the main protective factors, episiotomy on delivery (OR=3.91, 95% CI: 1.74-8.80) might be the risk factors. Conclusion: The HIV tested positive rate remained to be low and decreased year by year in pregnant women in Henan, but the mother to child HIV transmission rate was high. It is necessary to improve the prevention of mother to child HIV transmission.

[A retrospective cohort study on survival status of AIDS patients among 15 or above-year-olds in Henan province, from 2008 to 2015].

Objective: To explore the survival status and affecting factors among patients diagnosed as AIDS, in Henan province. Methods: Database of AIDS patients were downloaded from the China information system for disease prevention and control-AIDS with a retrospective study conducted. Inclusion criteria on patients would involve those diagnosed between 2008 and 2015, aged 15 years or above. Results: A total number of 25 525 HIV/AIDS patients were enrolled in this study. During the follow-up period, the overall mortality among all the patients was 24.9%. Mortality of those having received the highly active antiretroviral treatment (HAART) was 14.4%. Proportion for the treatment coverage increased gradually, from 72.1% in 2008 to 92.8% in 2015. The overall mortality rate dropped from 21.2% to 4.1% and the mortality of those having received HAART patients dropped from 9.2% to 2.6%. Results from the multiple factors analysis showed that factors as: CD(4)(+) T cell count (CD(4)) <50 cell/µl when the AIDS diagnosis was made (adjusted HR=2.45) were related to higher risk on mortality among HIV/AIDS patients. Patients having received HAART (adjusted HR=0.13) had lower risks on mortality. Among patients having received treatment, results from the multiple factors analysis showed that factor as TMP-SMZ dosage being administered (adjusted HR=0.76) were related to low mortality risk. As for CD(4) counts of the patients, the adjusted HRs were 1.26 in 50-cells/µl group and 1.97 in the <50 cells/µl group, respectively when the diagnosis was made. Both groups had high risk on mortality patients with lower baseline CD(4) counts (adjusted HR were 1.44, 1.84 in 50-cells/µl and <50 cells/µl groups, respectively) seemed to have higher risk on mortality. Conclusions: Antiretroviral therapy appeared an important factor that affecting the survival of HIV/AIDS patients. CD(4) count test, early identifying and treating the AIDS patients together with providing TMP-SMZ prevention and treatment programs, were important approaches in extending the survival time so as to reduce the death rates from AIDS related illnesses.

[Diversity of HIV-1 subtypes and primary HIV-1 drug resistance among 302 newly confirmed HIV infections/AIDS in Henan province, China].

OBJECTIVE: To investigate HIV-1 subtype diversity and the frequency of primary drug resistance in newly confirmed HIV infections/AIDS, and the ratio of recently infected cases in Henan. METHODS: Newly confirmed HIV infections/AIDS from June 2013 to October 2013 and from June 2014 to October 2014 in the municipal CDC and county CDC of six cities in Henan province (Nanyang, Luohe, Pingdingshan, Shangqiu, Xuchang and Zhengzhou) were included in this study. Information on demographics, route of infection and antiviral therapy regimen were obtained from report cards, and at follow-up visits. After collection of blood samples from 402 individuals for confirmatory diagnostic tests, 100 were excluded because of hemolysis or insufficient samples in 11 cases, and incomplete amplification results in 89 cases. Recent HIV infection was determined by the BED capture immunoassay. An in-house method were used for genotypic drug resistance tests and sequence analysis. RESULTS: Among the 302 individuals included, the mean age was (44.0±15.5) years, and 160 (53.0%) and 142 (47.0%) cases were confirmed in 2013 and 2014, respectively. The ratio of recent infections was 29.5% (89 cases), inside, the ratio of recent infections were 31.3% (20/64), 40.5% (30/74), 21.3% (32/150), 3/8 and 4/6 in 01_AE, 07_BC, B, 01_B and other subtypes (B/C, C, 01_BC and 08_BC) (χ(2)=13.48, P=0.009). The frequency of the B subtype was higher in former infections, at 55.4% (118/213), than in recent infections, at 36% (32/89) (χ(2)=9.49, P=0.002). In contrast, the ratios of both 07_BC and other subtypes were lower in former infections (20.7% (44/213) and 1% (2/213), respectively) than recent infections (33.7% (30/89), χ(2)=5.78, P=0.016 and 5% (4/89), χ(2)=4.08; P=0.044, respectively). The frequency of primary HIV-1 drug resistance was 6.0% (18 cases) in 302 subjects. The frequency of resistance to nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs was 2.7% (8 cases) and 3.6% (11 cases), respectively. Primary HIV-1 drug resistance was more frequent in subtypes B and 07_BC, at 8.7% (13 cases) and 5.4% (4 cases), respectively. CONCLUSION: Newly confirmed HIV infections/AIDS in Henan province harbored certain proportion of none-B subtypes, the frequency of primary resistance tended to be high in HIV-1B infection. The molecular epidemiology of HIV and the development of primary drug resistance should be regularly monitored.

[HCV infection status and related risk factors in drug users under HIV sentinel surveillance in Henan province, 2011-2015].

OBJECTIVE: To understand the hepatitis C virus infection status and related risk factors in drug users in Henan province during 2011-2015 and provide scientific evidence for the development of HCV infection prevention and control measures. METHODS: Cross-sectional questionnaire surveys were conducted among the drug users and blood samples were taken from them for HCV antibody detection during HIV sentinel surveillance period in Henan province from April to June during 2011-2015. RESULTS: The HCV infection rate in drug users increased from 3.70% in 2011 to 6.54% in 2015 (trend χ(2)=25.93, P<0.01). Multivariate analysis indicated that HCV infection related risk factors included age older (OR=1.23, 95% CI: 1.13-1.35, P=0.00), place of domicile (OR=3.45, 95%CI: 2.59-4.60, P=0.00), traditional drug user or mixed drug user (OR=1.46, 95%CI: 1.10-1.93, P=0.01; OR=1.82, 95%CI: 1.18-2.81, P=0.01), injecting drug user (OR=2.88, 95%CI: 2.45-3.39, P=0.00), commercial sex behavior in recent one year (OR=1.44, 95%CI: 1.20-1.72, P=0.00) and drug user in compulsory drug rehabilitation or those receiving methadone maintenance treatment (OR=1.79, 95% CI: 1.28-2.50, P=0.00; OR=1.74, 95% CI: 1.17-2.58, P=0.01). CONCLUSION: The HCV infection rate in drug users was higher in Henan and increased rapidly with years. In order to control HCV spread, it is necessary to strengthen the management of drug users and take effective intervention measures.

[Survival effect after antiretroviral treatment initiating at different times on AIDS patients in Henan province, 2002-2014].

OBJECTIVE: To study the survival effect of AIDS patients after the antiretroviral treatment that initiated at different times and to understand the factors associated with the survival time. METHODS: Information on AIDS patients who started receiving the antiretroviral therapy during 2002-2014 was collected from the Chinese HIV/AIDS Integrated Control System in Henan province. According to the level of baseline immunology, all the participants were divided into earlier treatment group [Baseline CD4(+)T lymphocyte cell counts (CD4) between 350/µl and 500/µl] or conventional treatment group (Baseline CD4 cell counts≤350/µl). Data was analyzed with both Survival and Review methods. RESULTS: A total number of 37 169 cases were selected, including 32 129 cases in the conventional treatment group and 5 040 cases in the earlier treatment group. Mortalities in the conventional treatment group and earlier treatment group were 4.3/100 person year and 1.8/100 person year, respectively. Data on the 11-year cumulative survival rate of both the conventional treatment group and earlier treatment group were 67.9% and 82.3%, respectively. By means of multi-variable analysis, we found that factors as gender, age, marital status, route of infection, number of symptoms, missed taking drugs in the past 7 days, degree of education at baseline of conventional treatment group etc. were associated with survival time of patients after the initiation of antiretroviral treatment (ART) (P<0.05) while factors as gender, age, marital status, ever missed taking drugs in the past 7 days at baseline etc. in the earlier treatment group were associated with the survival time of patients after the ART initiation (P<0.05). CONCLUSION: Strategy including earlier initiation of antiretroviral treatment on AIDS patients who had met the treatment criteria and programs related to the improvement on adherence to medication, could prolong the survival time of AIDS patients, in Henan province.

[Characteristics of long-term non-progressors and HIV controllers among HIV-infections in Henan, China].

OBJECTIVE: To study the prevalence and characteristics of long-term non-progressors (LTNPs) and HIV controllers (HCs) among HIV-infections in Henan, China. METHODS: Data in two databases (Information management system of HIV/AIDS prevention and control; HIV/AIDS testing application platform of Henan) were used to identify the LTNPs and HCs, investigation and verification, sample collection and correlation testing were carried out thereafter. RESULTS: A total of 148 LTNPs/HCs were identified. Among them, 71 were followed up, including 58 LTNPs and 22 HCs, 12 cases were both LTNP and HC, 46 cases were LTNP but non-HC(LTNP+ HC-), 10 cases of HC but non-LTNP. Of the 71 individuals, 50 (70.4%) were males, 55 (77.5%) were older than 40 years of age, all belonged to Han nationality, 61 (85.9%) were farmers, 52 (73.2%) were infected through former plasma donation, 56 (78.9%) were-HCV positive. Median (interquartile range) of the CD4 counts was 538 (445-654) cell/µl and with virus load as 3.14 (2.03-3.82) log(10) copies/ml. The median viral load of HC was lower than that of LTNP + HC-(P=0.001). CONCLUSION: The characteristic of LTNPs and HCs in Henan HIV-infections were remarkable, more accurate classification of these cases was helpful to further research.

First Report on the OPTN National Variance: Allocation of A2 /A2 B Deceased Donor Kidneys to Blood Group B Increases Minority Transplantation.

In 2002, the Organ Procurement and Transplantation Network (OPTN) Minority Affairs Committee (MAC) implemented a national, prospective, "variance of practice" to allow deceased donor, ABO blood group incompatible, A2 antigen, kidney transplantation into blood group B recipients; outcomes of this cohort were compared to ABO compatible recipients. The goal of the variance was to increase the number of transplants to B candidates without negatively impacting survival or compromising system equity. Only B recipients with low anti-A IgG titers (<1:8) were eligible to receive these kidneys. Across eight participating Donation Service Areas (DSA), there were 101 A2 /A2 B to B transplants through 12/31/11, of which the majority of the recipients (61%) were ethnic minorities. At 12, 24, and 36 months, Kaplan-Meier graft survival rates for the B recipients of A2 /A2 B kidneys were 95.0%, 90.6%, and 85.4%, respectively, comparable to outcomes for B recipients of B kidneys, 92.6%, 87.9%, and 82.5%, respectively (p-value = 0.48). Five DSAs increased the proportion of B transplants during 41 months postvariance, with a lesser proportional decrease in blood group A transplants. The data support the proposition that this allocation algorithm may provide a robust mechanism to increase access of blood group B minority candidates to kidney transplantation.

Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation.

There is limited data pertaining to the risk of End Stage Renal Disease (ESRD) after living kidney donation. The Organ Procurement and Transplantation Network and the Center for Medicare and Medicaid Services databases were used to identify living kidney donors (LKDs) who subsequently developed ESRD and to calculate LKD ESRD rates. We found 126 cases of ESRD among 56 458 LKDs (0.22%) who donated during October 1, 1987-March 31, 2003. The overall LKD ESRD rate was 0.134 per 1000 years at risk, with an average duration of follow-up of 9.8 years. ESRD rates for LKDs overall and for Black, White, male and female donors compared favorably to the ESRD incidence in the general population. The LKD ESRD rate was nearly five times higher for Blacks than for Whites and two times higher for males than females. However, these ethnic and gender-related differences were similar to those previously reported for ESRD in the general population. Our findings do not show an increase in the risk of ESRD for LKDs and support the current practice of living kidney donation. Further research is needed to determine if improved donor screening or follow-up will reduce the risk of postdonation ESRD.

Access and outcomes among minority transplant patients, 1999-2008, with a focus on determinants of kidney graft survival.

Coincident with an increasing national interest in equitable health care, a number of studies have described disparities in access to solid organ transplantation for minority patients. In contrast, relatively little is known about differences in posttransplant outcomes between patients of specific racial and ethnic populations. In this paper, we review trends in access to solid organ transplantation and posttransplant outcomes by organ type, race and ethnicity. In addition, we present an analysis of categories of factors that contribute to the racial/ethnic variation seen in kidney transplant outcomes. Disparities in minority access to transplantation among wait-listed candidates are improving, but persist for those awaiting kidney, simultaneous kidney and pancreas and intestine transplantation. In general, graft and patient survival among recipients of solid organ transplants is highest for Asians and Hispanic/Latinos, intermediate for whites and lowest for African Americans. Although much of the difference in outcomes between racial/ethnic groups can be accounted for by adjusting for patient characteristics, important observed differences remain. Age and duration of pretransplant dialysis exposure emerge as the most important determinants of survival in an investigation of the relative impact of center-related versus patient-related variables on kidney graft outcomes.