The predictive accuracy of machine learning for the risk of death in HIV patients: a systematic review and meta-analysis.

BACKGROUND: Early prediction of mortality in individuals with HIV (PWH) has perpetually posed a formidable challenge. With the widespread integration of machine learning into clinical practice, some researchers endeavor to formulate models predicting the mortality risk for PWH. Nevertheless, the diverse timeframes of mortality among PWH and the potential multitude of modeling variables have cast doubt on the efficacy of the current predictive model for HIV-related deaths. To address this, we undertook a systematic review and meta-analysis, aiming to comprehensively assess the utilization of machine learning in the early prediction of HIV-related deaths and furnish evidence-based support for the advancement of artificial intelligence in this domain. METHODS: We systematically combed through the PubMed, Cochrane, Embase, and Web of Science databases on November 25, 2023. To evaluate the bias risk in the original studies included, we employed the Predictive Model Bias Risk Assessment Tool (PROBAST). During the meta-analysis, we conducted subgroup analysis based on survival and non-survival models. Additionally, we utilized meta-regression to explore the influence of death time on the predictive value of the model for HIV-related deaths. RESULTS: After our comprehensive review, we analyzed a total of 24 pieces of literature, encompassing data from 401,389 individuals diagnosed with HIV. Within this dataset, 23 articles specifically delved into deaths during long-term follow-ups outside hospital settings. The machine learning models applied for predicting these deaths comprised survival models (COX regression) and other non-survival models. The outcomes of the meta-analysis unveiled that within the training set, the c-index for predicting deaths among people with HIV (PWH) using predictive models stands at 0.83 (95% CI: 0.75-0.91). In the validation set, the c-index is slightly lower at 0.81 (95% CI: 0.78-0.85). Notably, the meta-regression analysis demonstrated that neither follow-up time nor the occurrence of death events significantly impacted the performance of the machine learning models. CONCLUSIONS: The study suggests that machine learning is a viable approach for developing non-time-based predictions regarding HIV deaths. Nevertheless, the limited inclusion of original studies necessitates additional multicenter studies for thorough validation.

Triphenylamine Spirofunctionalized Light-Emitting Conjugated Polymer with an Ultradeep-Blue Narrowband Emission for Large-Area Printed Display.

Emerging printed large-area polymer light-emitting diodes (PLEDs) are essential for manufacturing flat-panel displays and solid lighting devices. However, it is challenging to obtain large-area and stable ultradeep-blue PLEDs because of the lack of light-emitting conjugated polymers (LCPs) with robust deep-blue emissions, excellent morphological stabilities, and high charging abilities. Here, a novel unsymmetrically substituted polydiarylfluorene (POPSAF) is obtained with stable narrowband emission for large-area printed displays via triphenylamine (TPA) spirofunctionalization of LCPs. POPSAF films show narrowband and stable ultradeep-blue emission with a full width at half maximum (FWHM) of 36 nm, associated with their intrachain excitonic behavior without obvious polaron formation. Compared to controlled poly[4-(octyloxy)-9,9-diphenylfluoren-2,7-diyl]-co-[5-(octyloxy)-9,9-diphenylfluoren-2,7-diyl] (PODPF), excellent charge transport is observed in the POPSAF films because of the intrinsic hole transport ability of the TPA units. Large-area PLEDs are fabricated via blade-coating with an emission area of 9 cm2, which exhibit uniform ultradeep-blue emission with an FWHM of 36 nm and corresponding Commission internationale de l'éclairage (CIE) coordinates of (0.155, 0.072). These findings are attributed to the synergistic effects of robust emission, stable morphology, and printing capacity. Finally, preliminary printed passive matrix (PM) PLED displays with 20 × 20 pixels monochromes are fabricated, confirmed the effectiveness of spirofunctionalization in optoelectronics.

Intrinsically Stretchable and Efficient Fully Π-Conjugated Polymer via Internal Plasticization for Flexible Deep-Blue Polymer Light-Emitting Diodes with CIEy = 0.08.

Intrinsically stretchable polymeric semiconductors are essential to flexible polymer light-emitting diodes (PLEDs) owing to their excellent strain tolerance capacity under long-time deformation operation. Obtaining intrinsic stretchability, robust emission properties, and excellent charge-transport behavior simultaneously from fully π-conjugated polymers (FCPs) is difficult, particularly for applications in deep-blue PLEDs. Herein, an internal plasticization strategy is proposed to introduce a phenyl-ester plasticizer into polyfluorenes (PF-MC4, PF-MC6, and PF-MC8) for narrowband deep-blue flexible PLEDs. Compared with controlled poly[4-(octyloxy)-9,9-diphenylfluoren-2,7-diyl]-co-[5-(octyloxy)-9,9-diphenylfluoren-2,7-diyl] (PODPFs) (2.5%), the freestanding PF-MC8 thin film shows a fracture strain of >25%. The three stretchable films exhibit stable and efficient deep-blue emission (PLQY > 50%) because of the encapsulation of π-conjugated backbone via pendant phenyl-ester plasticizers. The PF-MC8-based PLEDs show deep-blue emission, which corresponds to CIE and EQE values of (0.16, 0.10) and 1.06%, respectively. Finally, the narrowband deep-blue electroluminescence (FWHM of ≈25 nm; CIE coordinates: (0.15, 0.08)) and performance of the transferred PLEDs based on the PF-MC8 stretchable film are independent of the tensile ratio (up to 45%); however, they show a maximum brightness of 1976 cd m-2 at a ratio of 35%. Therefore, internal plasticization is a promising approach for designing intrinsically stretchable FCPs for flexible electronics.

Large-Area Blade-Coated Deep-Blue Polymer Light-Emitting Diodes with a Narrowband and Uniform Emission.

Large-area polymer light-emitting diodes (PLEDs) manufactured by printing are required for flat-panel lighting and displays. Nevertheless, it remains challenging to fabricate large-area and stable deep-blue PLEDs with narrowband emission due to the difficulties in precisely tuning film uniformity and obtaining single-exciton emission. Herein, efficient and stable large-area deep-blue PLEDs with narrowband emission are prepared from encapsulated polydiarylfluorene. Encapsulated polydiarylfluorenes presented an efficient and stable deep-blue emission (peak: 439 nm; full width at half maximum (FWHM): 39 nm) in the solid state due to their single-chain emission behavior without inter-backbone chain aggregation. Large-area uniform blade-coated films (16 cm2 ) are also fabricated with excellent smoothness and morphology. Benefitting from efficient emission and excellent printed capacity, the blade-coated PLEDs with a device area of 9 mm2 realized uniform deep-blue emission (FWHM: 38 nm; CIE: 0.153, 0.067), with a corresponding maximum external quantum efficiency and the brightness comparable to those of devices based on spin-coated films. Finally, considering the essential role of deep-blue LEDs, a preliminary patterned PLED array with a pixel size of 800 × 1000 µm2 and a monochrome display is fabricated, highlighting potential full-color display applications.

An Analysis of Injury Trends and Disease Burden From Three Surveillance Hospitals in Urumqi From 2006 to 2018.

Objective: To investigate injury trends, injury distribution, and disease burden from three surveillance hospitals in Urumqi from 2006 to 2018. Method: Injury data from the National Injury Surveillance System (NISS) from three hospitals in Urumqi (2006 to 2018) were collected to analyze changes in the characteristics of outpatient injury cases. Years of potential life lost (YPLL) were calculated to determine the disease burden of the injury cases. Results: A total of 161,400 injury cases were recorded over 13 years, and the average age of the patient seeking medical attention was 32.4 years old. Male patients outnumbered female patients with a ratio of 1.6:1, but the proportion of female patients was greater after 45 years of age. The highest number of cases occurred in patients 15-29 years of age, accounting for 26.8% of all injury cases. Injury in females occurred most frequently in the home. A total of 41.4% of injury cases occurred while doing housework. The top three causes of injury were falls (49.7%), blunt force of an object, (13.7%), and motor vehicle accidents (MVA) (13.5%). Years of potential life lost from injury accounted for 7.39% of the total YPLL in the three hospitals. Conclusion: Males should be targeted for injury prevention and intervention in Urumqi. The prevention of falls, blunt force of objects, and MVA should be made a priority. Injury prevention strategies and targeted projects should be developed to reduce the disease burden of injury.

Improving the Intrinsic Stretchability of Fully Conjugated Polymer for Deep-Blue Polymer Light-Emitting Diodes with a Narrow Band Emission: Benefits of Self-Toughness Effect.

It is challenging to construct the intrinsically stretchable active layer of rigid conjugated polymers (CPs) toward flexible deep-blue light-emitting diodes (FLEDs). Inspired by the self-toughness effect, sacrificial hydrogen bonding (H-bonding) and a cross-linked network synergistically enabled polydiarylfluorene (PFs-NH) films to present efficient deep-blue emission and excellent intrinsic stretchability. In particular, a cross-linked network structure presenting viscoelasticity behaviors, which was successfully inherited into postprocessed films with interchain interpenetration and a crystallinity domain and behaved as energy absorption and dissipation centers, was induced by the interchain H-bonding interaction in toluene (Tol) precursor solutions where the storage moduli (G') gradually exceeded the loss moduli (G″). Subsequently, intrinsic stretchable films with a tensile rate of 30% were prepared from Tol solutions, different from the brittle films from polar solvents. Eventually, narrow band, deep-blue PLEDs showed a maximum EQE of 1.28% and a full width half-maximum (fwhm) of 28 nm. Therefore, the self-toughness effect induced by hierarchical structures will be feasible to obtain high-performance FLEDs.

Prevalence of doravirine cross-resistance in HIV-infected adults who failed first-line ART in China, 2014-18.

OBJECTIVES: To evaluate the prevalence and characteristics of doravirine resistance and cross-resistance in patients who failed first-line ART in China. METHODS: From 2014 to 2108, 4132 patients from five provinces were tested for drug resistance by genotypic resistance testing. Drug resistance mutations were assessed using the Stanford HIVdb algorithm Version 9.0. Sequences classified as having low-level, intermediate and high-level resistance were defined as having drug resistance. RESULTS: Overall, the prevalence of doravirine and other NNRTIs cross-resistance was 69.5%, with intermediate and high-level resistance accounting for 56.4%. Doravirine resistance highly correlated with efavirenz (r = 0.720) and nevirapine (r = 0.721) resistance and moderately correlated with etravirine (r = 0.637) and rilpivirine (r = 0.692) resistance. The most frequent doravirine-associated resistance mutations were V106M (8.7%), K101E (6.8%) and P225H (5.1%). High-level resistance was mainly due to Y188L (3.2%) and M230L (2.7%). There were significant differences between genotypes and provinces. Compared with CRF01_AE, CRF07_BC (OR = 0.595, 95% CI = 0.546-0.648) and CRF08_BC (OR = 0.467, 95% CI = 0.407-0.536) were associated with lower risks of doravirine resistance. Conversely, genotype A (OR = 3.003, 95% CI = 1.806-4.991) and genotype B (OR = 1.250, 95% CI = 1.021-1.531) were associated with higher risks of doravirine resistance. The risk of doravirine resistance was significantly lower in Xinjiang compared with other provinces. CONCLUSIONS: In China, the prevalence of doravirine cross-resistance among patients who have failed first-line ART is high. Therefore, doravirine should not be used blindly without genotypic resistance testing and is not recommended for people who have failed first-line NNRTI-based ART.

HIV transmission in sero-discordant couples with the HIV-positive partner in Xinjiang: incidence and associated predictors.

INTRODUCTION: To control the spread of human immunodeficiency virus (HIV) among sero-discordant couples, we explored the HIV seroconversion and its contributing factors. METHODOLOGY: We recruited negative partners in HIV sero-discordant couples to established a prospective cohort between January 2010 and June 2015 from areas with severe HIV epidemic in Xinjiang. Follow up once every 3 months, serological tests and risk behavior surveys every 6 months. Variables were screened by LASSO regression and a Cox proportional hazards model was established. RESULTS: A total of 1162 negative partners of sero-discordant couples were recruited. The seroconversion occurred in 42 negative partners during follow-up period, with a seroconversion rate of 2/100 (95% CI = 1.21-2.27), and the median time for seroconversion was 0.92 years. The Cox model showed that frequency of sexual behavior for nearly six months, consistent condom use, knowledge of the transmission route for HIV, a history of sexually transmitted diseases, recent CD4 + T lymphocyte count were all significant contributing factors to the seroconversion in negative partner of HIV sero-discordant couples. In addition, the Cox model was used to evaluate the risk factors of seroconversion for HIV negative partners. CONCLUSIONS: The seroconversion rate of HIV negative partners in Xinjiang was lower. The LASSO Cox model may accurately predict the risk of HIV transmission in sero-discordant couples.

Identification of molecular mechanisms for achieving HIV-1 control in the absence of antiretroviral therapy.

AIMS: Antiretroviral therapy (ART) controls viral replication but cannot eradicate an infected virus and restore the immune response of patients. MATERIALS AND METHODS: The gene expression profiles of whole blood, PBMCs, CD4+ and CD8+ T cells were obtained from GSE108297. Coexpression analysis was carried out to evaluate differentially expressed genes (DEGs) between strong and weak responder HIV controllers (HICs). Enrichment analysis was used to explore the biological functions of DEGs. The key genes with common DEGs were screened using the Lasso Cox model. Then, the immune scores of HICs and HAART were calculated by ssGSEA. The content of CD4+ and CD8+ T cells, key genes were verified by flow cytometry, RT-PCR and Western blot analysis. KEY FINDINGS: DEGs were clustered into 24 coexpression modules. DEGs related to general immune responses had the highest correlation with strong responding HICs, while DEGs mainly related to the apoptotic process had the highest correlation with weak responder HICs. The hub genes CD8A and CCT2, as well as the key genes TMEM132C and S100A9, were DEGs in HICs and HARRT. The immune score and flow cytometry showed that CD4+ and CD8+ T cells of HICs were lower than those of HARRT in whole blood. Experiments confirmed the expression of key genes in HICs and HARRT. SIGNIFICANCE: The key genes identified in this study highlight the strong responder HICs features that to help the immune system control HIV-1 infection. These results will be useful for developing therapeutic targets.

Establishment and development of national community-based collaborative innovation demonstration areas to achieve the control target of hepatitis B in China.

BACKGROUND: The major infectious diseases of hepatitis B has constituted an acute public health challenge in China. An effective and affordable HBV control model is urgently needed. A national project of Community-based Collaborative Innovation HBV (CCI-HBV) demonstration areas has optimized the existing community healthcare resources and obtained initial results in HBV control. METHODS: Based on the existing community healthcare network, CCI-HBV project combined the community health management and health contract signing service for long-staying residents in hepatitis B screening. Moreover, HBV field research strategy was popularized in CCI-HBV areas. After screening, patients with seropositive results were enrolled in corresponding cohorts and received treatment at an early stage. And the uninfected people received medical supports including health education through new media, behavior intervention and HBV vaccinations. In this process, a cloud-based National Information Platform (NIP) was established to collect and store residents' epidemiological data. In addition, a special quality control team was set up for CCI project. RESULTS: After two rounds of screening, HBsAg positive rate dropped from 5.05% (with 5,173,003 people screened) to 4.57% (with 3,819,675 people screened), while the rate of new HBV infections was 0.28 per 100 person-years in the fixed cohorts of 2,584,322 people. The quality control team completed PPS sampling simultaneously and established the serum sample database with 2,800,000 serum samples for unified testing. CONCLUSIONS: CCI-HBV project has established a large-scale field research to conduct whole-population screening and intervention. We analyzed the HBsAg prevalence and new infection rate of HBV in the fixed population for the epidemic trend and intervention effect. The purpose of CCI-HBV project is to establish and evaluate a practical model of grid management and field strategy, to realize the new goal to control hepatitis B in China. To provide policymakers with a feasible model, our results are directly applicable. TRIAL REGISTRATION: The project was funded by the Major Projects of Science Research for the 11th and 12th five-year plans of China, entitled "The prevention and control of AIDS, viral hepatitis and other major infectious diseases", Grant Nos. 2009ZX10004901, 2011ZX10004901, 2013ZX10004904, 2014ZX10004007 and 2014ZX10004008.

[Prevalence of central obesity among floating population employment in 5 surveillance sites of Xinjiang Uygur Autonomous Region in 2012].

OBJECTIVE: To investigate the prevalence of central obesity among different gender and age groups of floating population employment in 5 surveillance sites of Xinjiang Uygur Autonomous Region. METHODS: 1491 floating population aged > 18 years old were selected through multistage clustering sampling method, stratified by 6 major industries in5 sites of Xinjiang Uygur Autonomous Region( Xinhe County, Yining County, Tianshan District, Hetian County and Kashi City) in 2012. Unified questionnaire( including basic information, behavioral risk factors, etc. ), designed by China CDC, were used to collect information by face-to-face interviews. Height, weight and waist circumference were measured by unified equipment. RESULTS: The average age was( 35. 73 ± 11. 61) years old. Male and female accounted for 48. 02%( 716/1491) and 51. 98%( 775/1491)each. Han, Uygur and other ethnic group accounted for 75. 59%( 1127/1491), 18. 31%( 273/1491) and 6. 10%( 91/1491). The prevalence of central obesity was 25. 62%( 382/1491) of floating population in 5 surveillance sites of Xinjiang Uygur Autonomous Region, 50-59 years age group( 45. 63%) and the obese group( 86. 15%) in BMI were the highest prevalence of central obesity. There was statistical significance on prevalence of central obesity in different age groups floating population( χ~2= 77. 295, P <0. 001), and in different BMI groups floating population( χ~2= 648. 619, P < 0. 001). CONCLUSION: Floating population aged 50-59 years old and obese in BMI of Xinjiang Uygur Autonomous Region were key groups for prevention and control of central obesity.

[Misreporting rate and influencing factors regarding the routes of transmission among reported HIV patients in Yili Kazakh Autonomous Prefecture of Xinjiang Uygur Autonomous Region of China].

OBJECTIVE: To understand the misreporting rate regarding the routes of transmission among the reported HIV patients in Yili prefecture of Xinjiang, since 2011. METHODS: An investigation focusing on the route of transmission among people living with HIV/AIDS was carried out to clarify the responsible reasons for the situation. RESULTS: The overall incorrect reporting rate on the route of transmission was 10.8%.The proportion of heterosexual transmission route was over estimated by 63.8% to 72.0%. However, the proportion of injecting drug was underestimated by 27.5% to 22.2%. The number of cases being confirmed as through heterosexual transmission but incorrectly reported was quite high, contributing 82.6% of all the incorrectly reported cases. Most of the patients that incorrect reported, were moved from injecting drug use to heterosexual transmission, which contributed 79.5% of all the total incorrectly reported cases. Results from multi-factor analysis showed that the risk related to incorrect reporting was 3.64 times in males than in females. People who anticipated to receive HIV testing were 2.23 times more than those who had not. Old-age groups were 3.511, 4.053, 4.415 and 6.524 times higher than those people who were aged below 16 years. CONCLUSIONS: The proportion of heterosexual transmission route was over- estimated while the proportion on injecting drug use was underestimated. However, the transmission pattern had changed from injecting drug use at the early epidemic stage, to current sexual transmission mode. We recommended that more attentions should be paid to patients who were males, at older age or those who had no expectation in receiving the HIV testing, during the initial following-up stage.

[Sex specific mortality in HIV/AIDS patients receiving antiretroviral therapy and risk factors in Xinjiang Uygur autonomous region].

OBJECTIVE: To analyze the sex specific mortality in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART) and risk factors in Xinjiang Uyghur autonomous region (Xinjiang), and provide evidence for the evaluation of the effect of HAART. METHODS: A retrospective analysis was conducted on the mortality and survival of 8 061 male cases and 6 001 female cases of HIV infection, who received HAART during July 2004-June 2013 in Xinjiang. The information of the cases were downloaded from national antiretroviral therapy reporting sub-system in national HIV/AIDS reporting system. Cox proportional hazard model was used to identify the risk factors of deaths. RESULTS: The male cases were older and had lower CD4 value at baseline compared with the female cases. The major transmission route was injecting drug use in males, but sexual contact in females. The overall mortality of the male cases was higher than that of the females, which was 10.87/100 person-years during the first three month after receiving HAART, and 7.00/100 person-years two years later in males, but 4.77/100 person-years during the first three month and 3.00/100 person-years two years later in females. The results from Cox analysis showed that the risk factors were the CD4 value at baseline and transmission route. Compared with the cases who had lower CD4 value (CD4<200 cells/µl) at baseline, the HR for the cases who had higher CD4 value (CD4≥350 cells/µl) was 4.08 (95% CI: 2.96-5.62) in males and 5.11 (95% CI: 3.16-8.35) in females. Compared with sexual transmission, the HR for IDUs was 1.99 (95% CI: 1.66-2.40) in males and 1.77 (95% CI: 1.24-2.52) in females. The results of cumulative survival analysis showed that in conventional treatment group (CD4<350 cells/µl) , the five year survival rates were 81% and 87% for the males and females infected through sexual contact and 66% and 75% for the males and females infected through injecting drug use, and in early treatment group (CD4≥350 cells/µl) , the five year survival rates were 97% and 98% for the males and females infected through sexual contact and 86% and 97% for the males and females infected through injecting drug use. CONCLUSION: In Xinjiang, the higher mortality in male HIV infection cases receiving HAART was related with lower CD4 value at baseline and higher infection rate through injecting drug use. Besides the weak intention for treatment and poor compliancy would be the deeper risk factors.

[Study on the mortality and risk factors among HIV/AIDS patients receiving antiretroviral therapy in Xinjiang Uygur Autonomous Region].

OBJECTIVE: To analyze the mortality and risk factors among HIV/AIDS patients receiving highly active antiretroviral therapy (HAART) in the Xinjiang Uyghur Autonomous Region (XUAR). METHODS: The objects of study were all HIV/AIDS adult patients who had received HAART in XUAR. The proceeding information was uploaded to the national ART reporting system which was a branch of the national HIV/AIDS reporting system. A retrospective cohort study was conducted among these patients who were treated during July 2004 to June 2013 in XUAR. Mortality rates and cumulative survival rates were calculated. Cox proportional hazard model was conducted to examine the risk factors for deaths. RESULTS: The proportion for death, lost, referral and withdrawal were 8.5% (1 200/14 062), 2.5% (351/14 062), 0.9% (121/14 062)and 15.4% (2 162/14 062) respectively. The P25, P50 and P75 of baseline CD4(+)T lymphocyte was 144.00, 244.50 and 331.00/µl, respectively. The overall mortality rate was 4.98/100 person-years. The cumulative survival rate of ART treatment after 1-5 years were 0.94,0.91,0.88, 0.84 and 0.81. The mortality rate had a significant difference among different population. The male (6.58/100 person-years) was higher than the female(2.87/100 person-years), the people who infected tuberculosis (TB) (9.79/100 person-years) was higher than those non TB (4.12/100 person-years), the people whose CD4(+)T lymphocyte count less than 200/µl (7.67/100 person-years) was higher than other groups, the people who were transmitted through injection (7.61/100 person-years) was higher than those sexual transmission (3.10/100 person-years), the people whose HB less than 80 g/L (13.84/100 person-years) was higher than those more than 80 g/L (4.74/100 person-years) (χ(2) values were 154.62, 177.47, 309.73, 228.99 and 84.27. P < 0.01). The risk of death of the one with the baseline CD4(+)T lymphocyte ≤ 200/µl was 3.61 (2.73-4.78) times of the one with the baseline CD4(+)T lymphocyte >350/µl. The risk of death of the one having more than 4 baseline symptom categories was 3.62 (2.42-5.42) times of the one having less than 3 baseline symptom categories. The risk of death of the one with baseline HB ≥ 80 g/L was 2.84 (2.21-3.64) times of the one with the baseline HB <80 g/L. The risk of death of the male was 1.48 (1.25-1.75) times of the female. The risk of death of the one infected TB was 1.39(1.18-1.64) times of the one not infected TB. The risk of death of the one injecting drugs was 1.84 (1.56-2.17) times of the one not injecting drugs. CONCLUSION: From 2004 to 2013, the mortality rate was low among HIV/AIDS patients receiving ART in XUAR. The mortality risk factors were low CD4 T cell count, having more baseline symptom categories, low HB level, injection drug transmission, male and TB infection, all these factors had positive correlation with death.

[Study on gay identity status and its association with sexual behaviors among men who has sex with men in Xinjiang Uygur Autonomous Region].

OBJECTIVE: To investigate gay identity status of men who have sex with men(MSM) in Xinjiang, and analyze its association with sexual behaviors. METHODS: From May to August in 2013, an anonymous questionnaire survey with convenience sampling was conducted among MSM in Urumqi, Kashgar, Aksu and Yining cities of Xinjiang. Those who were ≥ 16 years of age and claimed to have male-to-male sex behaviors were eligible for the survey. A total of 1 467 participants were recruited. Chi square analysis was performed for examining the association between ego-identity, social-identity and relevant sexual behaviors. Selected variables associated with ego-identity, social-identity in the univariate analysis were subsequently assessed in a multivariate analysis using logistic regression. RESULTS: The MSM with positive ego-identity accounted for 44.7% (656/1 467), and positive social-identity accounted for 29.1% (427/1 467). For ego-identity, Uyghur MSM were less positive than Han MSM (OR (95%CI) was 0.43 (0.32-0.58) ) ; those who were over 20 years of age when accepting their sexual orientation were less positive than those who were younger than 20 years of age when accepting their sexual orientation (OR (95%CI) was 0.61 (0.47-0.80) );and homosexuals were more positive than bisexuals (OR (95%CI) was 1.98 (1.50-2.61) ). For social-identity, Hui MSM were less positive than Han MSM (OR (95%CI) was 0.61 (0.42-0.88) ); those whose education level was higher than college were less positive than those with junior high education (OR (95%CI) was 0.60 (0.40-0.89) ); famers/herdsmen were more positive than students (OR (95%CI) was 4.17 (2.13-8.17) ); the divorced/widowed were more positive than the singles (OR (95%CI) was 2.40 (1.34-4.29) ); those who were over 20 years of age when accepting their sexual orientation were less positive than those who were younger than 20 years of age when accepting their sexual orientation (OR (95%CI) was 0.59 (0.44-0.81) ). Among the MSM with negative ego-identity and negative social-identity, the proportion of planning to get married with women was 66.8% (267/400) and 76.5% (306/400), respectively, which were higher than those with positive ego-identity (33.2% (133/400)) and positive social-identity (23.5% (94/400)) ; their proportion of intending to have offspring was 62.0% (287/463) and 73.4% (340/463), respectively, which were higher than those with positive ego-identity and social-identity (38.0% (176/463), 26.6% (123/463)) (χ(2) = 39.61 and 7.90, respectively, both P values were <0.05). Among the MSM with negative social-identity, the proportion of looking for male sexual partners in toilets or parks was 18.1% (188/1 040), in bathhouse or sauna was 17.3% (180/1 040), and through internet was 82.0% (853/1 040), which were higher than those with positive social-identity (8.9% (38/427), 9.8% (42/427) and 61.6% (263/427)) (χ(2) = 66.78, P < 0.01). CONCLUSION: In 2013, the gay identity of MSM in Xinjiang was relatively poor, and the factors associated with it included ethnicity, occupation, marital status and education level. The MSM with negative identity tended to involve in risk sexual behaviors, and had increased risk of HIV infection.

Mortality and treatment outcomes of China's National Pediatric antiretroviral therapy program.

BACKGROUND: The aim of this study was to describe 3-year mortality rates, associated risk factors, and long-term clinical outcomes of children enrolled in China's national free pediatric antiretroviral therapy (ART) program. METHODS: Records were abstracted from the national human immunodeficiency virus (HIV)/AIDS case reporting and national pediatric ART databases for all HIV-positive children ≤15 years old who initiated ART prior to December 2010. Mortality risk factors over 3 years of follow-up were examined using Cox proportional hazards regression models. Life tables were used to determine survival rate over time. Longitudinal plots of CD4(+) T-cell percentage (CD4%), hemoglobin level, weight-for-age z (WAZ) score, and height-for-age z (HAZ) score were created using generalized estimating equation models. RESULTS: Among the 1818 children included in our cohort, 93 deaths were recorded in 4022 child-years (CY) of observed time for an overall mortality rate of 2.31 per 100 CY (95% confidence interval [CI], 1.75-2.78). The strongest factor associated with mortality was baseline WAZ score <-2 (adjusted hazard ratio [HR] = 9.1; 95% CI, 2.5-33.2), followed by World Health Organization stage III or IV disease (adjusted HR = 2.4; 95% CI, 1.1-5.2), and hemoglobin <90 g/L (adjusted HR = 2.2; 95% CI, 1.2-3.9). CD4%, hemoglobin level, WAZ score, and HAZ score increased over time. CONCLUSIONS: Our finding that 94% of children engaged in this program are still alive and of improved health after 3 years of treatment demonstrates that China's national pediatric ART program is effective. This program needs to be expanded to better meet treatment demands, and efforts to identify HIV-positive children earlier must be prioritized.

Net financial benefits of averting HIV infections among people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China (2005-2010).

BACKGROUND: To quantify the contribution of locally implemented prevention programmes in contributing to reductions in treatment and care costs by averting HIV infections among those who inject drugs this study calculates net financial benefit of providing harm reduction programmes using information from services being implemented in Urumqi, Xinjiang Uighur Autonomous Region of China ( between 2005 and 2010). METHODS: Information was collected to assess cost of providing methadone treatment (MMT) and needle and syringe programmes (NSP). HIV incidence was estimated among people who inject drugs (PWID). HIV infections averted were calculated. Net benefit was assessed by estimating costs of providing prevention programmes and comparing these to the costs of providing care. RESULTS: An estimated 5678 (range 3982-7599) HIV infections were averted between 2005 and 2010 and the net financial benefit of providing harm reduction programmes compared to treatment and care costs for HIV infections averted was USD 4.383 million during the same time period. CONCLUSION: These results demonstrate the net and accumulating benefit of investing in harm reduction programmes for PWID in Urumqi. The return on investment progressively increased during the time period studied and it is clear that these cost savings will continue to accrue with the continued implementation of HIV prevention interventions in the community that include harm reduction programmes targeted at PWID.

Genetic and temporal dynamics of human immunodeficiency virus type 1 CRF07_BC in Xinjiang, China.

To explore the temporal genetic variation of human immunodeficiency virus type 1 CRF07_BC and reconstruct its epidemic in Xinjiang, China, we studied 216 C2-V4 fragments of env genes sampled from 1996 to 2008. Phylogenetic analysis indicates that the viruses prevailing in Xinjiang form a large monophyletic cluster and may have originated from a common ancestor. The epidemic in Xinjiang was probably established around 1995 (95% confidence interval, 1994-1996). We noted an increased diversity of CRF07_BC over time, with a rapid evolutionary rate we estimated to be 8.3x10(-3) substitutions per site per year in the env gene. After 5-6 years of the epidemic (1997-2002), the transmission rate of CRF07_BC in Xinjiang slowed down, although CRF07_BC infection remained at a high prevalence.

Predictors of HIV infection and prevalence for syphilis infection among injection drug users in China: community-based surveys along major drug trafficking routes.

OBJECTIVE: To assess the predictors and prevalence of HIV infection among injection drug users in highly endemic regions along major drug trafficking routes in three Chinese provinces. METHODS: We enrolled participants using community outreach and peer referrals. Questionnaire-based interviews provided demographic, drug use, and sexual behavior information. HIV was tested via ELISA and syphilis by RPR. RESULTS: Of the 689 participants, 51.8% were HIV-infected, with persons living in Guangxi having significantly lower prevalence (16.4%) than those from Xinjiang and Yunnan (66.8% and 67.1%, respectively). Syphilis seropositivity was noted in 5.4%. Longer duration of IDU, greater awareness of HIV transmission routes, and living in Xinjiang or Yunnan were associated with HIV seropositivity on multivariable analysis. Independent risk factors differed between sites. In Guangxi, being male and having a longer duration of IDU were independent risk factors for HIV infection; in Xinjiang, older age and sharing needles and/or syringes were independent factors; in Yunnan, more frequent drug injection, greater awareness of HIV transmission routes, and higher income were independent predictors of HIV seropositivity. CONCLUSION: Prevalence rates of HIV among IDUs in China are more than two out of three in some venues. Risk factors include longer duration of IDU and needle sharing. Also associated with HIV were factors that may indicate some success in education in higher risk persons, such as higher knowledge. A systemic community-level intervention with respect to evidenced-based, population-level interventions to stem the spread of HIV from IDU in China should include needle exchange, opiate agonist-based drug treatment, condom distribution along with promotion, and advocacy for community-based VCT with bridges to HIV preventive services and care.