Survival and risk factors associated with mortality in people living with HIV from 2005 to 2018 in Nanjing, China.

Background: Although the introduction of antiretroviral therapy (ART) decreased the mortality of people living with Human Immunodeficiency Virus (PLHIV), substantially, hundreds of thousands of people are dying of AIDS each year. The accurate survival patterns and factors related to death among PLHIV were rarely reported. In this study, we evaluated survival status and identified factors associated with death among PLHIV in Nanjing. Methods: We conducted a retrospective analysis of PLHIV followed-up in Nanjing and registered to the national HIV/AIDS comprehensive management information system from 2005 to 2018. We used the life table to calculate the cumulative survival rates. We applied the Kaplan-Meier to calculate median survival times and employed cox hazard proportional regression to analyze the associated factors related to death. Results: The median survival time of PLHIV was 11.8 (95%CI:11.6-11.9) years from 2005 to 2018. Among 4,235 PLHIV included in this study, 7.5% had died of AIDS-related disease and the AIDS-related mortality rate was 2.0/100 PYs. The cumulative proportion surviving at the end of the interval was 95.2% over the 1st year, 94.0% over the 2nd year, 91.8% over the 5th year, and 85.4% over the 10th year, respectively. PLHIV who unaccepted ART showed a greater risk of death compared to those who accepted ART (AHR = 16.2, 95%CI:11.9~22.2). For baseline CD4 count, compared to CD4 < 200 cell/µL, higher CD4 count was demonstrated as a protective factor, with AHR = 0.2 (95%CI: 0.1~0.3) for ≥500 cell/µL, AHR = 0.3 (95%CI:0.2~0.4) for 350~499 cell/µL, AHR = 0.4 (95%CI:0.3~0.6 for 200~349 cell/µL). In addition, we observed a higher death risk in PLHIV who were screened through outpatient (AHR = 1.6, 95%CI: 1.1~2.2) and inpatient (AHR = 1.6, 95%CI: 1.1~2.5) compared to through VCT; the age of diagnosis was ≥50 years old (AHR = 9.5, 95%CI: 3.7~24.1) and 25~49 years old (AHR = 5.0, 95%CI: 2.0~12.3) compared to ≤ 24 years old; educated from junior and below (AHR = 3.4, 95%CI: 2.3~5.1) and Senior high school (AHR = 1.7, 95%CI: 1.1~2.7) compared to college and above. Conclusion: The AIDS-related mortality among PLHIV in Nanjing was relatively low. A higher risk for AIDS-related deaths were observed among PLHIV who unaccepted ART, whose baseline CD4 cell count was<200 cell/µL, older age, and lower educated.

Trends in HIV Prevalence and HIV-Related Risk Behaviors Among Male Students Who Have Sex With Men From 2016 to 2020 in Nanjing, China: Consecutive Cross-Sectional Surveys.

Background: The growing HIV epidemic among student men who have sex with men (MSM) necessitates immediate attention from public health. In China, male students who have sex with men (SMSM) were also at an increasing risk of HIV transmission. The aim of this study was to investigate the trends in HIV prevalence, HIV-related risk behaviors, and HIV testing, as well as analyze the factors associated with HIV infection among SMSM in Nanjing. Methods: Data were collected through face-to-face questionnaire interviews and laboratory testing in Nanjing. The participants were recruited among SMSM by snowball sampling and internet-recruited convenience sampling annually from 2016 to 2020. The self-report data primarily included demographics, HIV knowledge, HIV-related behaviors, and HIV testing, while the laboratory test results of HIV and syphilis were collected. Linear-by-linear chi-square test was used to analyze the trends of HIV/syphilis prevalence and its risk behaviors. The binary logistic regression model was used to explore the factors associated with HIV infection. Results: During the 5 years from 2016 to 2020, a total of 775 SMSM were recruited in our survey (220, 112, 171, 142, and 120, respectively). The HIV prevalence was 5.2, 6.3, 5.3, 7.0, and 8.3%, without a significant increasing trend (P = 0.277). Syphilis prevalence fluctuated from 5.7% in 2016 to 4.2% in 2020, without a significant decreasing trend (P = 0.318). The proportion of consistent condom use in anal intercourse (48.5 to 56.2%, P < 0.05), and HIV testing in the past 12 months (51.0 to 59.2%, P < 0.05) were increasing. A remarkable growing trend has been reported in the percentage of MSM with more than one male sex partner (46.2 to 59.2%, P < 0.05). Multivariate analysis showed that HIV testing in the past 12 months was a protective factor against HIV infection. MSM who had unprotected anal intercourse (UAI) in the past 6 months, recreational drug use, and currently syphilis infection were risk factors for HIV infection. Conclusions: We observed stable HIV/ syphilis prevalence, increasing consistent condom use, increasing HIV testing rate, and increasing multiple male sex partners dramatically among SMSM in China. The original comprehensive intervention measures should be continuously strengthened for the subgroup. To satisfy the current HIV prevention requirements, new biological interventions should be introduced and carried out as major components of combination prevention programs.

Trends in HIV prevalence and risk behaviours among men who have sex with men from 2013 to 2017 in Nanjing, China: a consecutive cross-sectional survey.

OBJECTIVE: To examine the trends of HIV prevalence, risk behaviours and HIV testing among men who have sex with men (MSM) in Nanjing. DESIGN: Five consecutive cross-sectional surveys. SETTING: Nanjing, China. PRIMARY AND SECONDARY OUTCOME MEASURES: HIV and syphilis prevalence, HIV testing rate and factors associated with HIV infection; demographic characteristics and behaviours. RESULTS: 649, 669, 577, 633, 503 MSM were recruited from 2013 to 2017. HIV prevalence was 9.9%, 12.3%, 12.5%, 9.8% and 10.1%, respectively. Syphilis prevalence decreased with a range from 10.6% to 5.6%. Risk behaviours like unprotected anal intercourse (UAI) and unprotected virginal sex in the past 6 months decreased, but multiple sex partners and ever used rush popper rose significantly. MSM tested for HIV in the previous year remained stable from 57.0% to 64.1% (P=0.633). Multivariate analysis showed that tested for HIV in the past year was protective factor against HIV infection. MSM who had UAI in the past 6 months, sex role as receptive and dual, diagnosed with sexually transmitted diseases (STDs) in the past year and currently syphilis infected were risk factors for HIV infection. CONCLUSIONS: We observed stable high HIV prevalence, a steady HIV testing rate, decreasing syphilis prevalence and UAI among MSM in Nanjing. However, rush popper use rose dramatically. The HIV preventive strategies for MSM including condom promotion, HIV testing expansion and reduction of rush popper use, STDs screening and standardised treatment should be strengthened.

Weak binder for MHC molecule is a potent Mycobacterium tuberculosis-specific CTL epitope in the context of HLA-A24 allele.

Tuberculosis causes serious health problem for the world population. Antigenic peptides selected by pathogen-specific cytotoxic T lymphocytes (CTLs) are presented by major histocompatibility complex (MHC; or human leukocyte antigen [HLA] in humans) molecules, and HLA-A restricted responses may be of interest for vaccine development and the understanding of cellular immunity. A series of peptides derived from the 10-KDa culture filtrate protein (CFP10) and the 6 kDa early secretory antigenic target (ESAT-6) in the Mycobacterium tuberculosis (Mtb) have been screened and a CTL epitope restricted by the human leukocyte antigen HLA-A24, a common HLA allele in Asian people, has been identified. In this study, we studied a panel of CFP10 and ESAT-6-derived peptides to identify those with binding motifs for HLA-A24 molecules. The antigenicity of candidate peptides was assessed with in vitro refolding tests and an enzyme-linked immunospot (ELISPOT) assay, and by tetramer staining to determine the capacity to stimulate CTLs from peripheral blood mononuclear cells (PBMCs) of HLA-A24-positive TB Patients. We report that one novel candidate peptide at positions 5-14 of ESAT-6 of Mtb could induce peptide-specific CTLs from PBMCs of HLA-A24-positive patients, but not from HLA-A24-negative patients and HLA-A24-positive healthy controls. Identified epitope is a weak binder for HLA-A24 molecule in a mini MHC refolding assay. Since the peptide is presented by a common HLA class I molecule, it may be useful for immunotherapy against Mtb infection and vaccine development in the large population of Mtb-infected patients.