[Analysis of factors influencing AIDS-related deaths among HIV-infected people in Shandong Province, 2017-2021].

Objective: To explore the influencing factors of AIDS-related deaths among HIV-infected patients in Shandong Province, to help reduce the risk of death and prolong survival time. Methods: The study population was HIV-infected patients in Shandong Province from 2017-2021, and Cox proportional hazards regression model was used to analyze the influencing factors of AIDS-related deaths and deaths within one year of confirmation. Results: Among 14 700 HIV- infected patients reported in Shandong Province in 2017-2021, 351 AIDS-related deaths occurred, accounting for 2.4% (351/14 700). The results of multifactorial Cox proportional hazards regression model analysis showed that the risk factors for AIDS-related deaths among HIV-infected patients included education level of junior high school, high school, and secondary school (aHR=1.37, 95%CI:1.01-1.84), sample source from healthcare institutions (aHR=1.61, 95%CI:1.22-2.12), duration of disease in AIDS stage (aHR=9.86,95%CI:6.86-14.19), baseline CD4+T lymphocytes (CD4) undetected (aHR=3.93, 95%CI:2.69-5.75), duration of antiviral treatment (ART) <6 months (aHR=3.46, 95%CI:2.42-4.93) and no ART (aHR=1.45, 95%CI:1.02-2.07), final CD4 <200 cells/µl (aHR=3.51, 95%CI:2.18-5.65) and final CD4 undetected (aHR=10.58, 95%CI:6.15-18.19), and final viral load (VL) values of 50-999 copies/ml,≥1 000 copies/ml and undetected (aHR=2.59, 95%CI:1.07-6.26; aHR=9.50, 95%CI:5.60-16.12; aHR=15.33, 95%CI:8.91-26.36). Factors with higher risk of AIDS-related deaths within one year of confirmation of HIV-infected patients included samples originating from healthcare facilities (aHR=1.68, 95%CI: 1.19-2.36), AIDS stage of disease (aHR=10.60, 95%CI:7.13-15.75), baseline CD4 undetected (aHR=3.71, 95%CI:2.34-5.90), duration of ART <6 months (aHR=4.30, 95%CI:2.85-6.49) and no ART (aHR=2.05, 95%CI:1.35-3.13), final CD4 <200 cells/µl (aHR=5.45,95%CI:2.04-14.60) and final CD4 undetected (aHR=20.95, 95%CI: 7.69- 57.04), and final VL values of 50-999 copies/ml, ≥1 000 copies/ml and undetected (aHR=15.21, 95%CI: 2.54-91.21; aHR=42.93, 95%CI:9.64-191.20; aHR=61.35, 95%CI:13.85-271.77). Conclusions: Expanding the coverage of testing, promoting early detection and treatment, strengthening regular follow-up and the test of HIV-infected patients, grasping the progress of the disease to provide accurate management and treatment are important for reducing the disease mortality rate and prolonging the survival time of HIV-infected patients.

[Characteristics and depressive symptoms among self-reported HIV infection through heterosexual transmission men who have sex with men].

Objective: To understand the characteristics and depressive status of men who have sex with men (MSM) who self-reported HIV infection through heterosexual transmission and to provide evidence for personalized management of HIV infected people. Methods: A cross-sectional survey was carried out in Shandong province from September to December in 2019. Male HIV patients aged ≥15 years who self-reported HIV infection through heterosexual transmission were selected to verify the route of infection by one-to-one interview in Ji'nan, Qingdao, Weifang and Linyi cities of Shangdong province. According to the 1∶1 ratio, local HIV patients with age difference ≤3 years who self-reported MSM were selected as controls. A questionnaire survey was conducted, including data on demographic characteristics, behavior status, CES-D and PSSS. The related factors of the depressive symptoms and characteristics were analyzed. Results: A total of 373 male HIV patients were interviewed, and 39.7%(148/373) were confirmed as MSM after reexamination. The interviewers were: aged (40.3±12.0) years old, 41.9% (62/148) married/cohabiting. 27.0% (40/148) had been tested before HIV diagnosis, 71.6% (106/148) had homosexual partners ≥2 and 55.4% (82/148) had depressive symptom. Multivariate analysis showed that the MSM without HIV testings before diagnosis, had homosexual partners ≥2 before diagnosis, had first homosexual behavior at the age >30 years old and with depressive symptoms were more likely to conceal the true infection route. The incidence of depression among MSM who self-reported HIV infection through heterosexual transmission was related to physical health status social support and occupational stability. Conclusions: Some male HIV persons self-reported as being heterosexually transmitted were really transmitted through homosexual behavior. There were high-risk behaviors such as multiple partners and intersex among this group, and with high incidence of depression. It is necessary to encourage the reexamination program during follow-up and target on psychological and behavioral interventions, continuously.

[Analysis of the usage of post-exposure prophylaxis and related factors among men who have sex with men].

A survey was conduct to analyze the usage situation of post-exposure prophylaxis(PEP) and related factors among men who have sex with men(MSM) in 6 cities of Shandong Province. Total of 2 620 subjects, the use ratio was 2.98% (78/2 620). Compared with age≤24 years,monthly income<5 000 yuan,non-commercial sex, non-DU,non-STD,role for being insert in the anal intercourse,MSM was more likely to use PEP with age≥45 years(OR=3.87, 95%CI:1.12-13.36),monthly income≥5 000 yuan(OR=1.87, 95%CI:1.07-3.28),commercial sex (OR=3.13, 95%CI:1.56-6.28), drug users (DUs) (OR=4.63, 95%CI:2.51-8.52),STD patient (OR=2.35,95%CI:1.05-5.27),the mixed sex role group(OR=2.25,95%CI:1.10-4.62).

[An analysis on senior pupil's tobacco use and exposure in Shandong province in 2012 and 2019].

Objective: To analyze the changes in tobacco use and exposure in primary school students in Shandong province in 2012 and 2019. Methods: A multi-stage stratified cluster random sampling method was used in the survey. In 2012 and 2019, 5 861 and 4 021 students from 3 different cities of Shandong province were selected as the study population. The questionnaire was filled anonymously by the subjects. χ2 test was conducted to compare the difference of groups. Results: In 2012 and 2019, the rate of attempting smoking among pupils under this study in Shandong province were 6.0％and 6.3%, respectively, while the current smoking rate were 1.2％and 2.3%, respectively. The sex ratio of male and female students attempting to smoke was 2.56∶1 in 2012 and 1.31∶1 in 2019. The sex ratio of current smoking rate was 2.43∶1 and 2.00∶1, respectively in 2012 and in 2019. The rate of tobacco exposure in the public places was 50.5％and 41.4%, respectively. The rate of tobacco exposure in family was 49.7% and 46.4%, respectively. Two rates of tobacco exposure decreased, but the reduction in family (3.3%) was far less than that in public places (9.1%). In 2019, the rate of tobacco exposure in family was higher than that in public places. Conclusions: The tobacco exposure rate declined in senior pupils in Shandong province. However, the situation is still grim for the current smoking rate, growth trend of girls tobacco use, and tobacco exposure in family.

[Application of limiting antigen avidity enzyme immunoassay for estimating HIV-1 incidence in men who have sex with men].

Objective: To estimate the incidence of HIV-1 infection in men who have sex with men (MSM) in key areas of China through HIV-1 limiting antigen avidity enzyme immunoassay (LAg-Avidity EIA), analyze the deviation from the actual results and identify influencing factors, and provided reference for improving the accuracy of estimation results. Methods: Based on the principle of the cohort randomized study design, 20 cities were selected in China based on population size and the number of HIV-positive MSM. The sample size was estimated to be 700 according to the HIV-1 infection rate in MSM. MSM mobile phone app. was used to establish a detection appointment and questionnaire system, and the baseline cross-sectional survey was conducted from April to November 2019. LAg-Avidity EIA was used to identify the recent infected samples. The incidence of HIV-1 infection was calculated and then adjusted based on the estimation formula designed by WHO. The influencing factors were identified by analyzing the sample collection and detection processes. Results: Among the 10 650 blood samples from the participants, 799 were HIV-positive in initial screening, in which 198 samples (24.78%) missed during confirmation test. Only 621 samples were received by the laboratory. After excluding misreported samples, 520 samples were qualified for testing. A total of 155 samples were eventually determined as recent infection through LAg-Avidity EIA; Based on the estimation formula , the incidence of HIV-1 infection in MSM in 20 cities was 4.06% (95%CI:3.27%-4.85%), it increased to 5.53% (95%CI: 4.45%-6.60%)after the adjusting for sample missing rate. When the sample missing rate and misreporting rate were both adjusted, the incidence of HIV-1 infection in the MSM increased to 5.66% (95%CI:4.67%-6.65%). The actual incidence of HIV-1 infection in MSM in the 20 cities might be between 4.06% and 5.66%. Conclusions: Sample missing and misreporting might cause the deviation of the estimation of HIV-1 infection incidence. It is important to ensure the sample source and the quality of sample collection and detection to reduce the deviation in the estimation of HIV-1 infection incidence.

[Survey on tobacco use and associated factors in population in Shandong province, 2016-2017].

Objective: To understand the status of tobacco use and related influencing factors in population in Shandong province. Methods: Stratified multi-stage cluster sampling was used to select respondents from 216 villages (communities) of 36 districts (counties) in Shandong province. Influencing factors on smoking were analyzed by logistic regression model. Results: The adequate sample size was 6 271 participants. After complex weighted, the current smoking prevalence was 23.93%,45.58% in males and 1.18% in females. The Public's smoking rates varied widely among different groups in the population. 45-64 age group had the highest smoking rate (25.07%). Smoking rates were substantially different in education levels, with the highest in junior high school (28.94%). The rate was higher in the rural area (24.98%) than that in the urban areas (23.08%). The average daily smoking rate was 20.23%. The average age of initiating smoking was 21.21 years. The average daily cigarette intake was 16.31 cigarettes. Among all the former and current smokers, the quitting rate was 20.79%. Multiple logistic regression model analysis showed that gender, age, occupation, region, and health knowledge score were correlated with smoking behavior. The current smoking rate of men was much higher than that of women (OR=49.625, 95%CI: 37.832-65.093). The current smoking rate in 45-64 age group was higher than that in the 15-24 age group (OR=1.830, 95%CI: 1.048-3.194). The current smoking rate of medical (OR=0.403, 95%CI: 0.187-0.866) and retired personnel (OR=0.648, 95%CI: 0.481-0.873) were lower than those engaging in agriculture, forestry, animal husbandry and the fishery ,respectively. The prevalence of residents living in the central part showed lower rate on current smoking than that in the eastern region (OR=0.724, 95%CI: 0.606-0.865). The current smoking prevalence of smoke hazard in 1-3 score group was higher than that in the group with 4-6 score (OR=1.432, 95%CI: 1.240-1.654). Conclusions: Smoking rate in adults in Shandong remained stable and at a high level. Comprehensive intervention measures such as tobacco control and health education should be carried out to reduce the smoking rate.

[Genomic investigation of human Streptococcus suis infection in Shandong Province].

To investigate Streptococcus suis (S.suis) isolated from patients in Shandong province using genomic epidemiology and pathogenologic analysis. To provide the foundation to establish reasonable and accurate prevention and control measures of human S. suis infection. Molecular typing, whole genome phylogenetic tree, virulence gene typing, antibiotic resistance profile and mobile genetic elements carrying antibiotic resistance genes of isolated S. suis strains were investigated. The pathogenicity of isolated strains was also evaluated by comparing their capacity to induce pro-inflammatory cytokine production in vitro. S. suis infections in Shandong province were predominantly due to serotype 2 and sequence type 1 strains. The major symptoms were meningitis. The studied strains could be divided into five lineages. All strains belong to highly pathogenic type in Shandong province,Strains from lineage 2 possessed higher capacity to stimulate pro-inflammatory cytokine production than other strains did, even though other strains belong to highly pathogenic strains. In addition, multiple antibiotic resistance genes and corresponding mobile genetic elements werewidespread in S. suis strains from Shandong province, except strains from lineage 3. High diversities in genome, evolutionary path and pathogenicity of S. suis strains from Shandong province were revealed. It was necessary to surveillant the S. suis strain in genomic level.

Heterozygous Ins/Del genotype of the CASP8 rs3834129 polymorphism significantly decreases the risk of coal workers' pneumoconiosis in a Chinese Han population: a case-control study.

OBJECTIVE: Coal workers' pneumoconiosis (CWP) is a chronic inflammatory and fibrotic pulmonary disease that involves a complex interaction of multiple environmental and genetic factors. Polymorphism, as a genetic factor, may affect the onset of the disease in susceptible populations. The present study investigated the association between the polymorphisms of six genes and CWP risk in a Chinese Han population. PATIENTS AND METHODS: Six polymorphisms (CASP8 rs3834129, IL1A rs1800587, IL6 rs1800796, IL4 rs2070874, TNFA rs361525, and NLRP3 rs1539019) were examined in 222 CWP subjects and 247 dust-exposed control subjects. RESULTS: The CASP8 rs3834129 Ins/Del genotype significantly decreased CWP risk (p=0.040; adjusted odds ratio [OR] = 0.586; 95% confidence interval [CI] 0.367-0.935) compared with the Ins/Ins genotype. Stratification analyses revealed a significant interaction between the heterozygous Ins/Del genotype and age. Compared with the Ins/Ins + Del/Del genotype, this was particularly evident among subjects aged 41-60 (p<0.001; adjusted OR = 0.054; 95% CI 0.007-0.420) and those with an exposure time of 20-29 years (p=0.014; adjusted OR = 0.392; 95% CI 0.183-0.842). This decreased risk was also found in the group with former smokers (p=0.012; adjusted OR = 0.448; 95% CI 0.238-0.844). Findings revealed that the heterozygous Ins/Del genotype of CASP8 rs3834129 was related to a significantly decreased risk of stage I CWP (p=0.045; adjusted OR = 0.592; 95% CI 0.353-0.992), but not stage II or III CWP. CONCLUSIONS: Our study indicated that the heterozygous Ins/Del genotype of CASP8 rs3834129 significantly decreased CWP risk in a Chinese Han population.

[Relationship between new-type drug use and high risk sex behavior in men who have sex with men].

Objective: To understand the relationship between new-type drug use and high risk behavior in men who have sex with men (MSM) in Shandong province. Methods: Cross-sectional surveys was conducted to collect the information about demographics, sexual and drug use behaviors of MSM and HIV-related services in MSM in three sentinel surveillance sites in Shandong from April to July in 2019. Blood samples were taken from the MSM for serological tests of HIV antibody and syphilis antibody. Results: A total of 1 203 MSM were included in this study. The average age of the MSM was 30.2±8.9 years. Among these MSM, 67.7% (815) were unmarried; 66.9% (805) had education level of college or above; 62.2% (721/1 160) had unprotected sex behaviors and 16.3% (189/1 160) had group sex behavior in the past six months and 54.2% (652/1 203) ever used new-type drugs. HIV infection and syphilis prevalence rates were 3.1% (37/1 203) and 4.7% (56/1 203), respectively. Multivariable logistic analysis indicated that MSM who had unprotected anal sex in the past six months were more likely to be from Qingdao (aOR=1.59, 95%CI:1.13-2.23), with education level of high school or below (aOR=1.61, 95%CI: 1.20-2.16), with male sex partners from bars/dance halls or other venues (aOR=1.69, 95%CI: 1.06-2.69), with HIV knowledge awareness score <6 (aOR=1.55, 95%CI: 1.01-2.37), with ≥2 sex partner in the past week (aOR=1.48, 95%CI: 1.12-1.95), to have group sex behaviors in the past six months (aOR=2.43, 95%CI:1.61-3.67) and to use new-type drugs (aOR=1.46, 95%CI: 1.11-1.91). MSM who had group sex were more likely to have following features: being from Qingdao (aOR=2.21, 95%CI: 1.45-3.38), non-Shandong residents (aOR=2.13, 95%CI: 1.28-3.55), HIV knowledge awareness score ≥6 (aOR=3.11, 95%CI: 1.55-6.25), ever having unprotected anal sex behaviors (aOR=2.60, 95%CI: 1.71-3.96) and ever having male commercial sex (aOR=3.38, 95%CI: 1.92-5.95) in the past six months, ever using new-type drugs (aOR=2.71, 95%CI: 1.82-4.04), and never having HIV testing in the past year (aOR=2.66, 95%CI: 1.59-4.43). Conclusion: New-type drug use is common in MSM in Shandong. The use of new-type drugs promotes unprotected sex and group sex in MSM. Surveillance and intervention measures targeting this population should be strengthened.

[Impact of achievement of "90-90-90" goals on reduction in new HIV infections in Shandong province based on risk estimation equation].

Objective: To explore the impact of achievement of the "90-90-90" goals on reductions in HIV incidence in Shandong province. Methods: An algebraic method was developed to link new HIV infections and the "90-90-90" goals in Shandong province. The risk estimation equation was used to analyze the effect of achievement of the "90-90-90" goals on reductions of HIV incidence, and explore the impact of application of antiviral therapy based prevention and control strategy on reduction of new HIV infections. Results: If "90-90-90" goals were achieved in 2020 in Shandong compared with annual new HIV infections in 2010, the percentage of reduction would be 17.27%, 35.99% and 67.55% respectively when transmission rate decreased by 26.00%, 53.00% and 96.00% respectively. Compared with 2017, when the transmission rate decreased by 53.00%, the annual new HIV infections would has a decrease of 10.10% if the rates of diagnosis and ART reached 90.00%; the annual new HIV infections would has a decrease of 20.80% if the rates of diagnosis and viral suppression reached 90.00%; the annual new HIV infections would has a decrease of 12.29% if the rates of ART and viral suppression reached 90.00%. Conclusions: HIV incidence would decrease with the achievement of "90-90-90" goals in Shandong. Compared with the improvement of ART, the improvement in diagnosis of HIV infection and viral suppression would result in more rapid decrease of new HIV infections. Besides expanding ART coverage, more attention should be paid to the strengthening of the diagnosis of HIV infection and viral suppression in Shandong.

[Analysis of rush poppers use and related factors in men who have sex with men in Jinan and Qingdao, 2016].

Objective: To understand the use of drug and its related factors among men who have sex with men, and to provide reference for the development of reasonable intervention measures. Methods: MSM was recruited from Jinan and Qingdao by means of on-site and internet recruiting from March to June in 2016. Anonymous questionnaires were conducted and HIV and syphilis serological tests were performed. The questionnaire included the general situation, sexual behavior, HIV related services and so on. Multi-factor unconditioned logistic regression model was used to explore related factors about rush poppers use. Results: The rush poppers use rate of 901 MSM was 30.1%（271/901）, the age was (29.3±8.1) years, the HIV infection rate was 4.6% (41/901) and the syphilis infection rate was 8.7% (78/901). Multivariate analysis showed that compared with those who were>25 years old, the OR (95%CI) of those who were ≤ 25 years old was 1.571 (1.110-2.224); compared with the number of anal sexual behavior was<2 times in the last week, the OR (95%CI) of those whose number of anal sexual behavior was ≥2 times was 2.991 (1.100-8.132); compared with those who had not received peer education services in the last year, the OR (95%CI) of those who received peer education services was 13.651 (7.239-25.742). Conclusion: Rush poppers are very popular in the MSM crowd, and those who aged less than 25 years old, who had anal sex more than twice in the past week, and who had received peer education services were more likely to use rush poppers. We should carry out targeted interventions according to the characteristics.

[Behavior and influencing factors of HIV infection among men who have sex with men only and men who have sex with both men and women in Shandong province].

Objective: This study aimed to examine the demographic characteristics, HIV related knowledge and behavior, correlates of bisexual behavior and status of HIV infection among men who have sex with men only (MSMO) and men who have sex with both men and women (MSMW) in Shandong province. Methods: According to the requirements from "National HIV/AIDS sentinel surveillance program" , a cross-sectional survey was conducted to collect information on demographics, sexual and drug use behaviors, and HIV-related services among MSM in nine sentinel surveillance sites from April to July in 2018. Blood samples were drawn for serological tests on both HIV and syphilis antibodies. Results: A total of 3 474 participants were included in this study. Related information on these participants would include: average age as (31.66±9.01) years; 35.06% (1 218) married or cohabiting with a woman, 50.52% (1 755) had college or higher education, 80.11% (2 783) self-identified as gays and 14.22% (494) self-identified as bisexual men,16.87% (586) ever having sex with woman in the past 6 months, 10.51% (365) ever using drugs. HIV and syphilis prevalence rates were 2.99% (104/3 474) and 2.76%(96/3 474). Through multivariable logistic models, MSMW were more likely to be ≥35 years of age, local residents, self-identified as heterosexual/bisexual/uncertain, ever having commercial sex with man but less likely to consistently use condoms in the past 6 months, less using internet/dating software to find male sex partners and less using drugs. There was no significant differences noticed in the following areas: number of sexual partners in the last week, condom use in the last six months with commercial sex partners, with HIV or syphilis infection and self-reported history of STD in the past year between MSMO and MSMW (P>0.05). HIV-infected MSM were more likely to have the following features, ≥45 years of age, non-local residents, finding male sex partners from the bothhouses, park/toilets or from the internet/dating software, also less likely to consistently use condoms in the past 6 months, using drugs or with syphilis infection. Conclusions: High prevalence of bisexual behavior as well as higher risk of HIV infection were noticed among MSM in Shandong province. It is important to strengthen related surveillance and effective intervention programs for MSM with different characteristics in Shandong province.

[Study on the relationship between smoking behavior and health literacy among grade 4-6 primary students in Shandong province].

Objective: To investigate the associations between smoking and literacy on health among 4-6 grade primary school students. Methods: A questionnaire survey was conducted to research on health literacy and smoking among 4-6 grade pupils in Shandong province, through a multi-stage stratified cluster random sampling method. Sociodemographic characteristics, health literacy level and smoking rate were collected from respondents. Binary logistic regression analysis was used to evaluate the association of smoking and health literacy. Results: A total of 9 240 questionnaires were distributed, with the rate of valid response as 99.7%. The current smoking rate of the students was 2.6%, on higher in boys (3.1%) than in girls (2.0%). 60.8% of 4-6 grade students were found to have adequate health literacy level. Levels of literacy health in both boy and girl school students appeared 56.7% and 64.9%, respectively. Results indicated that health literacy in smokers (14.4%) was lower than that in non-smokers (62.0%). Results from the binary logistic regression analysis showed that the independent influencing factors would include grade, father's education level, economic situation of the family, self-assessment on the school record and literacy on health (P<0.01). After controlling the other independent variables, the smoking rate was 8.62 (1/0.116) times in students with low literacy level on health, than those with high literacy level. Conclusions: Literacy on health was significantly associated with smoking in the 4-6 grade pupils of Shandong province.

[Analysis of HIV testing status and relevant factors in male sexually transmitted diseases patients in Shandong Province].

A survey was conducted to analyze the HIV testing status and related influencing factors of male sexually transmitted diseases(STD) patients attending 18 county-level hospitals in Shandong Province from July 2015 to August 2016. The HIV detection rate of 1 570 subjects was 77.58% (1 218/1 570), and the HIV-antibody positive rate was 0.99% (12/1 218). Compared with general hospitals patients, urinary and anorectal patients, non-sexual patients, and patients with negative attitudes toward HIV testing, patients were more likely to be tested for HIV from specialized hospitals (OR=3.74, 95%CI:2.53-5.54), the skin and venereal section (OR=1.92, 95%CI: 1.31-2.79), the STD group (OR=2.02, 95%CI: 1.34-3.03) and patients with positive attitude (OR=15.20, 95%CI:10.74-21.52).

[Survival status and influencing factors of HIV/AIDS on highly active anti-retrovial therapy in Shandong province].

Objective: To understand the survival status and influencing factors for HIV/AIDS patients on highly active anti-retroviral therapy (HAART) in Shandong province. Methods: Both Kaplan-Meier (K-M) method and cumulative incidence function (CIF) were used to calculate the cumulative incidence of AIDS-related death respectively, and Fine-Gray model was used to identify the influencing factors related to survival time. Results: Through K-M method, a higher AIDS-related cumulated death rate than the CIF, was estimated. Among all the HIV/AIDS patients who initiated HAART from 2003 to 2015 in Shandong, 5 593 of them met the inclusion criteria. The cumulative incidence rate for AIDS-related death was 3.08% in 1 year, 4.21% in 3 years, 5.37% in 5 years, and 7.59% in 10 years respectively by CIF. Results from the F-G analysis showed that HIV/AIDS patients who were on HAART, the ones who had college degree or above (HR=0.40, 95%CI: 0.24-0.65) were less likely to die of AIDS-associated diseases. However, HIV/AIDS patients who were on HAART and living in the western areas of Shandong (HR=1.33, 95%CI: 1.01-1.89), diagnosed by medical institutions (HR=1.39, 95%CI: 1.06-1.80), started to receive care ≥1 year after diagnosis (HR=2.02, 95%CI: 1.30-3.15), their CD(4) cell count less than 200 cells/µl (HR=3.41, 95%CI: 2.59-4.59) at the time of diagnosis, with NVP in antiviral treatment (ART) regime (HR=1.36, 95%CI: 1.03-1.88), at Ⅲ/Ⅳ clinical stages (HR=2.61, 95%CI: 1.94-3.53) and CD(4) cell count less than 350 cells/µl (HR=5.48,95%CI: 2.32-12.72) at initiation of HAART ect., were more likely to die of AIDS-associated diseases. Conclusions: With the existence of competing risks, the cumulative incidence rate for AIDS-related death was overestimated by K-M, suggesting that competing risk models should be used in the survival analysis. Measures as early diagnoses followed by timely care and early HAART could end up with the reduction of AIDS-related death.

[Confirmatory process and follow-up of 1 case with long-term HIV infection in Shandong].

Objective: To describe the confirmation process and long-term follow-up results of 1 case of HIV with long term progression. Methods: The subject was a HIV infected man aged 27 years old. The first HIV antibody positive was detected by ELISA in August 7(th), 2013. Close contacts were identified as 3 homosexual partners who had been contacted before infection and the first sexual partner had been unable to get in touch. Adopting the first epidemiological survey questionnaire of AIDS comprehensive prevention and control information system in China, the investigators conducted face-to-face surveys on the general demographic characteristics and behavioral characteristics of the subject. After the first ELISA test result was positive, 4 rapid detections of colloid selenium, ELISA, western-blot, CD4(+)T and viral load test were followed up (August 14(th), 21(st), 30(th) and September 16(th), 2013). Long term follow-up was performed to detect CD4(+)T and viral load to observe the progress of the case after the diagnosis of infection. Results: The duration of sexual behavior was from 2011 to 2012 between the subject and his 1(st) sexual partner. During the study, repeated HIV antibody ELISA test results were negative. Sexual behavior maintained from January to April 2013 between the subject and his 2(nd) partner and the last one unprotected homosexual acts took place in April 2013. After the traceability survey, the 2(nd) sexual partner was an AIDS patient who had antiretroviral therapy in the anti HIV treatment module of AIDS comprehensive prevention information system. The subject and his 3(rd) partner maintained their sexual behavior from May to October 2013. The two ELISA tests of the 3(rd) partner were negative. Because of the need for hospital operation in August 7, 2013, the subject was tested for HIV antibody by ELISA and the result was positive while western blot test showed that the HIV-1 antibody was not confirmed (band type was gp160/gp120/p24). In the subsequent follow-up, 4 rapid detections of colloid selenium, ELISA and western-blot were conducted and all the results were positive (western-blot band type was gp160/gp120/gp41/p24/p17). Results of continuous follow-up for 5 years showed that the first four CD4(+)T cell counts were as follows: 520, 616, 834, 879. The following 22 CD4(+)T counts sustained at a high level and the median was 895 cells/µl. A total of 5 follow-up visits were conducted to detect viral load exceeding 1 000 copies/ml and the remaining 19 test results were lower than 1 000 copies/ml except that no viral load was detected in 2 follow-up visits. The result of homology analysis showed that the HIV types of the case and its 2(nd) sexual partner were all HIV-1 CRF_01AE. The similarity of gag region gene was 97.5%. So we inferred that the 2(nd) sexual partner was its source of infection, and the case was infected at the end of April 2013 with the last unprotected homosexual behavior. Conclusion: The infected person was found to be an early HIV infection. Continuous follow-up test results indicated that the case belonged to a HIV long-term nonprogressor.

[Epidemiological features of hepatitis C and its related influencing factors in Shandong province, 2007-2016].

Objective: To analyze the epidemiological characteristics, dynamic trend of development and related influencing factors of hepatitis C in Shandong, China, 2007-2016, also to provide epidemiological evidence for prevention and control of HCV. Methods: National surveillance data of hepatitis C from 2007 to 2016 in Shandong was used, with distribution and clustering map of hepatitis C drawn at the county level. Panel Poisson regression was used to explore the influencing factors of hepatitis C at the city level. Results: The incidence of hepatitis C in Shandong increased from 1.49/100 000 in 2007 to 4.72/100 000 in 2016, with the high incidence mainly clustered in the urban regions in Jinan, Zibo, Weihai et al. and surrounding vicinities. Majority of the cases were young adults, with 53.16% (14 711/27 671) of them being farmers. Results from the Multiple panel Poisson regression analysis indicated that factors as: population density (aIRR=1.07, 95%CI: 1.05-1.10), number of hospital per hundred thousand people shared (aIRR=1.16, 95%CI: 1.08-1.24), expenditure of medical fee in rural (aIRR=1.21, 95%CI: 1.08-1.37) and the proportion of the tertiary industry (aIRR=1.08, 95%CI: 1.07-1.09) were all correlated to the incidence of hepatitis C. Conclusions: The incidence of hepatitis C had been increasing rapidly in recent years, in Shandong. Prevention and control of HCV should focus on high risk population. In addition, rural, especially in areas with lower economics provision should be under more attentions, so as to find more concealed cases for early treatment.

[Analysis on the epidemic features of male HIV-infected and AIDS patients by sexual transmission in Shandong Province from 2007 to 2016].

Objective: To analyze the epidemic features of male HIV-infected and AIDS patients by sexual transmission in Shandong Province. Methods: Data on HIV-infected people and AIDS patients (HIV/AIDS) were derived from HIV/AIDS Comprehensive Response Information Management System. To analysis the epidemiological data of male HIV/AIDS by sexual transmission reported in Shandong Province from 1997 to 2016. Results: A total of 8 584 HIV/AIDS were reported by heterosexual transmission or homosexual transmission from 2007 to 2016. 2 421 cases were reported by heterosexual transmission and 6 163 cases were reported by homosexual transmission. Among cases infected by heterosexual transmission. The average age of cases infected by heterosexual transmission was (38.13±12.39) and (31.62±10.22) among cases who infected by homosexual transmission (t=24.95, P<0.001). 84 cases were reported by homosexual transmission and 138 cases by heterosexual transmission from 2007 to 2008, and 6 079 cases were reported by homosexual transmission and 2 283 cases by heterosexual transmission from 2009 to 2016. A total of 770 cases were dead after reported. Among the dead cases, 337 cases were infected by homosexual transmission and 433 cases by heterosexual transmission (χ(2)=328.21, P<0.001). 61.4% of the dead cases by heterosexual transmission were no longer than 6 months after reported and 54.3% in homosexual transmission (χ(2)=3.96, P=0.047). Conclusion: Homosexual transmission has been the main transmission of HIV/AIDS in Shandong Province. Epidemiological features and social demographic characteristics of each sexual transmission were different. As part of HIV cases developed to death in 6 months.

[Related factors on secondary drug resistance in HIV infected persons receiving antiretroviral therapy in Shandong province: a case-control study].

Objective: To explore the causes of secondary drug resistance among HIV infected persons who were receiving antiretroviral therapy in Shandong province, and provide evidence for the improvement of antiretroviral therapy strategy. Methods: A case-control study was designed with 1∶2 matching on case and control groups. Household and face-to-face interview were conducted in October, 2015. All the study subjects were screened from both the drug resistant database of antiretroviral therapy of Shandong provincial laboratory and national comprehensive HIV/AIDS database in Shandong. The sample size was estimated as 330 cases including 110 drug resistant and 220 non-drug resistant cases. Subjects were people living with HIV/AIDS (PLWHA) aged 15 or older and received antiretroviral therapy for more than 6 months with records of virus load (VL). Subjects who presented VL above 1 000 copies/ml would receive drug resistance testing. Subjects who were confirmed resistant to with secondary drug, were selected as case group, the rest subjects with non-secondary drug resistance would form the control group. EpiData 3.1 software and SPSS 22.0 software were used to establish a database. Related influencing factors were analyzed with non- conditional stepwise logistic regression model. Results: A total of 288 cases were enrolled, including 103 in the case and 185 cases in the control groups, with average age as (37.62±1.06) years and (37.90±0.74) years old, respectively. Most of them were male, married/cohabitant, with education level of junior/senior high school or below and under Han nationality. Results from the multivariate logistic regression model showed that ORs (95%CI) of receiving antiretroviral therapy for 1-3 years, or more than 3 years were equal to 8.80 (3.69-21.00), 3.00 (1.20-7.53), compared with receiving antiretroviral therapy less than one year, respectively. OR (95%CI) of Among the PLWHA that with missing rate above 25.0% on medication, the OR appeared as 15.41(4.59-51.71), compared with not missing medication. OR (95%CI) among those who took the medicine themselves was 0.22 (0.07-0.74). Conclusions: Factors as duration of treatment, missing rate on medication and taking medicine by oneself were of influence on secondary drug resistance. Other factors as duration on antiretroviral therapy longer than 1 year, missing rate above 25.0% on medication, were related to the risk on secondary drug resistance. However, if the medicine was taken by oneself, it served as a protective factor for secondary drug resistance. It is necessary to strengthen the intervention and health education programs related to antiretroviral therapy.

[Lead time bias and its control in observational studies for clinical outcomes].

Lead time bias might exist in observational study for clinical outcomes. This paper summarizes the concept of lead time bias, causes and control of lead time bias by using the studies of influences of screening diagnostic test on cancer patients'survival and highly active antiretroviral therapy on HIV/AIDS patients' survival as examples for the purpose of providing thinking and methods in the control of lead time bias for the accurate evaluation of the effects of interventions, such as test and treatment, on the diseases with multi courses or phases.