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1.
Curr HIV Res ; 17(2): 85-93, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31269884

RESUMO

The aim of this review is to describe long-term HIV epidemiology and prevention trends in Guangxi, a provincial-level region located along a major drug trafficking corridor in southwestern China. Between 1996 and 2006, HIV transmission in Guangxi was primarily fueled by Injection Drug Use (IDU). Since 2006, heterosexual sex has become the dominant mode of HIV transmission, followed by drug injection. Moreover, older, heterosexual adults appear to be at increased risk for HIV. The vast majority of new HIV cases are attributed to local HIV subtypes already circulating within Guangxi (93%), though imported subtypes are associated with younger age groups. Since 2011, HIV incidence in Guangxi has stabilized, due in part to HIV prevention efforts that include expanded HIV testing, antiretroviral treatment, and other intervention measures. Between 1996 and 2017, Guangxi, China experienced dramatic changes in the primary HIV transmission mode and at-risk age group. Due in part to local and National AIDS control and prevention campaigns, HIV incidence trends in Guangxi no longer appear to be increasing.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , China/epidemiologia , Infecções por HIV/transmissão , Humanos , Fatores de Risco
2.
BMJ Open ; 9(3): e025666, 2019 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-30928945

RESUMO

OBJECTIVES: China has continued to expand antiretroviral therapy (ART) services and optimise ART guidelines in an effort to significantly reduce and prevent mortality and transmission rates among HIV patients. However, no study to date has compared treatment outcomes of initial differential antiretroviral regimens among HIV patients in a real-world setting in China. This study aimed to compare the effects of different ART regimens on treatment outcomes among adults. DESIGN: Observational retrospective cohort study. SETTING: Data from 2011 to 2013 in Guangxi, China. PARTICIPANTS: Patients aged ≥18 years (n=25 732) were selected. RESULTS: A total of 25 732 patients were included in this study. The average mortality and attrition rate were 2.64 and 4.98, respectively, per 100 person-years. Using Cox proportional hazard models, zidovudine-based (AZT-based) regimen versus stavudine-based (D4T-based) regimen had an adjusted HR (AHR) for death of 0.65 (95% CI 0.58 to 0.73); the AHR of tenofovir-based (TDF-based) versus D4T-based regimens was 0.81 (95% CI 0.71 to 0.92), and of lopinavir-ritonavir-based (LPV/r-based) versus D4T-based regimens, 1.19 (95% CI 1.04 to 1.37). AZT-based versus D4T-based regimens had an AHR for dropout of 0.89 (95% CI 0.81 to 0.97); this ratio for TDF-based versus D4T-based regimens was 0.88 (95% CI 0.80 to 0.98), and for LPV/r-based versus D4T-based regimens, 1.42 (95% CI 1.27 to 1.58). AZT-based and TDF-based regimens had a lower risk compared with D4T-based regimens, while LPV/r-based regimens had a higher risk. High gastrointestinal reactions and poor adherence were observed among HIV patients whose initial ART regimen was LPV/r-based. CONCLUSIONS: Our study found that the treatment outcomes of initial ART regimens that were AZT-based or TDF-based were significantly better than D4T-based or LPV/r-based regimens. This finding could be related to the higher rates of gastrointestinal reactions and poorer adherence associated with the LPV/r-based regimens compared with other initial ART regimens.

3.
AIDS Res Ther ; 16(1): 6, 2019 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-30876476

RESUMO

OBJECTIVE: This study aimed to investigate the prevalence of HIV late presentation and advanced HIV disease and to identify the factors associated with HIV late presentation and advanced HIV disease among patients with newly diagnosed HIV/AIDS in the Guangxi Zhuang Autonomous Region, in Southwestern China. METHODS: Patients with newly diagnosed HIV registered in the HIV surveillance system of Guangxi Centers for Disease Control between January 2012 and December 2016 were included in this study. RESULTS: Of 45,118 newly diagnosed patients, 70.2% had late presentation, and 45.1% had advanced HIV disease. A higher prevalence of late presentation and advanced HIV disease was found in male heterosexuals and female people who use drugs (PWID). Heterosexuals (OR 2.11 [95% CI 1.90-2.34]) and PWID (OR 1.55 [95% CI 1.30-1.84]) had a higher risk of late presentation than men who have sex with men (MSM). Blood testing of the blood receivers (OR 1.75 [95% CI 1.36-2.26]) and diagnosed in hospital (OR 1.74 [95% CI 1.65-1.84]) had an increased risk of late presentation compared to those who diagnosis in voluntary counseling and testing (VCT). Heterosexuals (OR 2.86 [95% CI 2.51-3.27]), PWID (OR 2.23 [95% CI 1.83-2.71]), blood testing of the blood receivers (OR 1.58 [95% CI 1.29-1.94]) and diagnosed in hospital (OR 1.85 [95% CI 1.76-1.94]) were also independent risk factors associated with advanced HIV disease. Older age, lower level of education and being divorced or widowed were also associated with late presentation and advanced HIV disease. CONCLUSIONS: Late presentation and advanced HIV disease were very common among patients with newly diagnosed HIV in Guangxi, China during 2012-2016. Targeted programs are urgently required to reduce HIV late diagnosis in Guangxi, especially for male heterosexuals, PWID, and patients with characteristics such as older age, lower level of education, divorced or widowed.


Assuntos
Diagnóstico Tardio , Monitoramento Epidemiológico , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Adolescente , Adulto , Fatores Etários , China/epidemiologia , Aconselhamento , Estudos Transversais , Usuários de Drogas , Feminino , Heterossexualidade , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Minorias Sexuais e de Gênero , Adulto Jovem
4.
Sci Rep ; 9(1): 1006, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700732

RESUMO

HIV with HBV co-infection can result in greater HIV-related immunosuppression, morbidity and mortality. Currently, there are few studies to evaluate direct treatment effects on mortality and attrition rates between first-line antiretroviral therapy (ART) based-on tenofovir (TDF) and/or lamivudine (3TC) in a real-world setting. We used Cox proportional hazard models to evaluate direct treatment effects of the first-line ART containing stavudine (d4T), azidothymidine (AZT) and TDF on death and attrition among HIV patients with HBV coinfection. A total of 3912 patients met study eligibility criteria. The overall mortality rate and attrition rate was 2.85 (95% CI: 2.55-3.16) and 8.87 (95% CI: 8.32-9.41) per 100 person-years, respectively. The ART containing TDF had a significantly lower risk of death [adjusted hazard ratio (AHR) = 0.58, 95% CI: 0.44-0.77] when compared to the ART containing d4T, but the risk of death was not significantly different when compared to the ART containing AZT (AHR = 0.91, 95% CI: 0.69-1.20). Patients with HIV/HBV coinfection receiving the ART containing TDF had significantly lower risk rates of attrition compared to those receiving the ART containing d4T (AHR = 0.72, 95% CI: 0.60-0.86) or AZT (AHR = 0.67, 95% CI: 0.58-0.77). Compared with the ART containing d4T, the ART containing AZT was significant and not significant associated with a lower risk of death and attrition, respectively. The ART containing TDF had significant effects on both of death and attrition among HIV patients with HBV coinfection.

5.
Sci Rep ; 8(1): 17478, 2018 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-30478351

RESUMO

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

6.
Sci Rep ; 8(1): 12831, 2018 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-30150680

RESUMO

Although the Guangxi region accounts for 10% of all HIV-1 cases new reported in 2011 in China, the sources of the transmitted HIV-1 strains are virtually unknown. To determine the extent to which recent HIV infections were derived from already circulating local strains as opposed to recently introduced strains, we performed a cross-sectional molecular epidemiological investigation of recent infections across Guangxi during 2012-2013. HIV-1 nucleotide sequences were amplified and sequenced. Phylogenetic analyses of pol gene regions were used to determine HIV-1 transmission source strains. Based on 229 sequences generated, the subtype/CRF distribution was as follows: CRF01_AE (61.1%), CRF07_BC (18.8%), CRF08_BC (16.6%), CRF55_01B (3.1%), and subtype B' (0.4%). In total, 213 of 229 (93.0%) sequenced transmission strains were derived from already-circulating local strains. Multivariate logistic regression analysis showed that only an age of 18-25 years was significantly associated with transmission from outside Guangxi (compared to >25 years, AOR: 5.15, 95% CI: 1.18-22.48, p < 0.01). This is the first study to use a Bayesian discrete phylogeographic approach to analyze transmission source strains in China. Our results provide useful data for designing evidence-based prevention strategies and methods for combating the rapid spread of sexually transmitted HIV in Guangxi.

7.
J Stud Alcohol Drugs ; 79(2): 248-257, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29553354

RESUMO

OBJECTIVE: Since 2003, the Chinese central government has implemented several harm reduction and preventive measures to control HIV. We aim to describe epidemiological trends of HIV, hepatitis C virus (HCV), and syphilis in Guangxi drug users after the policy implementation. METHOD: A total of 12,161-15,870 drug users in Guangxi, China, were recruited annually from 2009 to 2015 through community outreach or snowball sampling. The participants' demographics, behavior, and infection status were used to characterize rates of protective behaviors and disease prevalence (HIV, syphilis, and HCV). Chi-squared trend testing was used. RESULTS: Relative to baseline, the prevalence of HIV, HCV, and syphilis decreased from 13.6% to 6.2%, 68.0% to 50.5%, and 8.5% to 5.2%, respectively, by 2015. Concurrently, the rate of injecting drugs, needle sharing, unprotected last sexual encounter, and regular unprotected intercourse decreased from 82.6% to 64.5%, 24.1% to 5.5%, 66.6% to 39.7%, and 74.0% to 51.2%, respectively. The usage of prevention services, methadone maintenance therapy or needle exchange, peer education programs, HIV testing in the previous year, and knowledge of HIV status increased from 63.4% to 93.6%, 52.0% to 56.6%, 37.4% to 43.1%, 45.3% to 91.3%, and 76.7% to 99.4%, respectively, from 2009 to 2015. CONCLUSIONS: After a decade of HIV control policies, this was the first Chinese study to show a decreasing prevalence of HIV, HCV, and syphilis in the context of increasing uptake of protective services and behaviors.


Assuntos
Infecções por HIV/epidemiologia , Redução do Dano , Hepatite C/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Sífilis/epidemiologia , Adulto , Idoso , China/epidemiologia , Usuários de Drogas , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Comportamento Sexual
8.
Sci Rep ; 8(1): 3431, 2018 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-29467460

RESUMO

Early antiretroviral therapy (ART) initiation is a recommended public health approach for the prevention of HIV-1 transmission. In this cohort study, we included 13132 serodiscordant couples. ART was initiated for patients with CD4+ T cell counts less than 200 cells/uL, 350 cells/uL, and 500 cells/uL respectively. This divided the ART treated couples into three groups. Univariate and multivariate intention-to-treat analyses were performed to examine the association between the study groups. Early-ART initiation was associated with a 45% lower risk of partner infection than was late-ART initiation (AHR 0.55, 95% CI, 0.37-0.81). Mid-ART initiation was associated with a 39% lower risk of partner infection than was late-ART initiation (AHR 0.61, 95% CI, 0.48-0.78). However, the risk reduction between the early and mid-ART groups was not significant. Drug compliance (AHR 1.55, 95% CI 1.03-2.35) and increased baseline viral load (AHR 1.41, 95% CI 1.33-1.51) were associated with an increased risk of infections among partners in the treatment. Prevention of HIV transmission as a result of early ART initiation was feasible on national and regional scales; however, many factors, such as the motivation to commence ART, adherence, and attrition, may affect the impact of this strategy in programmatic settings.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Adulto , Contagem de Linfócito CD4 , China/epidemiologia , Estudos de Coortes , Feminino , Infecções por HIV/epidemiologia , HIV-1/efeitos dos fármacos , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Prevenção Secundária , Parceiros Sexuais
9.
Microbiol Immunol ; 62(4): 248-254, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29377267

RESUMO

Whether the amount of HIV DNA is associated with the subtype of HIV-1 after antiretroviral therapy (ART) has not been reported. In the present study, the amount of HIV DNA and RNA and CD4+T counts in blood and semen prior to and after 18 months of ART were compared in 48 patients infected by CRF01_AE, subtype B or CRF07_BC of HIV-1. Viral RNA was suppressed and CD4 cell count recovery achieved in all patients. The level of HIV DNA were similar before ART; however, patients with CRF01_AE had less HIV DNA after ART than those with subtype B and CRF07_BC infection. According to prediction of co-receptor usage by Geno2Pheno and PSSM in combination, more than 35.6% of clones for CRF01_AE were predicted as CXCR4-using before ART, whereas less than 6% of those for subtype B and CRF07_BC were predicted as CXCR4-using. After 18 months of ART, no CXCR4-using clones were predicted in any of the subtypes. Despite more HIV RNA and fewer CD4 + T cells in patients with CRF01_AE before therapy, no significant differences (P > 0.05) in viral RNA or CD4 cell counts were observed between the subtypes after 18 months of ART. Thus, 18 months of antiretroviral therapy was more efficient in patients with CRF01_AE. Considering that successful ART dramatically reduces the viral load in both blood and semen, risks of sexual transmission of HIV were reduced, contributing to prevention of rapid spread of HIV among men who have sex with men in the region.


Assuntos
Antirretrovirais/farmacologia , Antirretrovirais/uso terapêutico , DNA Viral/sangue , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Adulto , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos , China , Vetores Genéticos , Genótipo , Humanos , Pessoa de Meia-Idade , RNA Viral/sangue , Carga Viral/efeitos dos fármacos , Adulto Jovem
10.
Infect Dis Model ; 3: 249-255, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30839859

RESUMO

Background: China has ambitious to achieve significant reductions in HIV transmission and HIV-related mortality by adopting the World Health Organization's "Treat All" approach. Such a prevention strategy is needed future study on regional scale. Methods: An observational cohort study of HIV epidemiology and treatment databases was used to study the effectiveness of antiretroviral therapy on the transmission of HIV in serodiscordant couples in Guangxi of China. Results: A total of 7713 couples were entered into the cohort study analysis which included 1885 couples in the treatment-naive cohort and 5828 couples in the treated cohort. During the follow-up of 18985.29 person-years from 2003 to 2014, the average incidence of HIV was 2.4 per 100 person-years (95% CI 2.1-2.6). HIV seroincidence rate was significantly higher among the treatment naive group (4.2 per 100 person-years, 3.7-4.8) compared with the on treatment group (1.6 per 100 person-years, 1.3-1.8). An overall 45% reduction in risk of HIV transmission among serodiscordant couple was associated with ART treatment (adjusted Hazard Ratio [HR] 0.55, 95% Confidence Interval [CI] 0.44-0.69). Treatment prevention had significantly effectiveness for most baseline characteristics of index partners, such as for male, female, age above 25 years, education below high school, farmer, infected by heterosexual intercourse. Conclusion: Treatment-as-prevention can be implemented in the real-world on a national or regional scale, but ART adherence and comprehensive harm reduction while implementing this strategy require further study.

11.
BMC Public Health ; 17(1): 759, 2017 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-28962612

RESUMO

BACKGROUND: A methadone maintenance treatment (MMT) program to curb the dual epidemics of HIV/AIDS and drug use has been administered by China since 2004. Little is known regarding the geographic heterogeneity of HIV and hepatitis C virus (HCV) infections among MMT clients in the resource-constrained context of Chinese provinces, such as Guangxi. This study aimed to characterize the geographic distribution patterns and co-clustered epidemic factors of HIV, HCV and co-infections at the county level among drug users receiving MMT in Guangxi Zhuang Autonomous Region, located in the southwestern border area of China. METHODS: Baseline data on drug users' demographic, behavioral and biological characteristics in the MMT clinics of Guangxi Zhuang Autonomous Region during the period of March 2004 to December 2014 were obtained from national HIV databases. Residential addresses were entered into a geographical information system (GIS) program and analyzed for spatial clustering of HIV, HCV and co-infections among MMT clients at the county level using geographic autocorrelation analysis and geographic scan statistics. RESULTS: A total of 31,015 MMT clients were analyzed, and the prevalence of HIV, HCV and co-infections were 13.05%, 72.51% and 11.96% respectively. Both the geographic autocorrelation analysis and geographic scan statistics showed that HIV, HCV and co-infections in Guangxi Zhuang Autonomous Region exhibited significant geographic clustering at the county level, and the Moran's I values were 0.33, 0.41 and 0.30, respectively (P < 0.05). The most significant high-risk overlapping clusters for these infections were restricted to within a 10.95 km2 radius of each of the 13 locations where P county was the cluster center. These infections also co-clustered with certain characteristics, such as being unmarried, having a primary level of education or below, having used drugs for more than 10 years, and receptive sharing of syringes with others. The high-risk clusters for these characteristics were more likely to reside in the areas surrounding P county. CONCLUSIONS: HIV, HCV and co-infections among MMT clients in Guangxi Zhuang Autonomous Region all presented substantial geographic heterogeneity at the county level with a number of overlapping significant clusters. The areas surrounding P county were effective in enrolling high-risk clients in their MMT programs which, in turn, might enable people who inject drugs to inject less, share fewer syringes, and receive referrals for HIV or HCV treatment in a timely manner.


Assuntos
Coinfecção/epidemiologia , Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Metadona/uso terapêutico , Programas Nacionais de Saúde , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Substâncias/virologia
12.
Lancet HIV ; 4(12): e555-e565, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28867267

RESUMO

BACKGROUND: Multistage, stepwise HIV testing and treatment procedures can result in lost opportunities to provide timely antiretroviral therapy (ART). Incomplete engagement of patients along the care cascade translates into high preventable mortality. We aimed to identify whether a structural intervention to streamline testing and linkage to HIV health care would improve testing completeness, ART initiation, and viral suppression and reduce mortality. METHODS: We did a cluster-randomised, controlled trial in 12 hospitals in Guangxi, China. All hospitals were required to be level 2A county general hospitals and ART delivery sites. We selected the 12 most similar hospitals in terms of structural characteristics, past patient caseloads, and testing procedures. Hospitals were randomly assigned (1:1) to either the One4All intervention or standard of care. Hospitals were randomised in a block design and stratified by the historical rate of testing completeness of the individual hospital during the first 6 months of 2013. We enrolled patients aged 18 years or older who were identified as HIV-reactive during screening in study hospitals, who sought inpatient or outpatient care in a study hospital, and who resided in the study catchment area. The One4All strategy incorporated rapid, point-of-care HIV screening and CD4 counts, and in-parallel viral load testing, to promote fast and complete diagnosis and staging and provide immediate ART to eligible patients. Participants in control hospitals received standard care services. All enrolled patients were assessed for the primary outcome, which was testing completeness within 30 days, defined as completion of three required tests and their post-test counselling. Safety assessments were hospital admissions for the first 90 days and deaths up to 12 months after enrolment. This trial is registered with ClinicalTrials.gov, number NCT02084316. FINDINGS: Between Feb 24 and Nov 25, 2014, we enrolled 478 patients (232 in One4All, 246 in standard of care). In the One4All group, 177 (76%) of 232 achieved testing completeness within 30 days versus 63 (26%) of 246 in the standard-of-care group (odds ratio 19·94, 95% CI 3·86-103·04, p=0·0004). Although no difference was observed between study groups in the number of hospital admissions at 90 days, by 12 months there were 65 deaths (28%) in the in the One4All group compared with 115 (47%) in the standard-of-care group (Cox proportional hazard ratio 0·44, 0·19-1·01, p=0·0531). INTERPRETATION: Our study provides strong evidence for the benefits of a patient-centred approach to streamlined HIV testing and treatment that could help China change the trajectory of its HIV epidemic, and help to achieve the goal of an end to AIDS. FUNDING: US National Institute on Drug Abuse Clinical Trials Network and China's National Health and Family Planning Commission.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , HIV/fisiologia , Adulto , Idoso , Terapia Antirretroviral de Alta Atividade , China , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Carga Viral , Adulto Jovem
13.
Sci Rep ; 7(1): 3129, 2017 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-28600549

RESUMO

Current WHO guidelines recommend initiating ART regardless of CD4+ cell count. In response, we conducted an observational cohort study to assess the effects of pre-ART CD4+ cell count levels on death, attrition, and death or attrition in HIV treated patients. This large HIV treatment cohort study (n = 49,155) from 2010 to 2015 was conducted in Guangxi, China. We used a Cox regression model to analyze associations between pre-ART CD4+ cell counts and death, attrition, and death or attrition. The average mortality and ART attrition rates among all treated patients were 2.63 deaths and 5.32 attritions per 100 person-years, respectively. Compared to HIV patients with <350 CD4+ cells/mm3 at ART initiation, HIV patients with >500 CD4+ cells/mm3 at ART initiation had a significantly lower mortality rate (Adjusted hazard ratio: 0.56, 95% CI: 0.40-0.79), but significantly higher ART attrition rate (AHR: 1.17, 95% CI: 1.03-1.33). Results from this study suggest that HIV patients with high CD4+ cell counts at the time of ART initiation may be at greater risk of treatment attrition. To further reduce ART attrition, it is imperative that patient education and healthcare provider training on ART adherence be enhanced and account for CD4 levels at ART initiation.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Adulto , Contagem de Linfócito CD4 , China , Feminino , Infecções por HIV/mortalidade , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Mortalidade , Análise de Regressão , Resultado do Tratamento
14.
Medicine (Baltimore) ; 95(22): e3726, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27258500

RESUMO

Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs).We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40-49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time.By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%-2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%-0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients preferred LTFSWs, especially older clients (81.9%).Our results suggest that HIV and syphilis infections are increasing in older clients who prefer LTFSWs. HIV and syphilis are likely increasing in Guangxi Province through heterosexual transmission.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/epidemiologia , HIV-1 , Vigilância de Evento Sentinela , Profissionais do Sexo/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Sífilis/epidemiologia , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Sífilis/prevenção & controle
15.
Clin Infect Dis ; 63(1): 108-14, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-27001800

RESUMO

BACKGROUND: Recent studies have suggested that CD4 cell count monitoring has little added value in patients who are virologically suppressed and immunologically stable if viral load (VL) testing is routinely available. These conclusions have not been directly assessed using mortality rate as a study end point in a real-world setting. METHODS: This human immunodeficiency virus (HIV) treatment cohort study from 2008 to 2014 was conducted in Guangxi, China. We used a Cox regression model to analyze associations between the frequency of CD4 cell counts and VL testing and death. RESULTS: Compared with monitoring CD4 cell counts ≥3 times during the first year of antiretroviral therapy (ART) initiation, as currently suggested by the Chinese National Free Antiretroviral Treatment Program, monitoring them less than twice during the first year of ART was significantly associated with death; however, monitoring them twice in that year did not significantly increase mortality rates. Compared with testing VL at least once during the first year of ART, as currently suggested by the National Free Antiretroviral Treatment Program, performing no VL tests in the first year after ART initiation was significantly associated with higher mortality rates. Routine CD4 cell count monitoring did not have an impact on mortality rates among HIV-infected patients with VLs <1000 copies/mL or CD4 cell counts ≥350/µL beyond 12 months after ART initiation. CONCLUSIONS: Our study suggests that CD4 cell counts can be reduced to twice during the first year of ART and be reduced or stopped for patients who have achieved virologic suppression or immunologic stability after 12 months of treatment.


Assuntos
Antirretrovirais/uso terapêutico , Contagem de Linfócito CD4/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Carga Viral/estatística & dados numéricos , Adulto , China , Feminino , Infecções por HIV/imunologia , Infecções por HIV/mortalidade , Infecções por HIV/virologia , Humanos , Masculino , Estudos Prospectivos
16.
Medicine (Baltimore) ; 94(24): e902, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26091454

RESUMO

The Chinese national observational cohort study suggests that the treatment-as-prevention (TasP) approach can be an effective public health HIV-1 prevention strategy. However, results from that study may have been biased because the follow-up time of index patients prior to their initiation of antiretroviral therapy (ART) was excluded. In this study, we correct for such bias by using an extended time-dependent Cox regression model to conduct a cohort study analysis of serodiscordant couples in Guangxi of China, inclusive of all follow-up time. During the follow-up of this observational cohort study of HIV-1 sero-discordant couples, the positive index partners may have never be treated with ART, or enter untreated but subsequently began treatment, or may have been treated immediately upon entry into the public health system. The treatment effectiveness of ART in HIV-1 acquisition among HIV-negative partners is assessed by the extended Cox regression model with treatment status as a time-varying covariate. A total of 6548 sero-discordant couples were included in the cohort study analysis. Among them, 348 negative partners sero-converted. HIV seroincidence was significantly higher among the nontreated (4.3 per 100 person-years, 3.7-4.9) compared with those receiving ART (1.8 per 100 person-years, 1.5-2.0). An overall 35% reduction in risk of HIV transmission was associated with receiving ART (adjusted hazard ratio [AHR] 0.65, 95% confidence interval [CI] 0.51-0.83), and the yearly risk reduction was also significant in the first 3 consecutive years of follow-up. Moreover, ART was found to be significantly inversely associated with multiple baseline characteristics of index partners. TasP may be feasible on a national or regional scale. In addition to other proven preventive strategies such as the use of condoms, ART adherence to maintain viral suppression would then be the key challenge for successful TasP implementation.


Assuntos
Antirretrovirais/administração & dosagem , Infecções por HIV/prevenção & controle , HIV-1 , Profilaxia Pré-Exposição/métodos , Parceiros Sexuais , Adolescente , Adulto , Contagem de Linfócito CD4 , China , Estudos de Coortes , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Profilaxia Pré-Exposição/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
17.
J Acquir Immune Defic Syndr ; 69(5): 551-9, 2015 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-25886927

RESUMO

BACKGROUND: Real-time adherence monitoring is now possible through medication storage devices equipped with cellular technology. We assessed the effect of triggered cell phone reminders and counseling using objective adherence data on antiretroviral therapy (ART) adherence among Chinese HIV-infected patients. METHODS: We provided ART patients in Nanning, China, with a medication device (Wisepill) to monitor their ART adherence electronically. After 3 months, we randomized subjects within optimal (≥95%) and suboptimal (<95%) adherence strata to intervention vs. control arms. In months 4-9, intervention subjects received individualized reminders triggered by late dose taking (no device opening by 30 minutes past dose time) and counseling using device-generated data. Controls received no reminders or data-informed counseling. We compared postintervention proportions achieving optimal adherence, mean adherence, and clinical outcomes. RESULTS: Of 120 subjects enrolled, 116 (96.7%) completed the trial. Preintervention optimal adherence was similar in intervention vs. control arms (63.5% vs. 58.9%, respectively; P = 0.60). In the last intervention month, 87.3% vs. 51.8% achieved optimal adherence [risk ratio (RR): 1.7, 95% confidence interval (CI): 1.3 to 2.2] and mean adherence was 96.2% vs. 89.1% (P = 0.003). Among preintervention suboptimal adherers, 78.3% vs. 33.3% (RR: 2.4, CI: 1.2 to 4.5) achieved optimal adherence and mean adherence was 93.3% vs. 84.7% (P = 0.039). Proportions were 92.5% and 62.9% among optimal adherers, respectively (RR: 1.5, CI: 1.1 to 1.9) and mean adherence was 97.8% vs. 91.7% (P = 0.028). Postintervention clinical outcomes were not significant. CONCLUSIONS: Real-time reminders significantly improved ART adherence in this population. This approach seems promising for managing HIV and other chronic diseases and warrants further investigation and adaptation in other settings.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Mensagem de Texto , Adulto , Fármacos Anti-HIV/administração & dosagem , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
PLoS One ; 10(2): e0115311, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25723548

RESUMO

INTRODUCTION: Female sex workers (FSWs) are at highest risk for contracting HIV and facilitating the current heterosexual HIV epidemic in Guangxi, China, yet little is known of the impact of recent harm reduction campaigns in the province. We analyzed sentinel surveillance data collected between 2010 and 2012 in Guangxi to explore correlations between the prevalence of HIV, hepatitis C (HCV), and syphilis and risk behaviors of different categories of FSWs in Guangxi. METHODS: The sentinel surveillance data for 5,1790 FSWs in all 14 prefectures and 64 city/county regions of Guangxi, China from 2010 to 2012 were collected. Differences between three categories of FSWs (grouped by venue) and disease trends (HIV, HCV, and syphilis) by year were analyzed using bivariate and multivariate logistic regression analyses as to evaluate risk factors correlated with HIV, HCV, or syphilis infection. RESULTS: HIV and HCV prevalence remained constant across the three FSW categories; however, syphilis prevalence showed a significant increase from 5.7% to 7.3% for low-tier FSWs. Most cases with HIV, HCV, syphilis and intravenous drug use were seen in low-tier FSWs. Testing positive for HIV and syphilis were most correlated with being HCV positive (AOR 4.12 and AOR 4.36), only completing elementary school (AOR 3.71 and AOR 2.35), low tier venues (AOR 2.02 and AOR 2.00), and prior STI (AOR 1.40 and AOR 3.56), respectively. HCV infection was correlated with ever injecting drugs (AOR 60.65) and testing positive for syphilis (AOR 4.16) or HIV (AOR 3.74). CONCLUSIONS: This study highlights that low tier FSWs with lower formal education levels are the most vulnerable population at risk for acquiring and transmitting HIV, HCV, and syphilis in Guangxi, China. Condom distribution with evolution to safer sex practices are the reasons to explain the non-increasing prevalence of HIV, HCV in Guangxi for 2010-2012.


Assuntos
Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Profissionais do Sexo , Sífilis/epidemiologia , Adulto , China/epidemiologia , Usuários de Drogas , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/etiologia , Hepatite C/diagnóstico , Hepatite C/etiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Fatores de Risco , Assunção de Riscos , Comportamento Sexual , Sífilis/diagnóstico , Sífilis/etiologia , Adulto Jovem
19.
Zhonghua Liu Xing Bing Xue Za Zhi ; 36(10): 1125-8, 2015 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-26837358

RESUMO

OBJECTIVE: To understand dynamic variation of CD4-Positive T-Lymphocytes counts and influencing factors among patients receiving highly active anti-retroviral therapy (HAART) in Guangxi. METHODS: Adult patients who received antiviral treatment for the first time after 1 January 2013 were selected. Their CD4-Positive T-Lymphocytes counts at baseline, 6 months and 12 months after treatment were analyzed. By using the general linear model repeated measures ANOVA, CD4-Positive T-Lymphocytes dynamic variations and influencing factors were described and analyzed. RESULTS: The average CD4 cell counts of 4 082 patients at baseline, 6(th) months and 12(th) months were (195.3 ± 155.7) cells/mm³, (331.9 ± 202.6) cells/mm³ and (380.9 ± 221.3) cells/mm³, respectively. The time specific differences in CD4-Positive T-Lymphocytes count among them were statistically significant (F=3 161.124, P=0.000). CD4-Positive T-Lymphocytes counts increased over time after treatment. The main influencing factors were sex, age, baseline CD4 cell count, medication, discontinuation of treatment or dose miss. Influenced by sex, age, medication, discontinuation of treatment or dose miss, the increased CD4-Positive T-Lymphocytes count showed a linear trend. Influenced by baseline CD4-Positive T-Lymphocytes counts and dose miss, the increase of CD4-Positive T-Lymphocytes count showed a trend which was conformed to quadratic curvilinear equation. CONCLUSION: CD4-Positive T-Lymphocytes counts among patients receiving HAART in Guangxi were influenced by many factors. It is necessary to select the time to start treatment according to patient's characteristics to get good outcome.


Assuntos
Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Adulto , Linfócitos T CD4-Positivos , China , Humanos
20.
PLoS One ; 9(10): e109452, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25286369

RESUMO

BACKGROUND: Rising HIV infection rates have been observed among elderly people in Guangxi, China. Inexpensive aphrodisiacs are available for purchase in suburban and rural areas. This study aims to investigate the association between aphrodisiac use and increased HIV risk for middle-aged and elderly men in Guangxi. METHODS: A matched case-control study of aphrodisiac use-associated HIV infection was performed among male subjects over 50 years old who were clients of low-cost commercial sex venues in Guangxi. The cases were defined as clients who were HIV-positive and two controls were selected for each case. The cases and the controls were matched on the visited sex venue, age (±3 years), number of years of purchasing sex (±3 years), and educational attainment. Subjects were interviewed and tested for HIV. Paired t-test or McNemar Chi-squared test were used to compare the characteristics between the cases and controls. A stepwise conditional logistic regression was used to identify risk factors associated with HIV infection. FINDINGS: This study enrolled 103 cases and 206 controls. Aphrodisiac use (P = 0.02, odds ratio (OR) = 1.81, 95% CI = 1.08-3.04), never using condom during commercial sex encounter (P = 0.03, odds ratio (OR) = 1.82, 95% CI = 1.08-3.07), and lacking a stable partner (P = 0.03, odds ratio (OR) = 1.76, 95% CI = 1.05-2.98) were found to be risk factors for HIV infection among the study groups. For subjects reporting aphrodisiac use, the frequency of purchasing sex was positively correlated with the frequency of aphrodisiac use (r = 0.3; p = 0.02). CONCLUSIONS: Aphrodisiac use was significantly associated with increased HIV infection risk in men over 50 years old who purchased commercial sex in the suburban and rural areas of Guangxi. Further research and interventions should address the links between aphrodisiac use, commercial sex work, condom use, and increased HIV transmission.


Assuntos
Afrodisíacos/farmacologia , Custos e Análise de Custo , Infecções por HIV/epidemiologia , Trabalho Sexual , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , China/epidemiologia , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Risco
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