China’s Free ART Program was initiated in 2002 as an emergency response to save and improve the lives of AIDS patients living mainly in impoverished rural regions of central China. With little experience in HIV/AIDS ...China’s Free ART Program was initiated in 2002 as an emergency response to save and improve the lives of AIDS patients living mainly in impoverished rural regions of central China. With little experience in HIV/AIDS treatment and care and resource limitations, China’s efforts to provide widespread access to free antiretroviral therapy has been a process fraught with difficulty. However, the Free ART Program is progressing from an emergency response to a standardized treatment and care system. The development of national guidelines, training programs, a laboratory sup- port network, a national patient database, programs for special populations such as children and patients living with co- infections, and operational research has improved the scope and quality of the free treatment program. As of June 30, 2005, a total of 19,456 patients in 28 provinces, autonomous regions, and special municipalities had received free ART. Challenges stemming from the nature of China’s health system and patient population persist, but with strong govern- ment support and a diverse set of resources, China has the capacity to overcome these challenges and to provide nationwide access to high quality treatment and care.展开更多
Objective To examine HIV self-testing uptake and its determinates among men who have sex with men （MSM） in Beijing, China. Methods A cross-sectional online survey was conducted in Beijing, China in 2016. Participant...Objective To examine HIV self-testing uptake and its determinates among men who have sex with men （MSM） in Beijing, China. Methods A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio （AOR） and 95% confidence interval （CI）. Results Among the 5,996 MSM included in the study, 2,383 （39.7%） reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income （AOR = 1.49; CI = 1.10-2.02; P = 0.010）, large number of male sex partners （≥2： AOR = 1.24; CI = 2.09-1.43; P = 0.002）, sexual activity with commercial male sex partners （〉 2： AOR = 1.94; CI = 1.34 -2.82; P = 0.001）, long-term drug use （AOR = 1.42; CI = 1.23-1.62; P 〈 0.001）, and long-term HIV voluntary counseling and testing （VCT） attendance （AOR = 3.62; CI = 3.11-4.22; P 〈 0.001） were all associated with increased odds of HIV self-testing uptake. Conclusion The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020.展开更多
The global commitment to providing antiretroviral therapy （ART） to people living with human immunodeficiency virus/acquired immunodeficiency syndrome （HIV/AIDS） in low-income countries has raised hope that the inc...The global commitment to providing antiretroviral therapy （ART） to people living with human immunodeficiency virus/acquired immunodeficiency syndrome （HIV/AIDS） in low-income countries has raised hope that the increasing momentum in the fight against the worldwide HIV/AIDS pandemic will be sufficient to control it. However, improved availability of subsidized antiretroviral （ARV） treatments in low-income .countries raises complex ethical issues. In many resource-constrained countries the number of individuals infected with HIV in need of treatment far exceeds the supply of ARV medication. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria. Healthcare systems and funding in low-income countries are limited, requiring a step-by-step approach to scaling- up programs to reach their stated aims.展开更多
Since the initiation of China＇s nationwide free antiretroviral therapy （ART） in 2002, the availability of highly active antiretroviral therapy （HAART） in China has increased dramatically. HAART has been proven to...Since the initiation of China＇s nationwide free antiretroviral therapy （ART） in 2002, the availability of highly active antiretroviral therapy （HAART） in China has increased dramatically. HAART has been proven to prolong survival and control HIV disease progression. At the same time, experience in developed countries indicates that the high mutation rate of the virus in the presence of HAART is associated with drug resistance and diminished efficacy. The increase in HAART availability and use in China therefore also comes with the potential for increased resistance. Transmission of drug-resistant strains to individuals who have never been exposed to ART is on the rise. Moreover, studies have shown that new infections by drug-resistant virus result in suboptimal response to ART. With the rapid scale up of ART in China in recent years, the prevalence of HIV drug resistance will likely increase, posing a major public health concern in China. This review article provides an overview of ART resistance, the current worldwide trends in HIV drug resistance, the effect of HIV drug resistance in clinical management, and the implications for China＇s HIV treatment and care.展开更多
Background In 2003, China＇s National Free Antiretroviral Treatment Program （NFATP） was initiated as a pilot, which covered only 100 HIV/AIDS patients. By 2011, the pilot had evolved into a nationwide program and ha...Background In 2003, China＇s National Free Antiretroviral Treatment Program （NFATP） was initiated as a pilot, which covered only 100 HIV/AIDS patients. By 2011, the pilot had evolved into a nationwide program and had provided free treatment for over 150 000 patients. The objective of this study was to report and evaluate the progress of China＇s free antiretroviral treatment program. Methods The NFATP Database was systematically reviewed and a total of 150 692 HIV/AIDS patients were included in this study. Program progress indicators including the number of treated HIV/AIDS patients, follow-up visit rate, CD4 test rate, and viral load test rate were summarized and examined over a calendar year to evaluate the progress of NFATP quantitatively and qualitatively. Results By the end of 2011, a total of 150 692 HIV/AIDS patients had been treated through the NFATP and 122 613 of them were still on treatment. Of all patients, about 72% were enrolled during the past four years. The dominant transmission route was blood related in the early phase of the NFATP, but gradually changed to sexual contact. Besides quantitative improvements, progress indicators also demonstrated significant qualitative improvements that the program had made during the past 9 years. Conclusions Great achievement has been made by China＇s NFATP. China＇s experience indicates the importance of a comprehensive response to the success of its treatment program. However, to ensure the quality and sustainability of treatment in the long term, more attention and resources should be paid towards program management.展开更多
Over the past decade, China has made remarkable progress in promoting universal access to HIV prevention, treatment and care and support. As a result, overall AIDS mortality among treatment eligible patients dropped 6...Over the past decade, China has made remarkable progress in promoting universal access to HIV prevention, treatment and care and support. As a result, overall AIDS mortality among treatment eligible patients dropped 63.9% between 2002 and 2009. However, many key challenges remain in the early identification of HIV-positive individuals and timely provision of antiretroviral treatment （ART）. To address these challenges, the Chinese government has taken steps to translate the latest scientific research findings into its newly issued national AIDS policy and strategy. China＇s recent adoption of ＂Treatment as Prevention＂ to reduce HIV incidence and HIV/AIDS related morbidity and mortality is intended to held achieve the United Nations Millennium Develooment Goals by 2015.展开更多
Background The initiation and expansion of China＇s national free antiretroviral therapy program has led to significant improvement of survival among its participants. Success of further scaling up treatment coverage ...Background The initiation and expansion of China＇s national free antiretroviral therapy program has led to significant improvement of survival among its participants. Success of further scaling up treatment coverage rests upon intensifying HIV screening and efficient linkage of care. Timely CD4 cell count testing after HIV diagnosis is necessary to determine whether a patient meets criteria for antiretroviral treatment, and represents a crucial link to engage HIV-infected patients in appropriate care, which has not been evaluated in China.Methods We evaluated all patients ≥16 years who tested HIV positive from 2005 to 2009 in Yunnan and Guangxi.Multivariate Logistic regression models were applied to identify factors associated with lack of CD4 cell count testing within 6 months after HIV diagnosis.Results A total of 83 556 patients were included. Over the study period, 30 635 （37%） of subjects received a CD4 cell count within 6 months of receiving the HIV diagnosis. The rate of CD4 cell count testing within 6 months of HIV diagnosis increased significantly from 7% in 2005 to 62% in 2009. Besides the earlier years of HIV diagnosis, negative predictors for CD4 cell count testing in multivariate analyses included older age, not married or unclear marriage status,incarceration, diagnosis at sexual transmitted disease clinics, mode of HIV transmission classified as men who have sex with men, intravenous drug users or transmission route unclear, while minority ethnicity, receipt of high school or higher education, diagnosis at voluntary counseling and testing clinics, and having HIV positive parents were protective.Conclusions Significant progress has been made in increasing CD4 testing among newly diagnosed HIV positive patients in Yunnan and Guangxi from 2005-2009. However, a sizable proportion of HIV positive patients still lack CD4testing within 6 months of diagnosis. Improving CD4 testing, particularly among patients with identified risk factors, is essential to link patients with ART services and optimize treatment coverage展开更多
Background Pulmonary tuberculosis （PTB） among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, ri...Background Pulmonary tuberculosis （PTB） among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB among asymptomatic patients with HIV/AIDS in Guangxi to facilitate the development of diagnostic and treatment strategies.Methods All asymptomatic adult HIV-infected patients with CD4 ＜350 cells/μl who attended four HIV clinics in Guangxi between August 2006 and March 2008 were evaluated for active PTB with physical examination, chest X-ray （CXR）,sputum smear and/or sputum liquid culture. Data were described using median （interquartile range, IQR） and frequencies.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with PTB.Results Among 340 asymptomatic subjects, 15 （4%） were diagnosed with PTB, with 4 （27%） sputum smear positive and 8 （53%） sputum culture positive. CXR has higher diagnostic sensitivity （87%） than sputum smear （25%） and sputum culture （67%）, but lower specificity （56%） compared with sputum smear （99%） and culture （100%）. In univariate analysis,injection drug user, body mass index （BMI） ＜18 kg/m2, CD4 ＜50 cells/μl and presence of peripheral lymphadenopathy were associated with an increased risk of asymptomatic PTB, while in multivariate analysis only peripheral lymphadenopathy maintained statistical significance （OR=7.6, 95% CI 1.4-40）. Patients with negative smear and minor or no abnormalities on CXR had longer interval between screening and TB treatment.Conclusions PTB was relatively common in this group of HIV＋ asymptomatic Chinese patients. Diagnosis is challenging especially where sputum culture is unavailable. These findings suggest that an enhanced evaluation for PTB needs to be integrated with HIV care in China and transmission prevention in China to control at both households and health care facilities, especially for patients with factors associated with a higher risk of PTB.展开更多
Background:Men who have sex with men(MSM)has become the group with the fastest growing HIV epidemic in China.Since many Chinese MSM are conducting HIV self-testing,we aimed to determine the rate of HIV care seeking af...Background:Men who have sex with men(MSM)has become the group with the fastest growing HIV epidemic in China.Since many Chinese MSM are conducting HIV self-testing,we aimed to determine the rate of HIV care seeking after self-testing,examine characteristics of“seekers”compared to“non-seekers,”and explore factors associated with HIV care-seeking behaviour.Methods:A cross-sectional study design was used and an online survey was conducted in Beijing,China in 2016,among users of a popular Chinese gay networking smart phone application.Chi-square test was used to compare characteristics of those who sought HIV care(“seekers”)and those who did not(“non-seekers”).Univariate and multivariate logistic regression analyses were conducted to assess factors associated with HIV care seeking.Results:Among 21,785 screened,2383 participants(10.9%)were included in the study.A total of 380 participants(15.9%)reported seeking HIV care after HIV self-testing while 2003(84.1%)did not.Lack of knowledge of the“window period”(adjusted odds ratio[AOR]=0.68,95%confidence interval[95%CI]=0.47-0.97,P=0.04)was associated with reduced odds of seeking HIV care,while lower monthly income(AOR=1.29,95%CI=1.03-1.62,P=0.03)and obtaining HIV self-testing kits from health facilities(AOR=2.40,95%CI=1.81-3.17,P<0.001),and non-governmental organizations(AOR=2.44,95%CI=1.79-3.34,P<0.001)was associated with increased odds of seeking HIV care.Among those who sought HIV care,a large majority(92.4%)had non-reactive HIV self-testing results.Only 29 out of 265 with reactive,uncertain,or unknown results sought HIV care.Conclusions:We found a very low rate of HIV care seeking among our sample of urban Chinese MSM.The observation that most with reactive,uncertain,or unknown results did not seek HIV care is a cause for concern.These people should be paid more attention and helped to enter the care cascade.Our findings highlight that interventions aimed at improving linkage to care after HIV self-testing are urgently needed.However,further study is required to inform the design and implementation of future interventions aiming to encourage HIV care-seeking behaviour.展开更多
Potent combination antiretroviral therapy(cART)has significantly improved the life expectancy of people living with human immunodeficiency virus(HIV),but it has many side effects such as lipodystrophy(LD),hepatic steato...Potent combination antiretroviral therapy(cART)has significantly improved the life expectancy of people living with human immunodeficiency virus(HIV),but it has many side effects such as lipodystrophy(LD),hepatic steatosis,and lactic acidosis.Nucleoside reverse transcriptase inhibitors(NRTIs)could damage the mito-chondria by inhibiting the human DNA polymerase gamma,leading to mtDNA deletion.However,it remains uncertain whether NRTIs could induce the hypervariable region(HV)mutations of the D loop of mitochondria in Chinese HIV/AIDS patients,and whether that effect is different between individuals with and without LD.Hereby,30 Chinese AIDS patients who were receiving antiretroviral drugs were recruited,among which 16 had symptomatic LD and 14 did not.Blood samples were collected prior to and after 96 weeks of treatment.Total DNA was extracted from peripheral blood mononuclear cells(PBMCs).Fragments of 728 bp in length containing HV 2 were amplified by standard polymerase chain reaction(PCR).Direct DNA-sequencing analysis techni-ques were used to detect mitochondrial sequence variants between paired longitudinal samples.Alterations were compared with the revised Cambridge Reference Sequence(rCRS)to determine mutation or polymorphism.Results showed that two years after ART,totally seven cases exhibited sequence variations,five individuals showed 73 A!G revised variation(two with and three without LD),while two cases of LD were found to have other nucleotide alterations.There was no new alteration in individuals without LD.In conclusion,NRTIs could induce mutation of mtDNA HV 2,which might contribute to the development of LD.展开更多
文摘China’s Free ART Program was initiated in 2002 as an emergency response to save and improve the lives of AIDS patients living mainly in impoverished rural regions of central China. With little experience in HIV/AIDS treatment and care and resource limitations, China’s efforts to provide widespread access to free antiretroviral therapy has been a process fraught with difficulty. However, the Free ART Program is progressing from an emergency response to a standardized treatment and care system. The development of national guidelines, training programs, a laboratory sup- port network, a national patient database, programs for special populations such as children and patients living with co- infections, and operational research has improved the scope and quality of the free treatment program. As of June 30, 2005, a total of 19,456 patients in 28 provinces, autonomous regions, and special municipalities had received free ART. Challenges stemming from the nature of China’s health system and patient population persist, but with strong govern- ment support and a diverse set of resources, China has the capacity to overcome these challenges and to provide nationwide access to high quality treatment and care.
基金funded by China-US Collaboration on HIV/AIDS(Grant#5U2GGH001153)China National Health&Family Planning Commission(131-16-000-105-02)
文摘Objective To examine HIV self-testing uptake and its determinates among men who have sex with men （MSM） in Beijing, China. Methods A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio （AOR） and 95% confidence interval （CI）. Results Among the 5,996 MSM included in the study, 2,383 （39.7%） reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income （AOR = 1.49; CI = 1.10-2.02; P = 0.010）, large number of male sex partners （≥2： AOR = 1.24; CI = 2.09-1.43; P = 0.002）, sexual activity with commercial male sex partners （〉 2： AOR = 1.94; CI = 1.34 -2.82; P = 0.001）, long-term drug use （AOR = 1.42; CI = 1.23-1.62; P 〈 0.001）, and long-term HIV voluntary counseling and testing （VCT） attendance （AOR = 3.62; CI = 3.11-4.22; P 〈 0.001） were all associated with increased odds of HIV self-testing uptake. Conclusion The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020.
文摘The global commitment to providing antiretroviral therapy （ART） to people living with human immunodeficiency virus/acquired immunodeficiency syndrome （HIV/AIDS） in low-income countries has raised hope that the increasing momentum in the fight against the worldwide HIV/AIDS pandemic will be sufficient to control it. However, improved availability of subsidized antiretroviral （ARV） treatments in low-income .countries raises complex ethical issues. In many resource-constrained countries the number of individuals infected with HIV in need of treatment far exceeds the supply of ARV medication. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria. Healthcare systems and funding in low-income countries are limited, requiring a step-by-step approach to scaling- up programs to reach their stated aims.
文摘Since the initiation of China＇s nationwide free antiretroviral therapy （ART） in 2002, the availability of highly active antiretroviral therapy （HAART） in China has increased dramatically. HAART has been proven to prolong survival and control HIV disease progression. At the same time, experience in developed countries indicates that the high mutation rate of the virus in the presence of HAART is associated with drug resistance and diminished efficacy. The increase in HAART availability and use in China therefore also comes with the potential for increased resistance. Transmission of drug-resistant strains to individuals who have never been exposed to ART is on the rise. Moreover, studies have shown that new infections by drug-resistant virus result in suboptimal response to ART. With the rapid scale up of ART in China in recent years, the prevalence of HIV drug resistance will likely increase, posing a major public health concern in China. This review article provides an overview of ART resistance, the current worldwide trends in HIV drug resistance, the effect of HIV drug resistance in clinical management, and the implications for China＇s HIV treatment and care.
文摘Background In 2003, China＇s National Free Antiretroviral Treatment Program （NFATP） was initiated as a pilot, which covered only 100 HIV/AIDS patients. By 2011, the pilot had evolved into a nationwide program and had provided free treatment for over 150 000 patients. The objective of this study was to report and evaluate the progress of China＇s free antiretroviral treatment program. Methods The NFATP Database was systematically reviewed and a total of 150 692 HIV/AIDS patients were included in this study. Program progress indicators including the number of treated HIV/AIDS patients, follow-up visit rate, CD4 test rate, and viral load test rate were summarized and examined over a calendar year to evaluate the progress of NFATP quantitatively and qualitatively. Results By the end of 2011, a total of 150 692 HIV/AIDS patients had been treated through the NFATP and 122 613 of them were still on treatment. Of all patients, about 72% were enrolled during the past four years. The dominant transmission route was blood related in the early phase of the NFATP, but gradually changed to sexual contact. Besides quantitative improvements, progress indicators also demonstrated significant qualitative improvements that the program had made during the past 9 years. Conclusions Great achievement has been made by China＇s NFATP. China＇s experience indicates the importance of a comprehensive response to the success of its treatment program. However, to ensure the quality and sustainability of treatment in the long term, more attention and resources should be paid towards program management.
文摘Over the past decade, China has made remarkable progress in promoting universal access to HIV prevention, treatment and care and support. As a result, overall AIDS mortality among treatment eligible patients dropped 63.9% between 2002 and 2009. However, many key challenges remain in the early identification of HIV-positive individuals and timely provision of antiretroviral treatment （ART）. To address these challenges, the Chinese government has taken steps to translate the latest scientific research findings into its newly issued national AIDS policy and strategy. China＇s recent adoption of ＂Treatment as Prevention＂ to reduce HIV incidence and HIV/AIDS related morbidity and mortality is intended to held achieve the United Nations Millennium Develooment Goals by 2015.
文摘Background The initiation and expansion of China＇s national free antiretroviral therapy program has led to significant improvement of survival among its participants. Success of further scaling up treatment coverage rests upon intensifying HIV screening and efficient linkage of care. Timely CD4 cell count testing after HIV diagnosis is necessary to determine whether a patient meets criteria for antiretroviral treatment, and represents a crucial link to engage HIV-infected patients in appropriate care, which has not been evaluated in China.Methods We evaluated all patients ≥16 years who tested HIV positive from 2005 to 2009 in Yunnan and Guangxi.Multivariate Logistic regression models were applied to identify factors associated with lack of CD4 cell count testing within 6 months after HIV diagnosis.Results A total of 83 556 patients were included. Over the study period, 30 635 （37%） of subjects received a CD4 cell count within 6 months of receiving the HIV diagnosis. The rate of CD4 cell count testing within 6 months of HIV diagnosis increased significantly from 7% in 2005 to 62% in 2009. Besides the earlier years of HIV diagnosis, negative predictors for CD4 cell count testing in multivariate analyses included older age, not married or unclear marriage status,incarceration, diagnosis at sexual transmitted disease clinics, mode of HIV transmission classified as men who have sex with men, intravenous drug users or transmission route unclear, while minority ethnicity, receipt of high school or higher education, diagnosis at voluntary counseling and testing clinics, and having HIV positive parents were protective.Conclusions Significant progress has been made in increasing CD4 testing among newly diagnosed HIV positive patients in Yunnan and Guangxi from 2005-2009. However, a sizable proportion of HIV positive patients still lack CD4testing within 6 months of diagnosis. Improving CD4 testing, particularly among patients with identified risk factors, is essential to link patients with ART services and optimize treatment coverage
文摘Background Pulmonary tuberculosis （PTB） among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB among asymptomatic patients with HIV/AIDS in Guangxi to facilitate the development of diagnostic and treatment strategies.Methods All asymptomatic adult HIV-infected patients with CD4 ＜350 cells/μl who attended four HIV clinics in Guangxi between August 2006 and March 2008 were evaluated for active PTB with physical examination, chest X-ray （CXR）,sputum smear and/or sputum liquid culture. Data were described using median （interquartile range, IQR） and frequencies.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with PTB.Results Among 340 asymptomatic subjects, 15 （4%） were diagnosed with PTB, with 4 （27%） sputum smear positive and 8 （53%） sputum culture positive. CXR has higher diagnostic sensitivity （87%） than sputum smear （25%） and sputum culture （67%）, but lower specificity （56%） compared with sputum smear （99%） and culture （100%）. In univariate analysis,injection drug user, body mass index （BMI） ＜18 kg/m2, CD4 ＜50 cells/μl and presence of peripheral lymphadenopathy were associated with an increased risk of asymptomatic PTB, while in multivariate analysis only peripheral lymphadenopathy maintained statistical significance （OR=7.6, 95% CI 1.4-40）. Patients with negative smear and minor or no abnormalities on CXR had longer interval between screening and TB treatment.Conclusions PTB was relatively common in this group of HIV＋ asymptomatic Chinese patients. Diagnosis is challenging especially where sputum culture is unavailable. These findings suggest that an enhanced evaluation for PTB needs to be integrated with HIV care in China and transmission prevention in China to control at both households and health care facilities, especially for patients with factors associated with a higher risk of PTB.
基金The study was supported by the National Health and Family Planning Commission,the People’s Republic of China,with grant numbers 131-14-000-105-01 and 2012ZX10001-007.The funding agency has no role in design and conduct of the studycollection,management,analysis,and interpretation of the data,or preparation,review,and approval of the manuscript。
文摘Background:Men who have sex with men(MSM)has become the group with the fastest growing HIV epidemic in China.Since many Chinese MSM are conducting HIV self-testing,we aimed to determine the rate of HIV care seeking after self-testing,examine characteristics of“seekers”compared to“non-seekers,”and explore factors associated with HIV care-seeking behaviour.Methods:A cross-sectional study design was used and an online survey was conducted in Beijing,China in 2016,among users of a popular Chinese gay networking smart phone application.Chi-square test was used to compare characteristics of those who sought HIV care(“seekers”)and those who did not(“non-seekers”).Univariate and multivariate logistic regression analyses were conducted to assess factors associated with HIV care seeking.Results:Among 21,785 screened,2383 participants(10.9%)were included in the study.A total of 380 participants(15.9%)reported seeking HIV care after HIV self-testing while 2003(84.1%)did not.Lack of knowledge of the“window period”(adjusted odds ratio[AOR]=0.68,95%confidence interval[95%CI]=0.47-0.97,P=0.04)was associated with reduced odds of seeking HIV care,while lower monthly income(AOR=1.29,95%CI=1.03-1.62,P=0.03)and obtaining HIV self-testing kits from health facilities(AOR=2.40,95%CI=1.81-3.17,P<0.001),and non-governmental organizations(AOR=2.44,95%CI=1.79-3.34,P<0.001)was associated with increased odds of seeking HIV care.Among those who sought HIV care,a large majority(92.4%)had non-reactive HIV self-testing results.Only 29 out of 265 with reactive,uncertain,or unknown results sought HIV care.Conclusions:We found a very low rate of HIV care seeking among our sample of urban Chinese MSM.The observation that most with reactive,uncertain,or unknown results did not seek HIV care is a cause for concern.These people should be paid more attention and helped to enter the care cascade.Our findings highlight that interventions aimed at improving linkage to care after HIV self-testing are urgently needed.However,further study is required to inform the design and implementation of future interventions aiming to encourage HIV care-seeking behaviour.
基金supported by grants from the National 11.5 Major Research Plan of China(No.2008ZX10001-007).
文摘Potent combination antiretroviral therapy(cART)has significantly improved the life expectancy of people living with human immunodeficiency virus(HIV),but it has many side effects such as lipodystrophy(LD),hepatic steatosis,and lactic acidosis.Nucleoside reverse transcriptase inhibitors(NRTIs)could damage the mito-chondria by inhibiting the human DNA polymerase gamma,leading to mtDNA deletion.However,it remains uncertain whether NRTIs could induce the hypervariable region(HV)mutations of the D loop of mitochondria in Chinese HIV/AIDS patients,and whether that effect is different between individuals with and without LD.Hereby,30 Chinese AIDS patients who were receiving antiretroviral drugs were recruited,among which 16 had symptomatic LD and 14 did not.Blood samples were collected prior to and after 96 weeks of treatment.Total DNA was extracted from peripheral blood mononuclear cells(PBMCs).Fragments of 728 bp in length containing HV 2 were amplified by standard polymerase chain reaction(PCR).Direct DNA-sequencing analysis techni-ques were used to detect mitochondrial sequence variants between paired longitudinal samples.Alterations were compared with the revised Cambridge Reference Sequence(rCRS)to determine mutation or polymorphism.Results showed that two years after ART,totally seven cases exhibited sequence variations,five individuals showed 73 A!G revised variation(two with and three without LD),while two cases of LD were found to have other nucleotide alterations.There was no new alteration in individuals without LD.In conclusion,NRTIs could induce mutation of mtDNA HV 2,which might contribute to the development of LD.
