Acceptance and Factors Associated With Participation in Functional Cure–Related Trials Among People Living With HIV: A Cross-sectional Study in Southern China

HIV remains a global health challenge,and research efforts directed towards a functional cure require people living with HIV(PLHIV)in-volvement in clinical trials.Our study assessed willingness to participate in HIV functional cure–related clinical trials and associated factors among PLHIV in Guangzhou,China,using a questionnaire survey approach.We analyzed responses from 718 questionnaires,finding that 71.2%were willing to participate in Phase Ⅲtrials,while 51.7%were willing to participate in Phase I trials and 42.9%expressed acceptability for analytic treatment interruption.Multivariate logistic regression demonstrated that male PLHIV,those with awareness of functional cure,and PLHIV,who had been on antiretroviral therapy(ART)for less than 1 year,were more willing to partic-ipate in Phase Ⅲtrials.Those with a body mass index greater than 24,and those without resistance to ART drug were more willing to participate in Phase I trials.The major motivations for participation in Phase Ⅲtrials were access to cutting-edge treatments(62.6%)and supporting research(55.3%).Safety was the main concern contributing to hesitancy.Our study revealed a high willingness to participate in HIV functional cure–related trials among PLHIV in Guangzhou,China,and willingness varied across different trial phases and was influenced by multiple factors.This study provides valuable references for future clinical trial recruitment strategies and public health policy formulation.

Immediate and long-term outcomes after treat-all among people living with HIV in China:an interrupted time series analysis

Background In 2003,China implemented free antiretroviral therapy(ART)for people living with HIV(PLHIV),establishing an eligibility threshold of CD4<200 cells/μl.Subsequently,the entry criteria were revised in 2012(eligibility threshold:CD4≤350 cells/μl),2014(CD4≤500 cells/μl),and 2016(treat-all).However,the impact of treat-all policy on HIV care and treatment indicators in China is unknown.We aimed to elucidate the immediate and long-term impact of the implementation of treat-all policy in China.Methods Anonymized programmatic data on ART initiation and collection in PLHIV who newly started ART were retrieved between 1 January 2015 and 31 December 2019,from two provincial and municipal Centers for Disease Control and Prevention and ten major infectious disease hospitals specialized in HIV care in China.We used Poisson and quasi-Poisson segmented regression models to estimate the immediate and long-term impact of treat-all on three key indicators:monthly proportion of 30-day ART initiation,mean CD4 counts(cells/μl)at ART initiation,and mean estimated time from infection to diagnosis(year).We built separate models according to gender,age,route of transmission and region.Results Monthly data on ART initiation and collection were available for 75,516 individuals[gender:83.8%males;age:median 39 years,interquartile range(IQR):28-53;region:18.5%Northern China,10.9%Northeastern China,17.5%Southern China,49.2%Southwestern China].In the first month of treat-all,compared with the contemporaneous counterfactual,there was a significant increase in proportion of 30-day ART initiation[+12.6%,incidence rate ratio(IRR)=1.126,95%CI:1.033-1.229;P=0.007]and mean estimated time from infection to diagnosis(+7.0%,IRR=1.070,95%CI:1.021-1.120;P=0.004),while there was no significant change in mean CD4 at ART initiation(IRR=0.990,95%CI:0.956-1.026;P=0.585).By December 2019,the three outcomes were not significantly different from expected levels.In the stratified analysis,compared with the contemporaneous counterfactual,mean CD4 at ART initiation showed significant increases in Northern China(+3.3%,IRR=1.033,95%CI:1.001-1.065;P=0.041)and Northeastern China(+8.0%,IRR=1.080,95%CI:1.003-1.164;P=0.042)in the first month of treat-all;mean estimated time from infection to diagnosis showed significant increases in male(+5.6%,IRR=1.056,95%CI:1.010-1.104;P=0.016),female(+14.8%,IRR=1.148,95%CI:1.062-1.240;P<0.001),aged 26-35(+5.3%,IRR=1.053,95%CI:1.001-1.109;P=0.048)and>50(+7.8%,IRR=1.078,95%CI:1.000-1.161;P=0.046),heterosexual transmission(+12.4%,IRR=1.124,95%CI:1.042-1.213;P=0.002)and Southwestern China(+12.9%,IRR=1.129,95%CI:1.055-1.208;P<0.001)in the first month of treat-all.Conclusions The implementation of treat-all policy in China was associated with a positive effect on HIV care and treatment outcomes.To advance the work of rapid ART,efforts should be made to streamline the testing and ART initiation process,provide comprehensive support services,and address the issue of uneven distribution of medical resources.

Correlates of Sexual Lifestyles Among Older Adults Living With HIV in China: Findings From the Sexual Well-being (SWELL) Study

Sexual lifestyles are closely related to overall human health and well-being.Few studies have focused on sexual lifestyles among older adults living with HIV(OALHIV),especially in low-and middle-income countries.This study is a part of the sexual well-being among older adults in China(SWELL)study,which is a multicenter cross-sectional study focused on sexual health among older adults aged 50 years and older.Participants were 680 OALHIV(≥50 years old)from the SWELL study conducted from June 2020 to December 2022.Data were collected through one-on-one interviews.We used logistic regression to assess the correlates of sexual activity and sexual satis-faction.Among all participants,37.1%were sexually active.Being older,male,in a steady relationship and employed were associated with being sexually active.The prevalence of sexual satisfaction was 69.8%among sexually active OALHIV.Being homosexual and reporting a better general health status were associated with sexual satisfaction.The OALHIV who have depressive symptoms were less likely to report sexual satisfaction.To support holistic healthy aging among OALHIV,it is important for healthcare providers to be educated about the importance of enquiring about sexual activity,satisfaction and problems and addressing concerns while conveying sex-positive attitudes during clinical reviews,as these are still critical aspects of their health and well-being.

Sexual Risk Behavior and Satisfaction Among Men Who Have Sex With Men Living With Detectable HIV Viral Loads:A Nationwide Online Survey in China

Little is known about sexual behavior and satisfaction among men who have sex with men(MSM)with detectable HIV viral loads(VL)in China.This study aims to investigate sexual risk behavior and sexual satisfaction among MSM living with HIV in China,as well as poten-tial predictors.This cross-sectional study was conducted in February 2021 using an anonymous online survey based on WeChat.Data were collected on sociodemographics,sexual behavior,HIV clinical information,sexual satisfaction and mental health.Descriptive sta-tistics,logistic regression and multivariable logistic regression were performed.MSM with detectable HIV VL(VL+)or VL not sure were more likely to report inconsistent condom use,even with HIV-negative/unknown-status regular male partners.Having an HIV-positive regular partner and recreational drug use were positively associated with inconsistent condom use during anal sex among MSM with undetectable VL(VL-).Alcohol use before or during sexual activities was positively associated with inconsistent condom use during anal sex among VL+or VL not sure MSM.A total of 58.3%of participants reported being sexually satisfied.MSM living with HIV who were currently employed,had experienced anal sex in the prior 6 months,had VL-HIV status,or had more frequent ejaculation during sex/masturbation were more likely to report sexual satisfaction.The development of targeted education and interventions to minimize sexual risk behavior among MSM living with HIV is in dire need.Treating sexual dysfunction and developing a reasonable antiretroviral therapy regimen to achieve viral suppression can help promote sexual satisfaction in MSM living with HIV.

Safety and Immunogenicity of SARS-CoV-2 Vaccines in People Living With HIV:A Systematic Review and Meta-analysis of Real-World Studies

The safety and immunogenicity of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccines in people living with HIV(PLWH)in real-world studies remain controversial.Thus,we conducted a comprehensive systematic review and meta-analysis to address this issue.Data search were conducted from PubMed,Web of Science and EMBASE.Adverse events following vaccination,the risk ratio(RR)of SARS-CoV-2–specific IgG seroconversion and the level of anti–SARS-CoV-2 neutralizing antibodies were compared between the PLWH group and a healthy control group.A total of 10,582 PLWH from 22 studies were included.In our analysis,the incidence of local or systemic adverse events after the first SARS-CoV-2 vaccine dose was not statistically different between PLWH and healthy controls.However,there was a statistical difference after the second dose(RR,0.83;95%CI,0.71–0.98).The seroconversion rate of SARS-CoV-2 IgGantibodies in PLWH was significantly lower than that in the healthy control group(RR,0.94;95%CI,0.89–0.98;I2=80%,P<0.01).The anti–SARS-CoV-2 neutralizing antibody titers in PLWH after full immunization were also significantly lower than those in the healthy control group(RR,0.91;95%CI,0.85–0.98;I2=81%,P<0.01).The safety and tolerance of COVID-19 vaccines in PLWHare acceptable.However,their immunogenicitymay be impaired to a certain extent,characterized by a lower IgGseroconversion rate and neutralizing antibody titers compared with healthy individuals.These findings should provide guidance for optimizing future COVID-19 vaccination strategies among PLWH.

Burdens Attributable to Intimate Partner Violence in Women Aged 15 Years or Older—China,1990–2019

Summary What is already known about this topic?Intimate partner violence(IPV)represents a significant global public health concern.What is added by this report?The burden of HIV/AIDS related to IPV demonstrated an upward trend from 1990 to 2019,exhibiting an annual growth of 4.66%in age-standardized death rates(ASDR)and 4.42%in age-standardized disabilityadjusted life years(DALYs)rates.Notably,the age groups 30–34 and 50–54 experienced a higher IPV burden compared to other age groups.What are the implications for public health practice?There is a pressing need for public health policymakers to develop efficacious interventions aimed at bolstering the surveillance and prevention of IPV targeted at women in China.

Transmission risk of asymptomatic SARS-CoV-2 infection:a systematic review and meta-analysis

Background:Global evidence on the transmission of asymptomatic SARS-CoV-2 infection needs to be synthesized.Methods:A search of 4 electronic databases(PubMed,EMBASE,Cochrane Library,and Web of Science databases)as of January 24,2021 was performed.Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines were followed.Studies which reported the transmission rate among close contacts with asymptomatic SARS-CoV-2 cases were included,and transmission activities occurred were considered.The trans-mission rates were pooled by zero-inflated beta distribution.The risk ratios(RRs)were calculated using random-effects models.Results:Of 4923 records retrieved and reviewed,15 studies including 3917 close contacts with asymptomatic indexes were eligible.The pooled transmission rates were 1.79 per 100 person-days(or 1.79%,95%confidence interval[CI]0.41%-3.16%)by asymptomatic index,which is significantly lower than by presymptomatic(5.02%,95%CI 2.37%-7.66%;p<0.001),and by symptomatic(5.27%,95%CI 2.40%-8.15%;p<0.001).Subgroup anal-yses showed that the household transmission rate of asymptomatic index was(4.22%,95%CI 0.91%-7.52%),four times significantly higher than non-household transmission(1.03%,95%CI 0.73%-1.33%;p=0.03),and the asymptomatic transmission rate in China(1.82%,95%CI 0.11%-3.53%)was lower than in other countries(2.22%,95%CI 0.67%-3.77%;p=0.01).Conclusions:People with asymptomatic SARS-CoV-2 infection are at risk of transmitting the virus to their close contacts,particularly in household settings.The transmission potential of asymptomatic infection is lower than symptomatic and presymptomatic infections.This meta-analysis provides evidence for predict-ing the epidemic trend and promulgating vaccination and other control measures.Registered with PROS-PERO International Prospective Register of Systematic Reviews,CRD42021269446;https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269446.

How Shenzhen, China avoided widespread community transmission: a potential model for successful prevention and control of COVID-19

Shenzhen is a city of 22 million people in south China that serves as a financial and trade center for East Asia.The city has extensive ties to Hubei Province,the first reported epicenter of the coronavirus disease 2019(COVID-19)outbreak in the world.Initial predictions suggested Shenzhen would experience a high number of COVID-19 cases.These predictions have not materialized.As of 31 March 2020 Shenzhen had only 451 confirmed cases of COVID-19.Contact tracing has shown that no cases were the result of community transmission within the city.While Shenzhen did not implement a citywide lockdown like Wuhan,it did put into place a rapid response system first developed after the severe acute respiratory syndrome(SARS)epidemic in 2003.In the wake of the 2003 SARS outbreak,Shenzhen health authority created a network for surveillance and responding to novel respiratory infections,including pneumonia of unknown causes(PUC).The network rapidly detected mass discussion about PUC and immediately deployed emergency preparedness,quarantine for close contacts of PUC.Five early actions(early detection,early reporting,early diagnosis,early isolation,and early treatment)and four centralized responses(centralized coordination by experts,centralized allocation of resources,centralized placement of patients,and centralized provision of treatment)ensured effective prevention and control.Tripartite working teams comprising community cadres,medical personnel and police were formulated to conduct contact tracing at each neighborhood and residential community.Incorporation of mobile technology,big data,and artificial intelligence into COVID-19 response increased accessibility to health services,reduced misinformation and minimized the impact of fake news.Shenzhen’s unique experience in successfully controlling the COVID-19 outbreak may be a useful model for countries and regions currently experiencing rapid spread of the virus.

Safety of SARS-CoV-2 vaccines:a systematic review and meta-analysis of randomized controlled trials

Background Various modalities of vaccines against coronavirus disease 2019(COVID-19),based on different platforms and immunization procedures,have been successively approved for marketing worldwide.A comprehensive review for clinical trials assessing the safety of COVID-19 vaccines is urgently needed to make an accurate judgment for mass vaccination.Main text A systematic review and meta-analysis was conducted to determine the safety of COVID-19 vaccine candidates in randomized controlled trials(RCTs).Data search was performed in PubMed,Embase,Cochrane library,Scopus,Web of Science,and MedRxiv.Included articles were limited to RCTs on COVID-19 vaccines.A total of 73,633 subjects from 14 articles were included to compare the risks of adverse events following immunization(AEFI)after vaccinating different COVID-19 vaccines.Pooled risk ratios(RR)of total AEFI for inactivated vaccine,viral-vectored vaccine,and mRNA vaccine were 1.34[95%confidence interval(CI)1.11–1.61,P<0.001],1.65(95%CI 1.31–2.07,P<0.001),and 2.01(95%CI 1.78–2.26,P<0.001),respectively.No significant differences on local and systemic AEFI were found between the first dose and second dose.In addition,people aged≤55 years were at significantly higher risk of AEFI than people aged≥56 years,with a pooled RR of 1.25(95%CI 1.15–1.35,P<0.001).Conclusions The safety and tolerance of current COVID-19 vaccine candidates are acceptable for mass vaccination,with inactivated COVID-19 vaccines candidates having the lowest reported AEFI.Long-term surveillance of vaccine safety is required,especially among elderly people with underlying medical conditions.

Oral Sexual Behavior Among HIV-Infected Men Who Have Sex with Men--China,February 2021

Summary What is already known about this topic?Unprotected oral sex carries a risk of the transmission of sexually transmitted infections(STIs),especially if the individual has poor oral health.What is added by this report?Most human immunodeficiency virus(HIV)infected men who have sex with men(MSM)had never used a condom when giving oral sex(89.30%,718/804)or receiving oral sex(90.32%,709/785).Among MSM with detectable viral loads who had ever received oral sex without a condom,40.00%reported ejaculation in their partner’s mouth.