Care of HIV-infected patients in China

Compared with high infection areas of the world, the total HIV infection rate in China is relatively low. Nonetheless, because of China’s vast territory and large population, the potential infection risk must be taken seriously. In the next few years, needle sharing among injection drug users will remain the most common route of transmission for the HIV/ AIDS epidemic in China. Unprotected sex is gradually becoming a major route of transmission. China began to imple- ment HAART in 1999 according to international standards. Prior to 2003, there were only about 150 HIV/AIDS patients were treated with HAART in some clinical trials and about 100 HIV/AIDS patients were treated by private sources. Results of those treatments are the scientific basis for development of the therapeutic strategies in China. In March of 2003, the Chinese government initiated China CARES program. In November of 2003, the Chinese Ministry of Health announced a national policy of free ARV treatment to all HIV+ Chinese citizens who were in poverty and required ARV therapy. There are total of 19,456 HIV/AIDS patients received free ARV drugs to date in 159 regions and 441 towns. Current challenges are how to follow-up and evaluate those patients in the clinical settings. The longer the therapy is postponed, the more side effects and the higher probability of drug resistance are going to occur. It remains unclear, therefore, when HAART regimen should be started in the HIV/AIDS population in China.

Factors associated with needle sharing among people who inject drugs in Yunnan, China: a combined network and regression analysis

Background:Network analyses have been widely utilized to evaluate large datasets,but have not yet been used to explore factors associated with risk behaviours.In combination with traditional regression analysis,network analyses may provide useful information and highlight key factors for reducing needle sharing behaviours among people who inject drugs(PWID).Methods:Sociodemographic data,and information on injection behaviour and sexual practices were collected from a cross-sectional survey that was conducted with PWID in five prefectures of Yunnan province,China.A combination of logistic regression and correlation network analyses were used to explore key factors for reducing needle-sharing behaviours among PWID.Results:In a total of 1049 PWID,37.5%had a history of needle or syringe sharing.The logistic analysis showed that Zhaotong,Qujing,Dehong,or Lincang residents,diazepam use,longer injection duration,needle reuse,and infection with HIV,viral hepatitis,tuberculosis and/or malaria were independently associated with needle sharing.The correlation network analyses showed that,compared to PWID who had never shared needles,PWID who did share needles would achieve harm reduction goals faster and more permanently.HIV serostatus and marital status were found to be closely associated with other risk factors.By combining regression analyses with network analyses,it was shown that PWID who are HIV seropositive will be an ideal target group for harm reduction programs.Conclusion:Needle-sharing behaviours are common among PWID in Yunnan,and harm reduction programs may help PWID who are HIV seropositive reduce risk behaviours and prevent blood borne diseases.

A mathematical model to predict the risk of hepatitis B infection through needle/syringe sharing in mass vaccination

Background:The Japanese Government settled a class litigation case with hepatitis B virus(HBV)carriers who claim to have been infected through needle/syringe sharing in childhood mass vaccination with a blanket compensation agreement.However,it is difficult to estimate how many of the present HBV carriers were infected horizontally from mass vaccination and how many were infected vertically from mothers.Methods:A mathematical model to predict the risk of infection through needle/syringe sharing in mass vaccination was proposed and a formula was developed.The formula was presented in a logarithmic graph enabling users to estimate how many people will be infected if a needle/syringe is shared by how many people for how many times under certain probability of infection.The formula was then applied to the historical data of mass tuberculin skin tests(TSTs)and BCG inoculation,from which a best estimate of how much needle/syringe sharing was practiced in different birth cohorts was determined.Results:For the oldest cohort born between 1951 and 1955,the prevalence of HBV carriers-0.65%at birth through vertical transmission-more than doubled in 1995(1.46%)through horizontal transmission.If the probability of infection through needle/syringe sharing is assumed to be 10%,it is theoretically likely that an average of five or more people shared a needle/syringe four times to achieve the prevalence of HBV carriers in 1995.However,for the youngest cohort born between 1981 and 1985,the effects of needle/syringe sharing were negligible because the later prevalence of HBV carriers was lower than the prevalence at birth.Conclusions:More than half of the HBV carriers born in the early 1950s might have contracted the disease by mass vaccinations.Japan’s experience needs to be shared with other countries as a caution in conducting mass vaccination programs under scarce needle/syringe supply(291 words).