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.

HLA-DR expression on regulatory T cells is closely associated with the global immune activation in HIV-1 infected subjects naive to antiretroviral therapy

Background The frequencies of regulatory T cells （Tregs） increased over the HIV infection but its counts actually decreased. We proposed that the decrease of Treg counts may cause the reduction of inhibitory effect and thereby account for the over-activation of Tregs during HIV infection. However, it remains unknown whether Tregs are also over-activated and thereafter the activation induced death may lead to the decrease of Tregs. Methods Tregs were defined as CD4＋CD25＋CD127lo/-T cells. Eighty-one HIV-1 infected patients were enrolled in our study, and twenty-two HIV-1 seronegative donors were recruited as the control. The levels of HLA-DR on Tregs were determined by FACSAria flow cytometer. Results Compared to HIV-1 seronegative donors, the levels of HLA-DR on CD4＋CD25＋CD127lo/- Tregs were significantly increased in HIV-1 infected patients, and its increase was positively associated with viral loads （r=0.3163, P=-0.004） and negatively with CD4 T-cell counts （r=-0.4153, P 〈0.0001）. In addition, significant associations between HLA-DR expression on CD4＋CD25＋CD127lo/- Tregs and the percentages of HLA-DR, CD38, Ki67 expressing CD4＋ and CD8＋ T cells were also identified. Conclusion HLA-DR on Tregs is a good marker for viral replication and disease progression. The over-activation of Tregs might result in the decrease of Tregs.

Evaluation of PIMA Point-of-care CD4 Analyzer in Yunnan, China

Background： CD4 count is used to determine antiretroviral therapy （ART） eligibility. In China, flow cytometers are mostly located in urban areas with limited access by patients residing in remote areas. In an attempt to address this issue, we conducted a study to validate the performance ofAlere PIMA point-of-care CD4 analyzer. Methods： Venous and finger-prick blood specimens were collected from HIV-positive participants from two voluntary counseling and testing sites in Yunnan Province. Both venous and finger-prick blood specimens were tested with the PIMA analyzer. Venous blood specimens tested with the Becton Dickinson FACSCalibur were used as a reference. Results： Venous specimens from 396 and finger-prick specimens from 387 persons were available for analysis. CD4 counts by PIMA correlated well with those from FACSCalibur with an R2 of 0.91 for venous blood and 0.81 for finger-prick blood. Compared to FACSCalibur, the PIMA analyzer yielded lower counts with a mean bias of- 47.0 cells/μl （limit of agreement, [LOA]： -204-110 cells/μl） for venous blood and -71.0 cells/μl （LOA： -295-153 cells/μl） for finger-prick blood. For a CD4 threshold of 350 cells/μl, the positive predictive value （PPV） of PIMA was 84.2% and 75.7% and the negative predictive value （NPV） was 97.6% and 95.8% for venous and finger-prick blood, respectively. For an ART threshold of 500 cells/μl, the corresponding PPV was 90.3% and 84.0% and NPV was 94.3% and 93.4%, respectively. Conclusions： CD4 counting using venous blood with PIMA analyzers is a feasible alternative to a large flow cytometer to determine ART eligibility.