Correlation between National Peak HIV Prevalence and Concurrency, STI Treatment Capability, Condom Use and Circumcision: An Ecological Study

Background: The extent of the differential spread of HIV around the world remains incompletely explained. This paper examines the extent to which five explanatory variables (circumcision prevalence, condom usage, STI treatment coverage, number of sex partners, partner concurrency) are correlated with peak HIV prevalence rates at a country level. Methods: We performed linear regression analysis to measure the association between each of the independent variables and the national peak HIV prevalence rates for 15 - 49 years old. Results: Our analysis shows a strong positive association between peak HIV prevalence and the prevalence of partner concurrency (rho = 0.853;P = 0.001). There was no association between peak HIV prevalence and circumcision prevalence (rho = 0.118;P = 0.161), condom usage (rho = 0.048;P = 0.794), STI treatment coverage (rho = 0.143;P = 0.136) and number of sex partners (rho = 0.134;P = 0.298) at a global level. There was however a strong negative association between peak HIV prevalence and circumcision prevalence when the analysis was limited to countries within sub Saharan Africa (rho = -0.659;P = 0.000). Sub Saharan Africa had the second and third highest circumcision rates in the world when the circumcision prevalence thresholds were set at 80% and 20% respectively. Conclusions: Differences in the prevalence of circumcision likely influence differential peak HIV prevalence within sub Saharan Africa but are implausible causes for the higher HIV prevalence in this region. The close association found between concurrency and HIV prevalence requires replication in further studies.

A Cascade Analysis of Community Transmission Risks for HIV among People Who Inject Drugs Living with HIV in Iran

There are 22 times as many people living with HIV in the population of drug users as in the general population.This is because the injection and sexually risky behaviors prevalent in this population.Having multiple sexual partners and maintaining sexual networks with people who inject drugs (PWIDs),can increase the risk of contracting a sexually transmitted infection^([1]).More than 65%of all HIVrelated cases in Iran can be traced back to people who inject drugs (PWID),and the number is estimated to be between 200,000 and 230,000 in Iran overall.Effective prevention,resources allocation and monitoring require an accurate estimate of the population of people who use illicit drugs^([2]).

Tioxolone niosomes exert antileishmanial effects on Leishmania tropica by promoting promastigote apoptosis and immunomodulation

Objective: To explore the antileishmanial effect of tioxolone and its niosomal form against Leishmania tropica. Methods: Tioxolone niosomes were prepared by the hydration method and were evaluated for morphology, size, release study, and encapsulation efficiency. The cytotoxicity of tioxolone and its niosomal form was measured by MTT assay, leishmanicidal activity against promastigote and amastigote by MTT assay, apoptosis by flow cytometry, IL-12, IL-10 and metacaspase gene expression levels by q-PCR. Results: Span/Tween 40 and Span/Tween 60 niosomes had good physical stability as depicted in their size distribution curves and high encapsulation efficiency(>99%). The release profile of the entrapped compounds showed Fickian’s model of tioxolone delivery based on diffusion through lipid bilayers. With the IC50 value for amastigote as(24.5±2.1) μg/mL and selectivity index as 10.5, the Span/Tween 60 niosome(NT2) had a superior effect to other drugs. The CC50 value and IC50 of promastigote value for NT2 were(257.5±24.5) μg/mL and(164.8±20.6) μg/mL, respectively. The flow cytometric analysis showed that tioxolone and niosomal forms induced apoptosis of Leishmania tropica promastigotes in a dose-dependent manner. NT2 increased the expression level of IL-12 and metacaspase genes and decreased the expression level of the IL-10 gene.Conclusions: Niosomes of tioxolone play an immunomodulatory role in increasing Th1 cytokine profile and inhibiting the Th2 cytokine profile. It could be used for treatment of anthroponotic cutaneous leishmaniasis.

南京市男男性行为者HIV暴露前预防使用意愿及其影响因素

目的了解南京市MSM对暴露前预防(PrEP)的使用意愿及其影响因素,为在该人群中推广PrEP提供参考。方法2022年4月12日至5月18日,采用方便抽样的方法,通过社会组织招募MSM为研究对象,利用“问卷星”平台收集人口学信息、行为学特征、PrEP知识知晓及使用意愿情况,并以PrEP使用意愿为因变量,进行单因素及多因素Logistics回归分析。结果共获得有效问卷696份,28.4%(198人)的调查对象知晓PrEP,77.2%(537人)的研究对象表示如发生高危行为愿意采用PrEP。多因素分析结果显示,职业为学生(OR=2.046,95%CI:1.069~3.914)、知晓PrEP(OR=20.331,95%CI:7.795~53.028)以及最近一年检测过HIV(OR=1.804,95%CI:1.179~2.761)是PrEP使用意愿的促进因素;待业/无业(OR=0.375,95%CI:0.182~0.772)、性向为同性恋(OR=0.614,95%CI:0.385~0.980)以及近6个月经常发生男性群交行为(OR=0.257,95%CI:0.082~0.804)为PrEP使用意愿的阻碍因素。结论南京市MSM具有较高的PrEP使用意愿,下一步需确保准确传播PrEP相关知识,大力推广在HIV咨询检测机构中宣传教育,尤其是针对近6个月经常发生男性群交行为及性向为同性恋的MSM的宣教,以促进PrEP的推广和使用。

Tools for the diagnosis of hepatitis C virus infection and hepatic fibrosis staging

Hepatitis C virus(HCV)infection represents a major public health issue.Hepatitis C can be cured bytherapy,but many infected individuals are unaware of their status.Effective HCV screening,fast diagnosis and characterization,and hepatic fibrosis staging are highly relevant for controlling transmission,treating infected patients and,consequently,avoiding end-stage liver disease.Exposure to HCV can be determined with high sensitivity and specificity with currently available third generation serology assays.Additionally,the use of point-of-care tests can increase HCV screening opportunities.However,active HCV infection must be confirmed by direct diagnosis methods.Additionally,HCV genotyping is required prior to starting any treatment.Increasingly,high-volume clinical laboratories use different types of automated platforms,which have simplified sample processing,reduced hands-on-time,minimized contamination risks and human error and ensured full traceability of results.Significant advances have also been made in the field of fibrosis stage assessment with the development of non-invasive methods,such as imaging techniques and serum-based tests.However,no single test is currently available that is able to completely replace liver biopsy.This review focuses on approved commercial tools used to diagnose HCV infection and the recommended hepatic fibrosis staging tests.

The Ebola virus:a review of progress and development in research

The Ebola virus was identified in the year 1976 and has caused periodic outbreaks in West African countries.The disease has a case fatality rate up to 90%.Ebola has been classified as a biosafety level four pathogen and there is no currently approved vaccine or treatment for the virus.However,remarkable progress has been demonstrated by researchers in understanding the pathogenicity of the Ebola virus.Several animal models have been cultivated to develop diagnostics,vaccines and therapeutic drugs.

Prediction of malaria cases in the southeastern Iran using climatic variables:An 18-year SARIMA time series analysis

Objective:To predict future trends in the incidence of malaria cases in the southeast of Iran as the most important area of malaria using Seasonal Autoregressive Integrated Moving Average(SARIMA)model,and to check the effect of meteorological variables on the disease incidence.Methods:SARIMA method was applied to fit a model on malaria incidence from April 2001 to March 2018 in Sistan and Baluchistan province in southeastern Iran.Climatic variables such as temperature,rainfall,rainy days,humidity,sunny hours and wind speed were also included in the multivariable model as covariates.Then,the best fitted model was adopted to predict the number of malaria cases for the next 12 months.Results:The best-fitted univariate model for the prediction of malaria in the southeast of Iran was SARIMA(1,0,0)(1,1,1)12[Akaike Information Criterion(AIC)=307.4,validation root mean square error(RMSE)=0.43].The occurrence of malaria in a given month was mostly related to the number of cases occurring in the previous 1(p=1)and 12(P=1)months.The inverse number of rainy days with 8-month lag(β=0.3292)and temperature with 3-month lag(β=-0.0026)were the best predictors that could improve the predictive performance of the univariate model.Finally,SARIMA(1,0,0)(1,1,1)12 including mean temperature with a 3-month lag(validation RMSE=0.414)was selected as the final multivariable model.Conclusions:The number of malaria cases in a given month can be predicted by the number of cases in the prior 1 and 12 months.The number of rainy days with an 8-month lag and temperature with a 3-month lag can improve the predictive power of the model.

Predicting cutaneous leishmaniasis using SARIMA and Markov switching models in Isfahan, Iran: A time-series study

Objective:To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average(SARIMA)models and Markov switching model(MSM).Methods:This descriptive study employed yearly and monthly data of 49364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province,located in the center of Iran from January 2000 to December 2019.The data were provided by the leishmaniasis national surveillance system,the meteorological organization of Isfahan province,and Iranian Space Agency for vegetation information.The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics.Results:The minimum relative humidity,maximum relative humidity,minimum wind speed,and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags(P<0.05).Comparing SARIMA and MSM,Akaikes information criterion(AIC),and mean absolute percentage error(MAPE)in MSM were much smaller than SARIMA models(MSM:AIC=0.95,MAPE=3.5%;SARIMA:AIC=158.93,MAPE:11.45%).Conclusions:SARIMA and MSM can be a useful tool for predicting cutaneous leishmaniasis in Isfahan province.Since cutaneous leishmaniasis falls into one of two states of epidemic and non-epidemic,the use of MSM(dynamic)is recommended,which can provide more information compared to models that use a single distribution for all observations(Box-Jenkins SARIMA model).

Spatio-temporal history of H9N2 viruses in Iran and neighbor countries by Bayesian analysis and molecular characterization

Objective: To delineate the H9N2 influenza virus circulation within Iran and its neighboring countries, the potential source of the epidemic in these countries, and its date of origin.Methods: We obtained all hemagglutinin(HA) and neuraminidase(NA) nucleotide sequences of influenza H9N2 available up to December 25, 2020 from Iran and its neighboring countries(i.e., Pakistan, Afghanistan, Turkmenistan, Armenia, Azerbaijan, Turkey, and Iraq). We also performed a Bayesian Markov chain Monte Carlo method to infer the evolutionary dynamic and the most recent common ancestor for the HA and NA sequences.Results: H9N2 epidemic may have started in Iran and Pakistan much earlier than the other investigated countries in the region, and an ongoing bidirectional dispersion of the virus between the investigated countries was also observed. The mean time of the most recent common ancestor of H9N2 viruses was 1988 for HA, and 1992 for NA.Conclusions: Strains from investigated countries rooted in Pakistan and Iran. Regular surveillance of H9N2 viruses, especially in the live bird markets, enhancing the biosecurity of poultry industry and screening newly arriving immigrants and tourists from neighboring countries at border should be considered to control spread of the virus. Furthermore, surveillance of viral molecular evolution should be initiated for effective prevention of epidemic and pandemic spreads.

Case fatality rate of coronavirus disease 2019(COVID-19) in Iran-a term of caution

Coronavirus disease 2019 (COVID-19) has spread to 72 countries by the time of writing this report on 4th March 2020[1].On 20th February 2020,the first two confirmed deaths from COVID-19were reported in Iran.Till 4th March 2020,2 922 confirmed and92 death cases have also been reported till 4th March 2020 in Iran(Figure 1)[1].A key question that remains unanswered or controversial among the public,media,and researchers is the exact COVID-19 case fatality rate (CFR) in Iran.Why does the CFR in Iran appear to be higher compared to the rest of the world until now?Or why the fatality rate is high at the beginning of the epidemic in Iran?

The Prevalence of Syphilis Is Associated with the Prevalence of Male Point-Concurrency: An Ecological Analysis

Objective: The prevalence of syphilis differs considerably between different populations and indi-vidual level risk factors such as number of sex partners seem unable to completely explain these differences. The effect of network level factors, such as the prevalence of partner concurrency, on syphilis prevalence has not hitherto been investigated. Study design: Linear regression was per-formed to assess the relationship between the prevalence of male concurrency and prevalence of syphilis in each of 11 countries for which we could obtain comparable data. The data for concur-rency prevalence was taken from the WHO/Global Programme on AIDS (GPA) sexual behavioural surveys. Syphilis prevalence rates were obtained from antenatal syphilis serology surveys done in the same countries. In addition, we used linear regression to assess if there was a relationship between syphilis and concurrency prevalence of various racial and ethnic groups within the United States and South Africa. Results: In the international study, we found a strong relationship between the prevalence of male concurrency and syphilis prevalence (r = 0.79, P = 0.003). In the subnational studies, the relationship between concurrency and syphilis prevalence was positive in all cases but was only statistically significant so in the case of South Africa’s racial groups (r = 0.98, P = 0.01). Conclusions: The findings of an ecological-level association between syphilis and partner concurrency need to be replicated but suggest that efforts directed towards decreasing partner concurrency may reduce syphilis prevalence.

南京市50岁及以上HIV/AIDS流行病学特征

目的分析南京市≥50岁人类免疫缺陷病毒感染者/艾滋病患者(HIV/AIDS)流行特征,计算晚发现比例并分析影响因素。为制定针对性的艾滋病防控策略提供理论依据。方法收集南京市2001—2017年6月报告≥50岁HIV/AIDS数据,应用SPSS 18.0软件进行分析统计。结果 783例病例中,男性为主(占86.0%),感染途径以性途径为主(占90.3%),样本多来源于医疗机构(占67.0%)。多因素分析发现,医疗机构(OR=1.968,95%CI=1.316~2.942)晚发现比例较高,女性(OR=0.617,95%CI=0.396~0.961)、由同性途径感染(OR=0.577,95%CI=0.409~0.814)和经注射吸毒途径感染(OR=0.186,95%CI=0.040~0.871)人群晚发现比例较低。结论今后在进一步加强老年人群防控力度的同时,还需更全面地推进医务人员主动提供艾滋病检测咨询工作(provider initiated HIV testing and counseling,PITC),减少二代传播,提高病人生存质量。

CD4基因多态性与HIV-1发生风险关联性研究的Meta分析

目的目前有很多关于CD4基因多态性与HIV-1发生风险的关联性研究,但彼此结论却不一致,所以本文对该关联性做一个全面的评估。方法搜索截至2020年1月1日之前Pubmed,Web of Science,ScienceDirect,万方和中国知网数据库中所有关于CD4 C868T位点和HIV-1发生风险的关联性研究。关联性强度用比值比(OR)和95%可信区间(CI)来评估。结果最终有3篇文章纳入。病例数共计698人。在显性模型中,和携带CC基因型的相比,携带CT/TT基因型增加了HIV-1的发病风险(OR=1.697,95%CI:1.107~2.601)。分层分析显示,同样的效应也见于非洲人(OR=1.685,95%CI:1.056~2.689)和婴儿(OR=2.660,95%CI:1.139~6.209)。结论CD4 C868T基因多态性可能与HIV-1易感性相关,需要一些功能性实验及大样本研究来证实。

南京市男男性行为者对暴露后预防使用意愿的影响因素分析

目的了解南京市MSM发生高危行为后暴露后预防(PEP)的使用意愿及影响因素。方法2022年4月12日至5月18日,通过南京市社会组织进行研究对象招募,收集MSM人口学信息、性行为特征、PEP知识知晓情况及使用意愿等。以PEP使用意愿为因变量,分别进行单因素及多因素Logistics回归分析,探讨使用意愿的影响因素。结果696名研究对象,236人(33.9%)知晓暴露后预防知识,554人(79.6%)如果发生感染HIV的高危行为愿意采用PEP。多因素Logistic回归结果显示,研究生及以上学历(OR=9.800,95%CI:3.138~30.608),咨询过PEP(OR=50.361,95%CI:18.170~139.582),知晓PEP知识(OR=15.168,95%CI:5.323~43.219)是PEP使用意愿的促进因素。年龄≥30岁(OR=0.495,95%CI:0.301~0.815)是PEP使用意愿的阻碍因素。结论南京市MSM PEP使用意愿较高,但知晓率尚待进一步提高,应进一步加强MSM的健康教育,尤其是年龄30岁以上的人群。

2014-2018年南京市随访管理病例的首次随访及CD4^+T淋巴细胞检测情况分析

目的了解2014-2018年南京市随访管理的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人的首次随访及首次CD4+T淋巴细胞(简称CD4细胞)检测情况。方法应用趋势χ2检验分析首次CD4细胞检测结果<200个/μL的比例变化趋势,应用二分类Logistic回归模型分析首次CD4细胞检测结果<200个/μL的影响因素。结果2014-2018年随访管理病例2748例,99.3%报病后30天内进行了随访。报告病例中首次CD4细胞检测结果<200个/μL的比例未呈现明显的上升趋势(χ趋势2=0.469,P=0.493)。30~39年龄组[比值比(OR)=2.911,95%可信区间(CI):1.466~5.779],40~49岁年龄组(OR=5.155,95%CI:2.524~10.528),≥50岁年龄组(OR=4.379,95%CI:2.134~8.986),家政、家务及待业(OR=1.681,95%CI:1.053~2.684),医疗机构(OR=2.104,95%CI:1.711~2.588)来源的样本更易发生首次CD4细胞结果<200个/μL的情况。结论南京市首次CD4检测结果<200个/μL的比例较高,今后在随访工作中,应加强宣传,建议患者尽早进行CD4细胞检测。

2004-2020年徐州市既往丙型肝炎患者抗病毒治疗情况及影响因素分析

目的了解江苏省徐州市丙型肝炎(简称丙肝)患者抗病毒治疗情况及当前感染状态,分析接受抗病毒治疗的影响因素。方法从中国疾病预防控制信息系统中下载2004-2020年徐州市报告所有已审核丙肝病例,进行现场问卷调查,并通过核酸检测确定其当前的感染状态。采用Pearsonχ^(2)检验和Logistic回归模型探讨影响丙肝患者接受抗病毒治疗的因素。结果本研究共调查丙肝患者1160例,其中有效问卷1106份(95.3%)且均采集到血样,接受过抗病毒治疗率为39.0%。多因素Logistic回归结果显示,曾进行丙肝核酸检测(OR=4.654,95%CI:3.573~6.061)、丙肝知识知晓(OR=1.543,95%CI:1.168~2.038)以及个人月收入>3000元(OR=1.524,95%CI:1.069~2.173)的患者接受抗病毒治疗率较高;年龄≥70岁(OR=0.601,95%CI:0.382~0.945)抗病毒治疗率较低。抗病毒治疗方案中直接抗病毒药物(DAAs)方案治愈率(93.7%)高于干扰素(IFN)方案(87.6%)。差异有统计学意义(χ^(2)=4.870,P=0.027)。结论徐州市既往丙肝患者抗病毒治疗率较低,应加强对丙肝患者的健康教育,提高抗病毒治疗覆盖率以消除丙肝公共卫生的危害。