AIDS Research and Its Role in China's AIDS Prevention and Control Policies

By the end of 2005,the estimated number of HIV infected people in China was 650,000. The seriousness of the epidemic calls for effective control measures to tackle the problems in order to avoid the tragedy in Africa from happening in China. "Prevention First" is the cornerstone of the country's health policy. On 2003 World AIDS Day,Premier Jiabao Wen announced a new national AIDS control policy,"Four Frees and One Care". This policy clearly shows that the Chinese government has once again taken full responsibility to solve public health problems and has profound impact far beyond the AIDS field. In early 2006,the central government put scientific and technology innovation as a national priority and set the target to build an innovative China by year 2020. Since then,the government has been increasing investment in science and technology with major emphasis on both infectious diseases control and new drug research and development. For the first time,development of 100 new drugs and control of major infectious diseases (AIDS,HBV,TB and other emerging infectious diseases) have been selected as national key scientific projects. China's best minds in related fields will be pooled to work together in order to remove the technical barriers blocking efficient control of the major infectious disease in China. Knowledge on molecular epidemiology,immunology,pathogenesis,HAART,as well as HIVDR strains will certainly provide urgently needed scientific information for China's AIDS control program. Only evidence-based strategy from good research will provide long-term effective control of AIDS.

Characteristics of the HIV/AIDS Epidemic among People Aged≥50 Years in China during 2018–2021

Objective This study aimed to determine the current epidemiological status of PLWHA aged≥50 years in China from 2018 to 2021.It also aimed to recommend targeted interventions for the prevention and treatment of HIV/AIDS in elderly patients.Methods Data on newly reported cases of PLWHA,aged≥50 years in China from 2018 to 2021,were collected using the CRIMS.Trend tests and spatial analyses were also conducted.Results Between 2018 and 2021,237,724 HIV/AIDS cases were reported among patients aged≥50 years in China.The main transmission route was heterosexual transmission(91.24%).Commercial heterosexual transmission(CHC)was the primary mode of transmission among males,while non-marital non-CHC([NMNCHC];60.59%)was the prevalent route in women.The proportion of patients with CHC decreased over time(Z=67.716,P<0.01),while that of patients with NMNCHC increased(Z=153.05,P<0.01).The sex ratio varied among the different modes of infection,and it peaked at 17.65 for CHC.The spatial analysis indicated spatial clustering,and the high-high clustering areas were mainly distributed in the southwestern and central-southern provinces.Conclusion In China,PLWHA,aged≥50 years,were predominantly infected through heterosexual transmission.The primary modes of infection were CHC and NMNCHC.There were variations in the sex ratio among different age groups,infected through various sexual behaviors.HIV/AIDS cases exhibited spatial clustering.Based on these results,the expansion of HIV testing,treatment,and integrated behavioral interventions in high-risk populations is recommended to enhance disease detection in key regions.

Control of HIV/AIDS can be achieved with multi-strategies

Over past three decades,many prevention strategies have been proven effective in reducing human immunodeficiency virus (HIV) transmission.However,none of these strategies alone are effective to stop the spread of HIV.This review discusses a few key prevention strategies,including testing,harm reduction,prevention,prophylaxis,and modern communication strategies.We argue that although there are great challenges remaining to stop HIV transmission via sexual contact and injecting drug use routes,the combination of these effective strategies,control HIV epidemic can be achieved.

Characteristics of the HIV/AIDS Epidemic in Women Aged 15-49 Years from 2005 to 2012 in China

Objective To describe the characteristics of the HIV/AIDS epidemic in women aged 15-49 years in China. Methods HIV/AIDS cases from 2005 to 2012 that fulfilled the inclusion and exclusion criteria were identified on the Chinese HIV/AIDS case reporting system. Descriptive and spatial analyses were performed. Results A total of 103,559 female HIV/AIDS cases were included in our study. Based on the descriptive analysis, between 2005 and 2012, the proportion of heterosexually acquired HIV infection among women （15-49 years） increased rapidly from 35.8% to 87.4%. Approximately 60% of these cases were infected through non-marital heterosexual contact. Among older women （40-49 years）, a slightly increasing trend was identified. The spatial analysis detected ＇hot spots＇ in the Xinjiang, Yunnan, Sichuan, Guangxi, and Chongqing provinces. The epidemic trends in these areas were predominately driven by heterosexual transmission. Conclusion Non-marital heterosexual contact is a very important factor in the HIV/AIDS epidemic in women aged 15-49 years, and the HIV infection rate in older women is increasing. Several epidemic hot spots were detected in northwestern and southwestern China. Efficient interventions are needed to control the spread of HIV/AIDS among women living in these areas.

Development and Challenge of HIV/AIDS Testing Laboratory Network and Quality Assurance System in China

This paper describes the development and challenge of HIV/AIDS testing laboratory network and quality assurance system in China. At present,the HIV/AIDS testing laboratories includes three classes,the National AIDS Reference Laboratory,HIV/AIDS confirmatory laboratories and HIV/AIDS screening laboratories. All of them are accredited by the health authorities,and each class of laboratories take charge of their function strictly according to the "National Management of HIV/AIDS Detection (2006)". A complete quality assurance and quality control system for HIV/AIDS testing has been developed,which includes technical training,strict laboratory monitoring and approval,examination or proficiency testing on HIV/AIDS detection,and quality evaluation and supervision of HIV/AIDS diagnostic kits. Besides conduct the routine anti-HIV antibody test,more and more laboratories began to conduct other tests,such as CD4+ T lymphocyte cell counting,HIV viral load,HIV DNA PCR,genotyping,drug resistance,and HIV-1 recent infection test. The primary challenges faced by the HIV/AIDS testing laboratory network are in the areas of laboratory management and quality control. For example,the provincial PT program is inefficient,the internal quality control is conducted perfunctorily,personnel training can not met the needs of the workplace,which need to be improved.

Living Conditions and Palliative Care Needs among End-of-Life Former Commercial Plasma Donors Affected with HIV/AIDS in Rural Henan of China

Objective China began providing antiretroviral therapy to people living with HIV/AIDS （PLWHA） in 2003. This study was to investigate the living conditions, including quality of life and happiness, and need for palliative care of end-of-life PLWHA in rural Henan. Methods One hundred end-of-life AIDS patients were selected from Weishi, Zhenping and Tanghe counties in Henan, using convenience sampling. The World Health Organization Quality of Life for HIV （WHOQOL-HIV） BREF Chinese Version was used to measure the quality of life and the Memorial University of Newfoundland Scale of Happiness （MUNSH） was employed to measure subjective welfare. Qualitative interviews and focus group discussions were undertaken to learn about the palliative care provided and the specific needs of the end-of-life patients. Results Patients’ overall quality of life was moderate （12.62±1.97）. Highest scores were in the spirituality/religion/personal beliefs, higher than the average scores in the Chinese population （P0.01）, while psychological （13.58±2.06） and environment （12.50±3.28） domain scores were similar to the latter （P0.05）. Both independence （12.15±2.15） and physiological （14.04±3.16） domain scores were lower than the average of the people living with HIV/AIDS in other studies （P0.01）; however, all were in the moderate range. The average MUNSH score was 21.00±6.20, which was also moderate. The in-depth interviews indicated that the Henan Provincial Government’s policy of treatment and care had a beneficial impact on end-of-life AIDS patients, although the care components could be improved. Conclusions Living conditions of the end-of-life AIDS patients were moderate, and the HIV/AIDS palliative care model used was beneficial to them. Care could be improved by assisting the family unit as a whole.

Epidemiology of HIV/AIDS in China: recent trends

We used nationally reported cases (NCAIDS/China CDC,2016) and published literature to summarize up-to the end of 2015 epidemiologic trends in the HIV/AIDS epidemic in China.HIV-positive cases are distributed unevenly with most infections found in southwest China and the most affected population being men who have sex with men.Transmission mode of HIV infection has shifted from drug injection to sexual contact,which accounts for 95% of total reported cases.Two thirds of cases are from heterosexual transmission.Transmission pattern varies greatly throughout China.Some provinces in China reported heterosexual transmission accounted for over 90% of cases while other provinces reported homosexual transmission accounted for over 80% of cases.Patterns of heterosexually acquired HIV also vary widely,with 80% of cases attributed to commercial sex in some provinces,while in other provinces non-commercial extramarital sex accounted for over 70% of cases.Significant increase in HIV infection was observed among young students aged 15-24.China has successfully controlled blood transfusion-and injecting drug-related transmissions of HIV.Homosexual and non-commercial extramarital heterosexual transmissions have become new challenges for China's HIV/AIDS program.Urgent adoption of the UNAIDS/WHO 90-90-90 target will help overcome these new challenges.

Prevalence and risk factors of HIV and syphilis,and knowledge and risk behaviors related to HIV/AIDS among men who have sex with men in Chongqing,China

High HIV prevalence and incidence burdens have been reported in men who have sex with men（MSM）in Chongqing,China.We aimed to estimate the prevalence of HIV and other sexually transmitted infections（STIs）,to appraise the knowledge and risk behaviors related to HIV/AIDS among MSM,and to analyze the possible causes of deviation between behavior and knowledge to make better strategies.We recruited 617 MSM from February to July in 2008 by using a respondent-driven sampling（RDS） method in Chongqing,China.Through the collection of questionnaire-based data and biological testing results from all objects,we launched a crosssectional survey.STATA/SE was used for data analysis by frequency,ANOVA,rank sum test and logistic regression models.MSM with syphilis（OR=4.16,95%CI：2.35-7.33,P〈0.0001） were more likely to be HIV infected.Being a company employee（OR=3.64,95%CI：1.22-10.08,P〈0.0001） and having bought male for sex（OR=3.52,95%CI：1.10-11.32,P〈0.034） were associated with a higher probability of syphilis.MSM with younger age,higher education and greater monthly income had a higher mean knowledge score.MSM who had HIV testing had a higher mean knowledge score than those who never had.Students,venues for finding sex partners by Internet and homosexuals in MSM had a higher mean knowledge score compared to other occupations,venues for finding sex partners and sexual orientation.There is an urgent need for delivery of barrier and biomedical interventions with coordinated behavioral and structural strategies to improve the effect of HIV interventions among MSM.

Relationship of HLA-A,-Cw Polymorphisms with HIV/AIDS in Chinese Yi Ethnic Group of Sichuan Province

The relationship of HLA-A, -Cw alleles on HIV infection and AIDS disease progression in the Chinese Yi ethnic group of Sichuan province were investigated. The genetic polymorphisms of HLA-A, -Cw alleles of 102 unrelated healthy Chinese Yi ethnic individuals, 68 HIV-1 infected and 21 HIV positive long-time survivors were typed by PCR-SSP assay. Statistic signifiance was determined by the χ2 test with the SPSS software. No significant differences were observed between the HLA-A, -Cw alleles of the 68 HIV-1 infected and 102 non-infected Chinese Yi control individuals. Whereas the prevalence of A*3601,Cw*14(01-03)and Cw*0304 was significantly higher in 21 long time survivors compared with 102 healthy controls with P values of 0.016, 0.016 and 0.000 by χ2 or the Fisher exact test respectively. The result implies that A*3601,Cw*14(01-03) and Cw*0304 may be associated with slow AIDS disease progression in the Chinese Yi ethnic group, further studies on this association may yield insight on the pathogenesis of HIV-1 infection.

Association between Macroscopic-factors and Identified HIV/AIDS Cases among Injecting Drug Users: An Analysis Using Geographically Weighted Regression Model

Drug use （DU）, particularly injecting drug use （IDU） has been the main route of transmission and spread of Human Immunodeficiency Virus （HIV）/Acquired Immune Deficiency Syndrome （AIDSJ among injecting drug users （IDUs）[1]. Previous studies have proven that needles or cottons sharing during drug injection were major risk factors for HIV/AIDS transmission at the personal level[z4]. Being a social behavioral issue, HIV/AIDS related risk factors should be far beyond the personal level. Therefore, studies on HIV/AIDS related risk factors should focus not only on the individual factors, but also on the association between HIV/AIDS cases and macroscopic-factors, such as economic status, transportation, health care services, etc[1]. The impact of the macroscopic-factors on HIV/AIDS status might be either positive or negative, which are potentially reflected in promoting, delaying or detecting HIV/AIDS epidemics.

Challenges and Opportunities:the Expanded Government-led HIV/AIDS Programs in China

HIV/AIDS has posed an increasingly serious issue in China. In recent years,Chinese government has taken further intensified efforts to combat HIV/AIDS with high-level political commitment,supportive policy development,increased financial allocation,large-scale of government-led initiatives,expanded international cooperation and great involvement of non-governmental organizations. Meanwhile gaps and challenges coexist impacting the implementation and the results of national HIV/AIDS programs. Thus,further government efforts are needed to improve and tailor the actions to meet the requirement of HIV/AIDS control in China.

Prevention and control of HIV/AIDS in China:lessons from the past three decades

In the past 37 years,human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)has undergone various major transmission routes in China,with the world most complex co-circulating HIV-1 subtypes,even the prevalence is still low.In response to the first epidemic outbreak of HIV in injecting drug users and the second one by illegal commercial blood collection,China issued the Anti-Drug Law and launched the Blood Donation Act and nationwide nucleic acid testing,which has avoided 98,232 to 211,200 estimated infections and almost ended the blood product-related infection.China has been providing free antiretroviral therapy(ART)since 2003,which covered>80%of the identified patients and achieved a viral suppression rate of 91%.To bend the curve of increasing the disease burden of HIV and finally end the epidemic,China should consider constraining HIV spread through sexual transmission,narrowing the gaps in identifying HIV cases,and the long-term effectiveness and safety of ART in the future.

Prospects for the Implementation of HIV Molecular Transmission Network–Informed AIDS Prevention and Control in China

The human immunodeficiency virus(HIV)-infected population with a transmission link has a strong genetic similarity in viral gene sequences that tend to cluster.In recent years,a strategy for guiding HIV/acquired immunodeficiency syndrome(AIDS)prevention using sequence-based transmission networks has been proposed.The execution of this strategy provides an opportunity to effectively control the spread of the AIDS epidemic in China.HIV molecular transmission network research has been actively pursued by a number of Chinese research groups.Medium-and long-term strategies were created with the goal of using HIV molecular transmission networks to guide targeted prevention and control in China.Technical guidelines for HIV transmission network monitoring and intervention have been written and released.Pilot studies are continuing in the meantime.Despite the fact that this strategy has a bright future,there are still many challenges to overcome to achieve the intended AIDS prevention and control goals.

HIV,HCV,and HBV Co-Infections in a Rural Area of Shanxi Province with a History of Commercial Blood Donation

Background： Unhygienic blood collection in the early 1990s led to blood-borne infections in Central China. This study aimed to estimate human immunodeficiency virus （HIV） co-infection with hepatitis C and B viruses （HCV and HBV） and their risk factors in a rural area of Shanxi Province with a history of commercial blood donation. Methods： A cross-sectional study was conducted in 2004. All adult residents in the target area were invited to participate in the study. Face-to-face interviews were completed and blood specimens were tested for HIV, HCV, and HBV surface antigen （HBsAg）. Results： Prevalence rates of HIV, HCV, and HBsAg were 1.3% （40/3 062）, 12.7% （389/3 062）, and 3.5% （103/2982）, respectively. Of the 40 HIV-positive specimens, 85% were HCV positive and 2.5% were HBsAg positive. The history of commercial blood donation was positively associated with HIV, HCV, and HIV/HCV co-infections, but was negatively associated with HBsAg seropositivity. Migration for employment in the last 5 years was positively related to HIV, HBsAg, and HIV/HCV co-infections. Univariate logistic analysis showed that illegal drug use, number of sex partners, extramarital sex behavior, commercial sex behavior, and condom use rate were not related to anti-HIV, anti-HCV, HBsAg seropositivity or their co-infections. Conclusion： The history of commercial blood donation was the main risk factor for HIV, HCV, and HIV/HCV co-infections in this former commercial blood donation area. HIV and HCV prevention and treatment interventions are important in this area.

A 1:1 ratio case-control study on coronavirus disease 2019

Objective:To compare the characteristics of COVID-19 patients and healthy people,including living habits and living environment in Danzhou,Hainan province,to provide evidence for policy making for disease control.Methods:Case-control study was used,and the 1:1 control group in Danzhou based on the matching conditions including same age and sex,age±2 years.The main contents of the questionnaire included social democracy characteristics,living habits,living environment,and exposure history.Results:There were 14 COVID-19 patients in Danzhou.In the comparison of the daily habits,it was found that the number of people in the case group who had the habit of wearing masks after catching a cold was lower than that in the control group.And the number of people in the case group who had the habit of spitting was higher than that in the control group.Besides,the results of the survey on eating habits showed that there was less than half of the subjects used serving chopsticks and spoons when having dinner with family members or others,both in the case group and the control group.In the comparison of preferred food types,6 people(42.9%)in the case group preferred cold vegetables,while only 2 people(14.3%)in the control group preferred cold vegetables.In comparison with the travel history and contact history of COVID-19,12 people(85.7%)in the case group had travel history in Wuhan or other regions,but only two in the control group had a history of living in Wuhan or other places.1:1 paired analysis showed that 5 pairs of had habits of spitting in the case group but had no habits of spitting in control group,and 1 pair had habits of spitting in control group but had no habits of spitting in the case group,the OR value was 5.0.Besides,there were 2 pairs of had the habit of wearing a mask when they went out after catching a cold in control group but not in the case group,and 4 pairs of had the habit of wearing a mask when they went out after catching a cold in control group but no such habit in case group,and the OR value was 0.5.In the investigation of dietary habits,the comparison results of whether like cold vegetables,tea and parties showed that the OR values were all greater than 1.Conclusion:For infectious diseases,exposure history was the most important risk factor.In future studies,possible risk factors should be more comprehensively investigated.

1:4 case-control study on coronavirus disease 2019

Objective:To analyze the risk factors of COVID-19 infection in Danzhou,Hainan province.Methods:Case-control study was used,and the 1:4 control group of healthy residents(in Danzhou,Haikou,Beijing)were selected based on the matching conditions including same age and sex,age±2 years.The main contents of the questionnaire included living habits,dietary habits living environment,and exposure history.Results:There were 14 COVID-19 patients in Danzhou.And the control group included 56 residents from Danzhou,Haikou and Beijing.It was found that 85.7%(12/14)of the subjects in the case group exercise regularly.The exercise places were mainly community parks in Danzhou and Haikou,while mainly gyms or stadiums in Beijing.For dietary habits,control group in Beijing tended to using serving chopsticks when having dinner with family members or others than that in the case group(50.0%vs.21.4%,78.6%vs.35.7%).The results of exposure history showed that living in Wuhan or other city with cases reports in recent two months,contacting people who had living history in Wuhan or other city with cases reports in recent two months,and contacted people who confirmed COVID-19 infection or had symptoms recent two months were risk factors.Conclusion:For infectious diseases,exposure history was the most important risk factor.The influence of lifestyle differences may be smaller compared with exposure,and the individual specificity might lead to the infection-related factors difficult to found.In future studies,matching variables should be carefully selected in the case-control study of infectious diseases,and possible risk factors should be more comprehensively investigated.

Comparative Analysis of Epidemiological Features of HIV/AIDS Cases Aged Over and Under 50 Years Old—China,2010-2022

Introduction:Recent data indicate a year-on-year increase in the proportion of human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)cases reported among individuals aged≥50 in China.This study compares the epidemiological characteristics of HIV/AIDS cases in populations above and below 50 years of age.By doing so,it seeks to scrutinize the current epidemiological landscape of HIV within these distinct age cohorts and suggest tailored interventions for each group.Methods:We utilized data from the Chinese HIV/AIDS Comprehensive Response Information Management System for our comparative analysis.Joinpoint regression analysis was employed to assess the trends in standardized detection rates.Results:In China,the number of newly reported HIV/AIDS cases in the 15-49 age group increased from 51,436 in 2010 to 55,397 in 2022,while it increased from 11,751 in 2010 to 51,856 in 2022 in the group aged≥50 years.Recent years have seen a greater proportion and detection rate of HIV/AIDS cases among the≥50 age demographic compared to the 15-49 age group.In 2022,significant statistical differences were observed between males and females in both age cohorts with respect to education,marital status,occupation,mode of transmission,location of diagnosis,and region.Conclusions:The observed trend of a rising proportion of HIV/AIDS cases in individuals aged 50 years and older necessitates heightened attention.It is imperative that we develop and implement interventions specifically designed to prevent and control the transmission of HIV within this demographic.

Trends in Mortality and Prevalence of Reported HIV/AIDS Cases——China,2002-2021

Summary What is already known about this topic?Annually,only the incidence and mortality for Acquired Immune Deficiency Syndrome(AIDS)patients are officially disclosed.What is added by this report?For the first time,information detailing the reported rate,mortality rate,and prevalence rate trends of HIV,AIDS,and HIV/AIDS in China’s entire population over the past two decades has been provided.What are the implications for public health practice?Our research overcomes the longstanding limitation of HIV/AIDS analysis as the sole denominator.Rather,it incorporates a comprehensive examination of the overall population,utilizing indicators and analytic methods from chronic disease analyses.

Prevalence of HCV Antibody and its Associated Factors: A Study from Sentinel Hospitals in China

Objective The prevalence and related factors of serum anti-HCV in different regions and hospitals have not been studied extensively in China. We used routine screening data to determine the prevalence of HCV antibody in hospital patients, evaluate the epidemic trend of hepatitis C and formulate screening strategies.Methods Patient information and HCV antibody testing results were collected from January 2017 to December 2019 in 77 HCV sentinel hospitals in China. Univariate and multivariate logistic regression was used to determine the characteristics and associations.Results HCV antibody prevalence rates were distinct among patients in different departments, with a range of 0.33%–6.93%. Patients who were admitted to the liver disease-related departments(aOR =10.76;95% CI, 10.27–11.28), Internal Medicine(aOR = 2.87;95% CI, 2.75–3.00), and Department of Surgery(aOR = 1.95;95% CI, 1.87–2.04), were more likely to be tested for HCV antibody positive. HCV antibody prevalence was associated with patients aged 45 years and older(aOR = 2.74;95% CI,2.69–2.80), testing in infetious disease hospitals(aOR = 2.33;95% CI, 2.26–2.40) and secondary hospitals(aOR = 1.72;95% CI, 1.69–1.75). Patients in sentinel hospitals of the Northeast(aOR = 12.75;95% CI,12.40–13.11), the Central(aOR = 1.65;95% CI, 1.61–1.70), and the West(aOR = 1.78;95% CI, 1.73–1.83)China had higher HCV prevalence than those who were in the Eastern coastal area. Conclusion Those who were over 45 years old and saw doctors for liver diseases, and invasive diagnosis and treatment should be referred to HCV antibody testing.

Neutralizing Antibody Responses against Five SARS-CoV-2 Variants and T Lymphocyte Change after Vaccine Breakthrough Infections from the SARS-CoV-2 Omicron BA.1 Variant in Tianjin, China: A Prospective Study

Objective To investigate whether Omicron BA.1 breakthrough infection after receiving the SARS-CoV-2 vaccine could create a strong immunity barrier.Methods Blood samples were collected at two different time points from 124 Omicron BA.1 breakthrough infected patients and 124 controls matched for age,gender,and vaccination profile.Live virus-neutralizing antibodies against five SARS-CoV-2 variants,including WT,Gamma,Beta,Delta,and Omicron BA.1,and T-lymphocyte lymphocyte counts in both groups were measured and statistically analyzed.Results The neutralizing antibody titers against five different variants of SARS-CoV-2 were significantly increased in the vaccinated population infected with the Omicron BA.1 variant at 3 months after infection,but mainly increased the antibody level against the WT strain,and the antibody against the Omicron strain was the lowest.The neutralizing antibody level decreased rapidly 6 months after infection.The T-lymphocyte cell counts of patients with mild and moderate disease recovered at 3 months and completely returned to the normal state at 6 months.Conclusion Omicron BA.1 breakthrough infection mainly evoked humoral immune memory in the original strain after vaccination and hardly produced neutralizing antibodies specific to Omicron BA.1.Neutralizing antibodies against the different strains declined rapidly and showed features similar to those of influenza.Thus,T-lymphocytes may play an important role in recovery.