Superior Effects of Antiretroviral Treatment among Men Who have Sex with Men Compared to Other HIV At-Risk Populations in Hunan, China

This study assesses association between CD4 level at initiation of antiretroviral treatment (ART) on subsequent treatment outcomes and mortality among people infected with HIV via various routes in Hunan province, China. 

Over a period of 10 years, a total of 7333 HIV-positive patients, including 553 (7.5%) MSM, 5484 (74.8%) heterosexuals, 1164 (15.9%) injection drug users (IDU) and 132 (1.8%) former plasma donors (FPD), were recruited. 

MSM substantially demonstrated higher initial CD4 cell level (242, IQR 167-298) than other populations (Heterosexuals: 144 IQR 40-242, IDU: 134 IQR 38-224, FPD: 86 IQR 36-181). During subsequent long-term follow up, the median CD4 level in all participants increased significantly from 151 cells/mm³ (IQR 43-246) to 265 cells/mm³ (IQR 162-380), whereas CD4 level in MSM remained at a high level between 242 and 361 cells/mm³. 

Consistently, both cumulative immunological and virological failure rates (10.4% and 26.4% in 48 months, respectively) were the lowest in MSM compared with other population groups. Survival analysis indicated that initial CD4 counts ≤200 cells/mm³ (AHR = 3.14; CI, 2.43-4.06) significantly contributed to HIV-related mortality during treatment. 

Timely diagnosis and treatment of HIV patients are vital for improving CD4 level and health outcomes.

Full PDF article at:   http://goo.gl/kZOkua  Abstract:   http://goo.gl/5QL8eJ

By:  Su S1,2, Chen X3, Mao L4, He J5, Wei X6, Jing J7, Zhang L8,9,10,11.

• 1Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3004, Australia. ssu27@student.monash.edu.
• 2School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. ssu27@student.monash.edu.
• 3Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. chenxi161@sohu.com.
• 4Center for Social Research in Health, Faculty of Arts and Social Science at the University of New South Wales, Sydney, NSW 2052, Australia. limin.mao@unsw.edu.au.
• 5Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. jmhe69@126.com.
• 6Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. isqq2011@163.com.
• 7Comprehensive AIDS Research Center, Tsinghua University, Beijing 100084, China. jingjun@tsinghua.edu.cn.
• 8Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu.
• 9School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu.
• 10Comprehensive AIDS Research Center, Tsinghua University, Beijing 100084, China. lei.zhang1@monash.edu.
• 11Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu. 
• Int J Environ Res Public Health. 2016 Mar 8;13(3). pii: E283. doi: 10.3390/ijerph13030283.

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HIV Drug Resistance Mutations (DRMs) Detected by Deep Sequencing in Virologic Failure Subjects on Therapy from Hunan Province, China

Objective

Determine HIV drug resistance mutations (DRMs) prevalence at low and high levels in ART-experienced patients experiencing virologic failure (VF).

Methods

29 subjects from 18 counties in Hunan Province that experienced VF were evaluated for the prevalence of DRMs (Stanford DRMs with an algorithm value ≥15, include low-, intermediate and high-level resistance) by both Sanger sequencing (SS) and deep sequencing (DS) to 1% frequency levels.

Results

DS was performed on samples from 29 ART-experienced subjects; the median viral load 4.95×10⁴ c/ml; 82.76% subtype CRF01_AE. 58 DRMs were detected by DS. 18 DRMs were detected by SS. Of the 58 mutations detected by DS, 40 were at levels <20% frequency (26 NNRTI, 12 NRTI and 2 PI) and the majority of these 95.00% (38/40) were not detected by standard genotyping. Of these 40 low-level DRMs, 16 (40%) were detected at frequency levels of 1–4% and 24 (60%) at levels of 5–19%. SS detected 15 of 17 (88.24%) DRMs at levels ≥ 20% that were detected by DS. The only variable associated with the detection of DRMs by DS was ART adherence (missed doses in the prior 7 days); all patients that reported missing a dose in the last 7 days had DRMs detected by DS.

Conclusions

DS of VF samples from treatment experienced subjects infected with primarily AE subtype frequently identified Stanford HIVdb NRTI and NNRTI resistance mutations with an algorithm value 15. Low frequency level resistant variants detected by DS were frequently missed by standard genotyping in VF specimens from antiretroviral-experienced subjects.

Below:  Prevalence of ≥1% DRMs by Stanford HDRM (algorithm value ≥15)

Full article at:   http://goo.gl/ZY39t9

By:  

Xi Chen, Xiaobai Zou, Jianmei He, Jun Zheng

Hunan Provincial Center for Disease Control and Prevention, Changsha, China

Jennifer Chiarella, Michael J. Kozal

Yale School of Medicine, New Haven, United States of America

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Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients

In a pragmatic cluster-randomised trial, 36 districts/counties (each with at least 300 active pulmonary TB patients registered in 2009) within the provinces of Heilongjiang, Jiangsu, Hunan, and Chongqing, China, were randomised using stratification and restriction to one of four case-management approaches in which patients received reminders via text messages, a medication monitor, combined, or neither (control). 

From 1 June 2011 to 7 March 2012, 4,292 new pulmonary TB patients were enrolled across the 36 clusters. A total of 119 patients (by arm: 33 control, 33 text messaging, 23 medication monitor, 30 combined) withdrew from the study in the first month because they were reassessed as not having TB by their managing doctor (61 patients) or were switched to a different treatment model because of hospitalisation or travel (58 patients), leaving 4,173 TB patients (by arm: 1,104 control, 1,008 text messaging, 997 medication monitor, 1,064 combined). The cluster geometric mean of the percentage of patient-months on TB treatment where at least 20% of doses were missed was 29.9% in the control arm; in comparison, this percentage was 27.3% in the text messaging arm, 17.0% in the medication monitor arm, and 13.9% in the combined arm. Patient loss to follow-up was lower in the text messaging arm than the control arm. Equipment malfunction or operation error was reported in all study arms. Analyses separating patients with and without medication monitor problems did not change the results. Initiation of intensive management was underutilised.

Reminders from medication monitors improved medication adherence in TB patients, but text messaging reminders did not. In a setting such as China where universal use of DOT is not feasible, innovative approaches to support patients in adhering to TB treatment, such as this, are needed.

Read more at: http://goo.gl/efRDMm

By: Xiaoqiu Liu, Hui Zhang, Jun Li, Xue Li, Hongguang Chen, Mingming Liu, Rong Chen, Junying Chi, Shiming Cheng, Lixia Wang, Shiwen Jiang

National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China